In primary health care we arrange screening tests because we know that if we can catch some diseases in the early stages we can offer treatment and stop the disease from advancing. In Canada we are fortunate to be able to access screening tests for free which goes a long way to reducing illness and death.
I am often asked why we don't start screening for some diseases, such as breast cancer, at an earlier age? Or why we don't screen for other conditions at all, such as ovarian cancer? In primary care we have guidelines to help us decide when to start screening and these guidelines are based on evidence. That said, every decision to screen is based on a conversation between patient and provider with an assessment of each patient's personal and family medical history. For some people early screening or different screening tests are appropriate. That's why it is important to see your health care provider and ask about screening tests that you should have.
Below is a summary of some of the basic screening tests offered in Canadian primary care. All "screening tests" are performed when people have no symptoms of disease and meet the criteria for general screening.
The screening test for breast cancer is a mammogram. In Ontario we have the Ontario Breast Screening Program (OBSP) operated by Cancer Care Ontario. Women with normal risk for breast cancer between the ages of 50 and 74 years should have a mammogram every 2 years. Women with a higher risk for breast cancer (e.g. family history of breast cancer) may be eligible for early or more frequent screening and should see their NP or MD to discuss this. To learn more about breast cancer screening please visit OBSP.
The screening test for colorectal cancer is the fecal occult blood test (FOBT). In Ontario we have the ColonCancerCheck program operated by Cancer Care Ontario. Men and women with normal risk for colorectal cancer between the ages of 50 and 74 years should complete an FOBT kit every 2 years. People with a higher risk for colorectal cancer (e.g. family history of colorectal cancer, personal history of Crohn's disease) are eligible for a colonoscopy and should see their NP or MD to discuss this. To learn more about colorectal cancer screening please visit ColonCancerCheck or see my article Colorectal Cancer Screening Update.
The PSA (prostate specific antigen) blood test is the best way to screen for prostate cancer. Unfortunately, the PSA test is not specific to cancer (other non-cancerous conditions can elevate the PSA level) and is therefore not considered a screening test. In the province of Ontario an NP or MD can order a PSA test for you if you have a higher risk of prostate cancer (e.g. family or personal history of prostate cancer, African ancestry). If you are not considered high risk you may still opt to have the PSA test but the government of Ontario will charge you a fee. To learn more about prostate cancer screening in Ontario please visit the Ontario Government site on prostate cancer screening.
Since 2017 there is a Lung Cancer Screening Pilot Project in Ontario. Men and women ages 55 to 74 years who have smoked cigarettes (current or ex smokers) for 20 years or more (does not need to be consecutive) are eligible for a low dose CT scan. Screening tests are performed in Oshawa, Renfrew, Sudbury, & Ottawa. Please see your NP or MD to discuss lung cancer screening and be referred for the test if eligible. You can read more about the pilot project on the Lakeridge Health website.
The screening test for cervical cancer is the Pap Test. In Ontario the Cervical Screening Program is operated by Cancer Care Ontario. Women with normal risk for cervical cancer between the ages of 21 and 70 years who are or have been sexually active should have a Pap test every 3 years. Women with a higher risk for cervical cancer (e.g. previous abnormal Pap test, previous cervical treatment) are eligible for more frequent Pap tests and should see their NP or MD to discuss this. Please note women in same-sex relationships, women who are not currently sexually active, and women who have received the HPV vaccine should have Pap tests. Women who have had a hysterectomy should discuss Pap testing with their NP or MD. To learn more about cervical cancer screening please visit the Ontario Cervical Screening Program.
The two main screening tests for heart disease in Ontario are blood pressure and blood tests for cholesterol levels. Both of these tests can be performed at a primary care clinic. Blood pressure is generally checked on all adult patients when they see their primary care provider. The Canadian Task Force on Preventive Health Care recommends that women with a normal risk have their cholesterol checked after age 50 years or after menopause. Men with normal risk should have their cholesterol checked after age 40 years. The frequency of cholesterol testing is every 1-5 years depending on patient profile. Men and women with higher risk of heart disease (e.g. smokers, family history of heart disease) are eligible for earlier and more frequent cholesterol testing. To read more about heart disease screening and prevention please see the Heart and Stroke Foundation of Canada website.
The screening test for diabetes are two blood tests - fasting blood sugar (FBS or FPG fasting plasma glucose) and glycated hemoglobin (HbA1C). The Canadian Task Force On Preventive Health Care and the Canadian Diabetes Association recommend that men and women with normal risk have their blood work checked after age 40 years. The frequency of diabetes blood test screening is every 3 years. People with a higher risk of diabetes (e.g. obesity, family history of diabetes) are eligible for earlier and more frequent blood testing. To read more about diabetes screening and prevention please see the Canadian Diabetes Association Screening Guidelines.
The screening test for osteoporosis is a bone mineral density (BMD) test. Men and women with normal risk for osteoporosis over age 65 years should have BMD testing. Frequency of testing is determined by the results of your first test and is generally between 1 and 5 years. Men and women with higher risk for osteoporosis (chronic steroid medication, early menopause, smokers, history of fractures, Crohn's disease) are eligible for earlier and more frequent screening. To read more about osteoporosis screening and prevention please see the Osteoporosis Society of Canada Guidelines.
The information provided on npsam.ca is not intended to replace consultation with a qualified health care professional. You are encouraged to inform your nurse practitioner or physician of any changes you make to your lifestyle. If you have questions or concerns about any medical conditions please book an appointment with your nurse practitioner or physician.
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