Happy Screening from A-Z Canada
Sourced from Canada Task Force on Preventive Health Care, 2020
Asymptomatic Thyroid Dysfunction: advised against screening in primary care setting, advised to monitor for unusual fatigue, unexpected weight loss or gain, menstrual irregularities or cases of pituitary/hypothalamic diseases.
- This recommendation excludes individuals who have been diagnosed with thyroid disease/surgery, individuals receiving thyroid medication or medications that may affect function, those with previous or ongoing exposure to radioiodine therapy or radiotherapy to the neck.
Abdominal Aortic Aneurysm: one-time screening with ultrasound for men 65-80 years of age.
- Please note that while smoking is a risk factor for AAA, the Canadian Task force has not recommended separate screening of this population due to lack of evidence of screening outcomes.
Asymptomatic Bacteriuria in Pregnancy: recommended to to screen once during the first trimester with urine culture (including women who are not experiencing symptoms of a UTI or are not at an increased risk of asymptomatic bacteriuria).
Breast Cancer: women 40-49 years are recommended not to screen with mammography (conditional on woman’s personal values and preference in their decision to be screened), women 50-69 years are recommended to be screened with mammography every 2-3 years, women 70-74 years recommended to be screened with mammography every 2-3 years.
- It is recommended not to use magnetic resonance imaging, tomosynthesis or ultrasound to screen women not at increased risk, clinical breast examinations are not recommended to screen for breast cancer, it is recommended not to advise women to practice self-breast examination to screen for breast cancer.
Cervical Cancer: women <20 years are not recommended for routine screening of cervical cancer (strong), women 20-24 years are recommended not to routinely screen for cervical cancer (weak), women 25-29 years are recommended to routinely screen for cervical cancer every 3 years (weak), women 30-69 years are recommended to screen for cervical cancer every 3 years (strong), women >70 years who have been adequately screened (3 successive negative Pap tests within 10 year span) are recommended to cease screening.
Cognitive Impairment: it is recommended to not screen asymptomatic adults >65 years of age for cognitive impairment.
- This recommendation excludes those who are concerned of their own cognitive performance, are suspected of dementia by clinicians or non-clinicians in care and/or have symptoms suggestive of mild cognitive impairment or dementia.
Colorectal Cancer: adults 50-59 years are recommended to be screened via FOBT (gFOBT or FIT) every 2 year or flexible sigmoidoscopy every 10 years, adults 60-74 years are recommended to be screened via FOBT (gFOBT or FIT) every 2 year or flexible sigmoidoscopy every 10 years, adults >75 years are not recommended to be screened.
- Colonoscopy is not recommended as a screening tool for colorectal cancer.
Depression: for adults at average risk of depression it is not recommended to routinely screen for depression, for adults in subgroups of the population who may be at an increased risk of depression it is not recommended to routinely screen for depression.
- Please note that this excludes the adolescent population in which case screening for depression is recommended.
Developmental Delay: it is not recommended to screen for developmental delay using standardized tools in children aged 1-4 years with no apparent signs of developmental delay and whose parents and clinicians have no concern about development.
- This recommendation does not apply to children who present with signs, symptoms or parental concern that could indicate delayed development or whose development is being closely monitored due to risk factors (prematurity or low birth weight)
Diabetes Mellitus, Type II: for adults at low-moderate risk it is recommended not to routinely screen, for adults at high risk it is recommended to screen every 3-5 years with A1C, for adults of very high risk it is recommended to screen annually with A1C.
- CANRISK calculation questionnaire: https://canadiantaskforce.ca/tools-resources/type-2-diabetes-2/type-2-diabetes-canrisk/
Esophageal Adenocarcinoma: it is not recommended to screen adults with chronic gastroesophageal reflux disease for esophageal adenocarcinoma or precursor conditions (Barrett esophagus or dysplasia).
- This recommendation does not apply to those exhibiting alarm symptoms such as dysphagia, odynophagia, recurrent vomiting, unexplained weight loss, anemia, loss of appetite or GI bleeding or those diagnosed with Barrett esophagus.
Hepatitis C: it is not recommended to screen adults who are not at elevated risk.
- This recommendation applies to asymptomatic adults with no elevated risk for Hepatitis C.
Hypertension: it is recommended to screen for blood pressure (via BP measurement) at all appropriate primary care visits, for those who are found to have an elevated blood pressure during screening the criteria for assessment and diagnosis of hypertension should be applied.
- Diagnostic algorithm: https://www.onlinecjc.ca/article/S0828-282X(17)30110-1/fulltext
Impaired Vision: for adults >65 years it is not recommended to screen for impaired vision in the primary care setting
- This recommendation excludes those >65 years who are not already under the care of a specialist ophthalmologist or those who have a known condition predisposed vision impairment (glaucoma or diabetes) or those diagnosed with dimentia.
Lung Cancer: for adults 55-74 years with at least a 30 pack year smoking history or quit 15 year prior it is recommended to annually screen with low dose computed tomography up to three consecutive times (to only be carried out in a health care setting with expertise present), for all other adults regardless of age or risk factors it is not recommended to screen for lung cancer with low dose computed tomography.
- Chest X-ray is not recommended as a tool for screening of lung cancer (with or without sputum cytology).
Obesity: for all children and youth (0-17 years) who present to primary care it is recommended to monitor growth using WHO Growth Charts (https://www.dietitians.ca/Secondary-Pages/Public/Who-Growth-Charts.aspx), it is not recommended to offer structured interventions aimed at preventing overweight and obesity in healthy weight children and youth, for children or youth who are overweight or obese it is recommended to offer or refer to structured behavioural interventions aimed to healthy weight management, for children aged 2-11 years who are overweight or obese it is not recommended to offer Orlistat (weak), for children and youth 12-17 years who are overweight and obese it is not recommended to offer Orlistat (weak), for children and youth 2-17 years it is not recommended to refer for surgical intervention, for adults (>18 years) it is recommended to measure height, weight and BMI at appropriate primary care visits, for obese adults (30<BMI<40) and at high risk of diabetes it is recommended to offer or refer to structured behavioural interventions aimed at weight loss (strong), for adults overweight or obese it is recommended to offer or refer to structural behavioural interventions (weak), for adults who are overweight or obese it is not recommended to offer pharmacologic interventions (Orlistat or Metformin) for weight loss.
- Prevention recommendations exclude children and youth with eating disorders, underweight, overweight or are obese and adults with eating disorders, underweight, pregnant, overweight or obese.
- Adults with a BMI >40 are recommended to offer or refer for surgical intervention, adults with a BMI>35 with a related medical problem (heart disease, diabetes, breathing problems) are recommended to offer or refer for surgical intervention.
Pelvic Exam: it is not recommended to perform a screening pelvic exam to screen for noncervical cancer, pelvic inflammatory disease or other gynecological conditions in asymptomatic women.
Prostate Cancer: for men <55 years it is not recommended to screen with prostate-specific antigen test (PSA) (strong), for men 55-69 it is not recommended to screen with PSA (weak), for men >70 years it is not recommended to screen with PSA (strong).
- This recommendation applies to men not previously diagnosed with prostate cancer, including those with lower urinary tract infection symptoms or benign prostatic hyperplasia.
Tobacco Smoke: for children and youth (5-18 years) who do not currently smoke tobacco it is recommended to ask about tobacco use and offer brief information and advice at appropriate primary care visits to prevent tobacco smoking.