Canadian Task Force on Preventive Health Care
Developing and disseminating clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence.
The CTFPHC is comprised of 14 independent primary care experts who lead the development of recommendations for clinical preventive services in Canada. The Evidence Review and Synthesis Centre, based at McMaster University and co-funded collaboratively by CIHR and PHAC, develops systematic evidence reviews to inform practice guidelines and recommendations.
Message from the Chair
Greetings! The Task Force has seen a very busy and exciting past few months with the release of our guideline on Breast Cancer Screening (more info on below). Months of hard work put in by the CTFPHC members, the Evidence and Review Synthesis Centre at McMaster University, the Task Force Office, and peer reviewers made this guideline possible, and resulted in recommendations that will give patients and primary care practitioners guidance on when to screen for breast cancer.
I’m pleased to announce the release of the CTFPHC’s new video (more info below), which will aid in the doctor–patient discussion surrounding screening for breast cancer. We hope this new media will highlight the importance of having an informed conversation on the harms and benefits of screening.
Looking ahead to 2012, the CTFPHC is continuing their work on a number of guidelines that are in progress (more of this below) and we invite you to stay up to date on our work by linking up with us on our website at canadiantaskforce.ca.
Marcello Tonelli, MD, SM
Breast cancer screening guideline
In November of 2011, the CTFPHC released recommendations on screening for breast cancer in average-risk women aged 40–74 years, published in the Canadian Medical Association Journal. These recommendations weigh the potential benefits of breast cancer screening against the harms of false positives and unnecessary biopsies.
Reporting the facts
Media coverage surrounding the release of the Task Force guideline on breast cancer screening was closely monitored and observed. Based on these observations, the CTFPHC noted some inaccuracies and misrepresentations in the coverage of these recommendations. For the sake of clarity, we would like to bring the following to our reader’s attention:
- Contrary to what readers may have concluded from some of the media coverage, the CTFPHC is not anti-screening, nor are we pro-screening. The updated guideline supports optimum screening. These recommendations were developed to ensure the best use of mammograms and examinations for women in the 40–74 age group at average risk of developing breast cancer.
- Our guideline’s scientific literature on breast cancer screening is current as of October 2011. Like the independent expert panels in other countries, the CTFPHC did not include observational studies to assess the benefits of treatment because of the risk of biases and of over-estimating the benefits of treatment as they have an inherently higher risk of reaching incorrect conclusions about the potential benefits of treatment.
- The CTFPHC guidance on mammography is largely in keeping with the current practices of the provincial and territorial screening programs. Most provinces do not actively recruit patients under 50 years of age. Women who are under 50 years of age can get a screening mammogram in many provinces upon self-referral or physician referral—which is consistent with the CTFPHC recommendation that women and their physicians have an open dialogue about their options and whether or not that individual should undergo screening.
- Our recommendations are also consistent with guidelines from independent organizations in the United States, The United Kingdom and Australia. The guidelines have also been endorsed by the College of Family Physicians of Canada.
- CTFPHC members are all unpaid volunteers, and contrary to many critics of the guideline, we do not have any financial or scientific conflicts of interest. For more information on the CTFPHC’s conflict of interest policy, please review our Procedural Manual.
Ultimately, we want women to understand both the benefits and the risks of mammography and speak to their primary care providers about these benefits and risks when discussing their options for breast cancer screening.
Breast cancer screening video
The CTFPHC has released a video to aid in facilitating the provider–patient discussion around breast cancer screening.
Available on the CTFPHC’s website, it is our hope that this tool will help to interpret the breast cancer screening guideline and bring the importance of the doctor–patient discussion into focus. Every patient is different, and we encourage every woman to discuss the risks and benefits of screening with their doctor before deciding on the best approach for them.
Resources for patients
A patient algorithm was developed to walk patients through the CTFPHC’s recommendations by asking questions related to risk and age.
For more information on the CTFPHC’s guideline on breast cancer screening, consult our FAQ for Patients.
As always, the CTFPHC encourages women to discuss their screening options with a primary care practitioner who is aware of their health background and family history.
Stay tuned on our website, as the CTFPHC will be releasing new tools to help doctors and patients work through these new guidelines.
Guidelines in progress
The CTFPHC has begun the guideline development process on a number of topics after meeting in 2010 to establish topic priorities. Criteria for topic selection were developed and applied to ensure transparency, reproducibility and objectivity in the topic-selection process. On the basis of these criteria, the topic prioritization working group solicits and considers input from the Task Force and its partners about which topics should be addressed.
Guidelines currently being worked on are:
- Screening for diabetes
- Screening for hypertension
- Screening for depression
- Screening for cervical cancer
- Screening for obesity in adults
- Screening for obesity in children
Rating the evidence
There are numerous evidence rating systems in use by different guideline developing organizations. With so many systems in existence, it is often difficult to compare ratings and guidelines within or among countries.
The Grading of Recommendations, Assessment and Evaluation system (GRADE) is an international system that aims to increase comparability among guidelines from different organizations.
The CTFPHC selected grade because it is a transparent and explicit decision-making system that has overcome the shortcomings associated with many previous rating systems.
- What is GRADE?
GRADE is the gold standard for qualifying the rigor of research studies in the development of guidelines.
- What does a strong recommendation mean?
A strong recommendation means that most individuals should receive the intervention and it can be adapted as policy in most situations.
- What does a conditional (weak) recommendation mean?
A conditional recommendation recognizes that different choices will be appropriate for individual patients and that clinicians must help each patient arrive at a management decision consistent with his or her values and preferences. Policy making will require substantial debate and involvement of various stakeholders.
- Who has endorsed or used GRADE?
World Health Organization (International), The Scottish Intercollegiate Guidelines Network (U.K.), Ministry of Health and Long-Term Care (Ontario, Canada), American College of Physicians (U.S.), The Cochrane Collaboration (International), British Medical Journal (U.K.), Agency for Healthcare Research and Quality (U.S.), etc.
Those wishing to learn more about grade may be interested in reading their introductory version published in the British Medical Journal.
Interested in learning more about GRADE? Sign-up to attend a workshop today!
- 23–24 March, 2012: Introductory course and advanced GRADE workshop (mainly in German) in Freiburg, Germany
- 2 April, 2012: Half-day introductory grade workshop in Clearwater, Florida, U.S.
CTFPHC at FMF, NAPCRG
At the 2011 Family Medicine Forum (FMF), that took place in Montreal, Quebec from 3–5 November, 2011, the CTFPHC held a presentation focused on GRADE and broke into groups for a workshop to help attendees better understand GRADE.
The CTFPHC presented a workshop at the North American Primary Care Research Group (NAPCRG) annual meeting, held in Banff, Alberta from 12–16 November, 2011. The meeting, which was attended by family physicians and international guideline developers, included a workshop by the CTFPHC based around their methodology and the guideline development process.
Be sure to check back on our website for upcoming events and CTFPHC presence at future conferences.
EMR meeting in Toronto
Select CTFPHC members and CTFPHC Office staff met with external experts on Electronic Medical Records (EMR) in Toronto on 11 January, 2012. Held at St. Michael’s Hospital, this all-day meeting facilitated some key strategies for the CTFPHC to consider in order to best meet the needs of primary care providers in today’s ever-advancing technological age.
A report of the EMR meeting in Toronto will be online on the CTFPHC’s website once available. To receive CTFPHC updates as they become available, please sign up for our mailing list.