Canadian Task Force Updates Breast Cancer Screening Guidelines

MedicalResearch.com Interview with:

Dr. Ainsley Moore MD, CFPC, MSc(HB), MSc(CLinEpi) Cand
Associate Professor,McMaster University
Associate Editor,Canadian Medical Education Journal
Vice-Chairof the Canadian Task Force on Preventive Health Care
Dr. Moore

Dr. Ainsley Moore MD, CFPC, MSc(HB), MSc(CLinEpi) Cand
Associate Professor,McMaster University
Associate Editor,Canadian Medical Education Journal
Vice-Chair,  Canadian Task Force on Preventive Health Care

MedicalResearch.com:  What is the background for this study?

Response: The Canadian Task Force for Preventive Health Care has updated its Breast Cancer Screening Guideline. It places an emphasis on shared decision-making between women and their health care provider so that women can make an informed decision based on how they prioritize the benefits and harms of screening with mammography.  

Screening may identify breast cancer earlier and lead to a reduction in breast cancer mortality; however, i talso has known harms such as false positive results, further testing including biopsy, and over diagnosis leading to unnecessary treatment with associated complications.

MedicalResearch.com: What are the main findings?

Response: An updated review of the evidence continues to show a close balance between potential benefits and harms of breast cancer screening; this balance appears to be less favourable for younger women than for women aged 50 to 74 years.

A separate review conducted for this guideline on women’s values and preferences about mammography screening suggests that many women aged 40 to 49 years would choose not to be screened if they were aware of the outcomes for their age group. On the other hand, women aged 50 to 74 years are more likely to choose screening given their more favourable balance of benefits and harms

The recommendations:

  • The TaskForce provides conditional recommendations against screening women age 40 to49 years who are not at increased risk of breast cancer, low certainty evidence shows a small potential reduction in breast cancer death along with higher risk of harms including false positive results, further testing including possible breast biopsy and overdiagnosis leading to unnecessary treatment with associated complications. Recommendations are conditional upon how an individual woman from this age group weighs the benefits and harms of screening
  • The TaskForce provides conditional recommendations in favour of screening women aged 50 to 74 years who are not at increased risk of breast cancer, very low-certainty evidence suggests a modest reduction in risk of breast cancer death and, while the risk of harms of screening are lower than for younger women, it remains a concern.  Recommendations are conditional upon who an individual woman of this age group weighs the benefits and harms of screening

MedicalResearch.com: What should readers take away from your report?

Response: The Task Force provides information on the benefits and harms of breast cancer screening and has developed tools on their website to help guide the discussion between women and their health care provider so that they can make the decision that is best for themFor more details on the Task Force’s findings and recommendations and patient tools, please visit: canadiantaskforce.ca

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: More and better-quality evidence is needed on the impact of breast cancer screening for women of all ages.  Additional studies on Canadian women’s values and preferences for screening that are based on accurate estimates of both benefits and harms conducted in a transparent and easily comparable manner would assist in guiding future recommendations.

MedicalResearch.com: Is there anything else you would like to add?

Response: The Public Health Agency of Canada established theCanadian Task Force for Preventive Health Care to make recommendations forCanadian primary care providers on a broad array of preventive health issues.The members of the Task Force were selected for their expertise in Preventive health care delivered in primary care settings. Task Force members adhere to the highest ethical standards including the avoidance of professional conflicts of interest in order to ensure the scientific credibility of its recommendations.

Citation:

Recommendations on screening for breast cancer in women aged 40–74 years who are not at increased risk for breast cancer

Scott Klarenbach, Nicki Sims-Jones, Gabriela Lewin, Harminder Singh, Guylène Thériault, Marcello Tonelli, Marion Doull, Susan Courage, Alejandra Jaramillo Garcia and Brett D. Thombs; for the Canadian Task Force on Preventive Health Care

CMAJ December 10,2018 190 (49) E1441-E1451; DOI:https://doi.org/10.1503/cmaj.180463

Dec 11, 2018 @ 8:44 pm

The information onMedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Aggression in Dementia: Alternatives to Antipsychotics Also Have Side Effects

MedicalResearch.com Interview with:

Jennifer Watt, PhD Clinical Epidemiology and Health Care Research Institute of Health Policy, Management, and Evaluation University of Toronto

Dr. Watt

Jennifer Watt, PhD
Clinical Epidemiology and Health Care Research
Institute of Health Policy, Management, and Evaluation
University of Toronto

MedicalResearch.com: What is the background for this study?  

Response: Behavioral and psychological symptoms of dementia (e.g. aggression, agitation) are common among persons living with dementia.

Pharmacological (e.g. antipsychotics) and non-pharmacological (e.g. reminiscence therapy) interventions are often used to alleviate these symptoms. However, antipsychotics are associated with significant harm among older adults with dementia (e.g. death, stroke). Regulatory agencies such as the Food and Drug Administration (FDA) and Health Canada issued black box warnings to advise patients and clinicians of this potential for harm. And initiatives were championed to decrease the use of antipsychotics in persons living with dementia.

