Adherence to cancer screening guidelines across Canadian provinces: an observational study

Abstract

BackgroundCancer screening guidelines reflect the costs and benefits of population-based screening based on evidence from clinical trials. While most of the existing literature on compliance with cancer screening guidelines only measures raw screening rates in the target age groups, we used a novel approach to estimate degree of guideline compliance across Canadian provinces for breast, colorectal and prostate cancer screening. Measuring compliance as the change in age-specific screening rates at the guideline-recommended initiation age (50), we generally found screening patterns across Canadian provinces that were not consistent with guideline compliance.MethodsWe calculated age-cancer-specific screening rates for ages 40-60 using the Canadian Community Health Survey (2003 and 2005), a cross-sectional, nationally representative survey of health status, health care utilization and health determinants in the Canadian population. We estimated the degree of compliance using logistic regression to measure the change in adjusted screening rates at the guideline-recommended initiation age for each province in the sample.ResultsFor breast cancer, after adjusting for age trends and other covariates, being above age 50 in Quebec increased the probability of being screened by 19 percentage points, from an average screening rate of 24% among 40-49 year olds. None of the other regions exhibited a statistically significant change in screening rates at age 50. Additional analyses indicated that these patterns reflect asymptomatic screening and that Quebec's breast cancer screening program enhanced the degree of guideline compliance in that province. Colorectal cancer screening practice was consistent with guidelines only in Saskatchewan, as screening rates increased at age 50 by 12 percentage points, from an average rate of 6% among 40-49 year olds. For prostate cancer, the regions examined here are not compliant with Canadian guidelines since screening rates were quite high, and there was not a discrete increase at any particular age.ConclusionsScreening practice for breast, colorectal and prostate cancer was generally not consistent with Canadian clinical guidelines. Quebec (breast) and Saskatchewan (colorectal) were exceptions to this, and the impact of Quebec's breast cancer screening program suggests a role for policy in improving screening guideline compliance.

Association of sociodemographic factors and prostate-specific antigen (PSA) testing

“…However, other organizations at the time the data was collected, such as the Canadian Task Force on Preventive Health Care and the U.S. Preventive Services Task Force concluded that the evidence was insufficient to recommend PSA screening for prostate cancer in men over 50 years of age [4,19]. Two studies have suggested that looking at the age group just before guideline cut off is an appropriate way to monitor screening guideline compliance and note that there should be little to no testing in the age groups preceding the cut off age [20,21]. Our finding that there is testing occurring in younger men suggests that official guidelines at the time were not being followed in many instances.…”

Efficacy of an educational intervention on family physicians’ risk assessment and management of colorectal cancer

“…Up-to-date CRC screening for patients at average risk has been reported at less than 20 % in several studies across Canada (Strumpf et al 2010;Zarychanski et al 2007). Data from the 2008 Canadian Community Health Survey showed that 32 % (range 16-47 %) of Canadians aged 50-74 reported being screened with either FOBT in the previous 2 years or sigmoidoscopy/colonoscopy in the previous 5 years (Canadian Cancer Society et al 2011).…”

Incidence and Mortality of Prostate Cancer in Canada during 1992–2010

“…Prostate cancer screening guidelines exist at the national level; however, most individual provinces do not have asymptomatic screening programs for this malignancy [ 3 ]. To illustrate, the Canadian Task Force on Preventative Health Care and the Canadian Cancer Society published guidelines for asymptomatic prostate cancer screening in 1994 and 2000, respectively [ 3 , 4 , 5 ].…”

“…Prostate cancer screening guidelines exist at the national level; however, most individual provinces do not have asymptomatic screening programs for this malignancy [ 3 ]. To illustrate, the Canadian Task Force on Preventative Health Care and the Canadian Cancer Society published guidelines for asymptomatic prostate cancer screening in 1994 and 2000, respectively [ 3 , 4 , 5 ]. The former recommends not to order the prostate specific antigen (PSA) test for asymptomatic screening, whereas the latter recommends discussing its risks and benefits with a physician [ 3 , 4 ].…”

“…To illustrate, the Canadian Task Force on Preventative Health Care and the Canadian Cancer Society published guidelines for asymptomatic prostate cancer screening in 1994 and 2000, respectively [ 3 , 4 , 5 ]. The former recommends not to order the prostate specific antigen (PSA) test for asymptomatic screening, whereas the latter recommends discussing its risks and benefits with a physician [ 3 , 4 ]. Despite these recommendation, in 2003, ~50% of men >50 reported undergoing a PSA test in their lifetime [ 3 ].…”