Ask the Pharmacist
by Ron & Marla Chapleau

October 9,2016


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Q) It seems like the recommendations for cancer screenings are constantly being changed. Can you give me a quick update to the most current guidelines for the most common forms of cancer?

A) Cancer is currently the leading cause of death in Canada and will likely continue to be so in the near future.

Currently almost half of all Canadians will develop a malignancy at some point in their lifetime and researchers believe that by 2032 the number of new cancer cases will rise by almost 79%.

As such, early screening and detection will continue to be a key part of the Canadian health care strategy but the key is to make smart decisions when it comes to setting these guidelines.

Err too far on over-screening and an already overstressed health care system will waste millions of dollars on needless testing with the potential for treating individuals for tumors that would have been better left alone. However, to err on the other side is to risk diagnosing people only after their tumor has grown to such a size that treatment is more palliative than curative. Truly, these are important but extremely difficult and often controversial decisions.

When it comes to breast cancer, early detection has been largely credited with the decrease in mortality rates by 44% over the last 29 years. Current Canadian guidelines recommend that women aged 50 to 74 years receive routine mammograms every 2 to 3 years. For most females less than 50, the risks associated with false positives outweigh the benefits of early screening.

In the 74-and-over age group a scarcity of evidence either way has made it difficult for experts to come up with a consensus as to whether screening is indeed worthwhile.

While cervical cancer is not nearly as prevalent as breast cancer is, in 2015 it was estimated that 1,500 Canadian women would be diagnosed with cervical cancer and that 380 would die from it that year. Recommendations suggest that women aged 25-29 years of age should undergo a Pap smear every 3 years although the experts are very divided in this demographic.

The evidence is much stronger for women between the ages of 30 to 69 years of age. They should undergo a Pap smear every 3 years as well. For women over the age of 70, routine screening is only suggested if the screening has been inconsistent in the past (i.e. fewer than 3 consecutive negative Pap tests in the previous 10 years).

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Approximately 423 new colorectal cancer diagnoses are made in Canada every week, with an unfortunate 175 of them dying weekly since so many of these diagnoses occur when the disease is already in an advanced stage. The newest guidelines suggest screening all low-risk individuals between 50 and 74 years with fecal occult blood tests (i.e. looking for blood within a stool sample) every 2 years or a flexible sigmoidoscopy every 10 years. The recommendation is strongly encouraged especially for those between 60 and 74. Screening is not recommended for those 75 or older.

Note these recommendations do not apply to those who are at a high risk for colorectal cancer such as those with a family history or symptoms.

Prostate cancer is also extremely common with one out of 8 men likely to be diagnosed with it at some point in their lifetime. This is one of the cancers for which the screening recommendations have changed drastically and repeatedly over the last few years. Currently, routine age-based screening is not recommended in asymptomatic men due to the high potential for false positives. That being said, there may well be a small benefit in testing those between 55 and 69. Screening usually involves a blood test known as the prostate-specific antigen test (PSA) with or without a digital rectal examination. (i.e. the infamous glove..)


For more information on this or any other topic, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination in Kincardine and Port Elgin

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Sunday, October 09, 2016