In response, we have seen a rise in the use of other pharmacological interventions, such as trazodone (an antidepressant). Its potential to cause harm in older adults with dementia is largely unknown. Continue reading

What is Risk of Sexual Transmission of HIV With Treatment-Suppressed Low Viral Load?

MedicalResearch.com Interview with:

"HIV infecting a human cell" by NIH Image Gallery is licensed under CC BY 2.0

HIV Infecting T Cell

Rachel Rodin
Centre for Communicable Diseases and Infection Control
Public Health Agency of Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: On December 1, 2016 (World AIDS Day), the Honourable Jody Wilson-Raybould, federal Minister of Justice, committed to working with provinces and territories, affected communities, and medical professionals to examine the criminal justice system’s response to non-disclosure of HIV status in the context of sexual relations.

To this end, Justice Canada worked with the Public Health Agency of Canada (PHAC), provincial and territorial public health and justice counterparts, and a variety of other stakeholders to develop a comprehensive report on the issue of HIV non-disclosure. As part of this work, Justice Canada asked PHAC to provide an assessment of the most recent medical science on sexual HIV transmission risk.

In collaboration with external peer reviewers, PHAC undertook a systematic review of the full body of scientific evidence on sexual HIV transmission risk. The review found that the risk of sexual transmission of HIV is negligible when an individual is taking antiretroviral therapy as prescribed and maintains a suppressed viral load. The review also concluded that the risk remains low when the individual is on antiretroviral therapy with varying viral load, or is not on antiretroviral therapy but uses condoms.    Continue reading

Program Can Help Parents Manage Kids’ Pain from Vaccines

MedicalResearch.com Interview with:

Dr. Anna Taddio BScPhm PhD Professor at the Leslie Dan Faculty of Pharmacy University of Toronto and Senior Associate Scientis The Hospital for Sick Children 

Dr. Taddio

Dr. Anna Taddio BScPhm PhD
Professor at the Leslie Dan Faculty of Pharmacy
University of Toronto and Senior Associate Scientis
The Hospital for Sick Children 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In our prior research, parents have reported they are not educated about how to soothe their infants during painful procedures like vaccinations and that they want to know how they can help. Parents also reported that concerns about their infant’s pain affects their decision-making around vaccination. We therefore set out to target parents for education about how to soothe their infants.

We picked the hospital setting because almost all parents are in the hospital for some period of time following the birth of an infant and already routinely receive education about healthy baby topics. Providing information about pain management was easy to add. We found that about 1 out of 10 parents that were given this information acted on it. 

MedicalResearch.com: What should readers take away from your report?

Response: No parent wants to see their child in pain and a parents’ desire to reduce pain is supported when we provide them with evidence-based strategies to use. These strategies are easy to use, and not only decrease unnecessary infant suffering, they also help parents. Parents are less anxious about their children getting vaccinations. Attending to infant distress is also important for healthy infant development. Targeting parents at the time of birth also ensures that parents will use and advocate for better pain care for their children across different  medical settings and throughout the lifespan.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We need to find ways to reach more parents so that they can use this information to help their children. We also need to follow parents over time and teach them about the strategies that are helpful for children of different ages. Finally, we need to study how better pain management practices impacts on vaccination rates.

Citation:

Effectiveness of a hospital-based postnatal parent education intervention about pain management during infant vaccination: a randomized controlled trial Anna Taddio BScPhm PhD, Vibhuti Shah MD, Lucie Bucci MA, Noni E. MacDonald MD, Horace Wong MSc, Derek Stephens MSc

CMAJ 2018 October 22;190:E1245-52. doi: 10.1503/cmaj.180175

Oct 22, 2018 @ 9:53 pm

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Who Has the Highest Rate of Readmission After Hospital Discharge?

MedicalResearch.com Interview with:
"patient in hospital bed with nursing staff gathered around" by Penn State is licensed under CC BY-NC-ND 2.0Andrea Gruneir, PhD
Department of Family Medicine
University of Alberta
Edmonton, AB Canada

MedicalResearch.com: What is the background for this study?

Response: Hospital readmissions – when a patient is discharged from hospital but then returns to hospital in a short period of time – are known to be a problem, both for the patients and for the larger health system. Hospital readmissions have received considerable attention and there have been a number of initiatives to try to reduce them, but with mixed success. Older adults are among the most vulnerable group for hospital readmission. Older adults are also the largest users of continuing care services, such as home care and long-term care homes (also known as nursing homes). Yet, few large studies have really considered how older adults with different pathways through hospital compare on the risk of hospital readmission.

In our study, we take a population-level approach and use health administrative data to create a large cohort of older adults who were hospitalized in Ontario between 2008 and 2015. For each of the 701,527 patients in our study, we identified where they received care before the hospitalization (in the community or in long-term care) and where they received care after discharge (in the community, in the community with home care, or in long-term care).  Continue reading

Age, Sex and Genetics Can Identify Groups at Higher Risk of Alzheimer’s Disease

MedicalResearch.com Interview with:

Ruth Frikke-Schmidt, Professor, Chief Physician, MD, DMSc, PhD Department of Clinical Biochemistry Rigshospitalet, Blegdamsvej & Deputy Head Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen

Dr. Frikke-Schmidt

Ruth Frikke-Schmidt, Professor, Chief Physician, MD, DMSc, PhD
Department of Clinical Biochemistry
Rigshospitalet, Blegdamsvej &
Deputy Head
Department of Clinical Medicine
Faculty of Health and Medical Sciences
University of Copenhagen

MedicalResearch.com: What is the background for this study?

 

Response: Alzheimer’s disease and other forms of dementia are devastating, neurodegenerative disorders affecting more than 47 million people in 2015, a number projected to triple by 2050 (1,2). Available curative treatments are lacking, and no useful risk prediction tools exist. The potential for prevention is however substantial, emphasized by the recently observed incidence decline in Western societies, likely caused by improved treatment and prevention of vascular risk factors (1,3,4). Population growth and aging, will however triple dementia prevalence by 2050, if no action is taken. Acting now with ambitious preventive interventions, delaying onset of disease by five years, is estimated to halve the prevalence globally (1,5).

Despite important preventive efforts over the last decades – resulting in decreased smoking, lower blood pressure and lower cholesterol levels in the general population – physical inactivity, overweight, and diabetes remain threats for our health care system, and in particular for cardiovascular disease and dementia. Intensifying preventive efforts in general is thus of crucial importance, and especially for those patients at highest risk who most likely will benefit the most from early and targeted prevention. Risk stratification and specific treatment goals according to the estimated absolute 10-year risk, has been implemented in cardiovascular disease for years (6,7). There is an un-met need for similar strategies in dementia, underscored by the publication of several randomized multicomponent trials that seem to improve or maintain brain function in at-risk elderly people from the general population (8-10) Continue reading

Clinical Chemistry Score Helps Rule Out Diagnosis of Heart Attack

MedicalResearch.com Interview with:

Peter Kavsak, PhD, FCACB, FAACC, FCCS Professor, Pathology and Molecular Medicine McMaster University 

Prof.. Kavsak

Peter Kavsak, PhD, FCACB, FAACC, FCCS
Professor, Pathology and Molecular Medicine
McMaster University 

MedicalResearch.com: What is the background for this study?

Response: For patients who present to the hospital with symptoms suggestive of acute coronary syndrome (ACS) the preferred blood test to help physicians in making a diagnosis is cardiac troponin.

Recent studies have demonstrated that a very low or undetectable cardiac troponin level when measured with the newest generation of blood tests (i.e., the high-sensitivity cardiac troponin tests) in this population may rule-out myocardial infarction (MI or a heart attack) on the initial blood sample collected in the emergency department, thus enabling a faster decision and foregoing the need for subsequent serial measurements of cardiac troponin over several hours as recommended by the guidelines. The problem with this approach, however, is that using high-sensitivity cardiac troponin alone to do this has not reliably been demonstrated to achieve a sensitivity >99% for detecting MI, which is the estimate that most physicians in this setting consider as safe for discharge.

Our study goal was to compare the diagnostic performance of a simple laboratory algorithm using common blood tests (i.e., a clinical chemistry score (CCS) consisting of glucose, estimated glomerular filtration rate (eGFR), and either high-sensitivity cardiac troponin I or T) to high-sensitivity cardiac troponin alone for predicting MI or death within the first month following the initial blood work. Continue reading

Immunity to the Acellular Whooping Cough Vaccine Wanes With Time

MedicalResearch.com Interview with:
Dr. Kevin Schwartz, MD MSc
Infection Prevention and Control Physician
Infection Prevention and Control
Public Health Ontario | Santé publique Ontario

MedicalResearch.com: What is the background for this study?

Response: There has been a resurgence of pertussis, or ‘whooping cough’, in several countries and regions since the introduction of the new “acellular” pertussis vaccine in the 1990s to replace the older “whole cell” vaccine. In Ontario, we have not seen large increases but observed a small outbreak in 2012 that affected both unvaccinated people, as well as in those who have been vaccinated against pertussis. Our objective was to evaluate the effectiveness of the current acellular vaccine used in Ontario. We wanted to find out whether immunity wanes with time in the same way as had been previously observed during a large outbreak in California. We also wanted to study the impact of receiving the older ‘whole cell’ vaccine, which we used in Ontario until 1997.

Continue reading