Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Guideline

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
Scott Klarenbach
Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nicki Sims-Jones
Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Gabriela Lewin
Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Harminder Singh
Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Guylène Thériault
Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marcello Tonelli
Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Marion Doull
Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Susan Courage
Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Alejandra Jaramillo Garcia
Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Brett D. Thombs
Department of Medicine (Klarenbach), University of Alberta, Edmonton, Alta.; Department of Family Medicine (Lewin), University of Ottawa, Ottawa, Ont.; Departments of Internal Medicine and Community Health Sciences (Singh), University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Thériault), McGill University, Montréal, Que.; Department of Medicine (Tonelli), University of Calgary, Calgary, Alta.; Public Health Agency of Canada (Sims-Jones, Courage, Doull, Jaramillo Garcia), Ottawa, Ont.; Department of Psychiatry (Thombs), McGill University, Montréal, Que.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

Article Figures & Tables

Tables

    • View popup
    Table 1:

    Breast cancer mortality using mammography with or without clinical breast examination*15

    Age, yrRange of follow-up, yrNo. and design of studiesWomen who die from breast cancer, %†Women who are not screened: risk of dying of breast cancer per 100015Relative risk (95% CI)‡Women who are screened: risk of dying from breast cancer per 1000 (95% CI)Absolute effect per 1000 (95% CI)Number needed to screen (95% CI)GRADE rating of certainty of evidence
    Mammogram with or without clinical breast examinationUsual care, %
    40–4917.7 to 25.78 RCTs23, 33–37¶Unavailable††0.43.850.85 (0.78 to 0.93)3.27 (3.00 to 3.58)0.58 fewer (0.27 fewer to 0.85 fewer)1724 (1176 to 3704)⊕⊕○○
    LOW‡‡
    50–59§18 to 306 RCTs33, 35–37¶Unavailable††0.55.000.85 (0.78 to 0.93)4.25 (3.90 to 4.65)0.75 fewer (from 0.35 fewer to 1.10 fewer)1333 (909 to 2857)⊕○○○
    VERY LOW§§
    60–6913.1 to 304 RCTs23,33,35–36**Unavailable††0.66.150.85 (0.78 to 0.93)5.23 (4.80 to 5.72)0.92 fewer (from 0.43 fewer to 1.35 fewer)1087 (741 to 2326)⊕⊕○○
    LOW‡‡
    70–7413.2 to 13.62 RCTs23,35Unavailable††1.010.310.85 (0.78 to 0.93)8.76 (8.04 to 9.59)1.55 fewer (from 0.72 fewer to 2.27 fewer)645 (441 to 1389)⊕○○○
    VERY LOW ¶¶
    • Note: CI = confidence interval, GRADE = Grading of Recommendations Assessment, Development and Evaluation system, RR = relative risk.

    • ↵* This table presents screening outcomes based on short-case accrual methods. The systematic review conducted for this guideline presents screening outcomes using both short- and long-case accrual methods.15 In short-case accrual (initial + 7 subsequent screens; 23 years of follow-up), only those cases diagnosed during the screening period are included (median 7 yr; range 3 to 12 yr), whereas long-case accrual (initial + 4 subsequent screens; 14 years of follow-up) includes all cases diagnosed to the end of the follow-up period. Short-case accrual reduces bias from contamination because women in the control group would not have been screened until the trial was over, while long-case accrual may underestimate the benefits of screening as women in the control group are more likely being screened after the trial.15

    • ↵† The baseline risk in the control groups may not have been representative of all included studies because the numerators or denominators were either unclear or not reported.

    • ↵‡ A subgroup analysis of relative risk by age was assessed based on published methodology.31,32 No difference in RR among subgroups was detected and true differences resulting from age were deemed unlikely. The use of the all-ages RR data rather than focusing on each decade of age aligns with this assessment. It is appropriate to use control event rates relevant to each age group to determine corresponding risks, with attendant implications on absolute benefit (calculations provided in Appendix 4).

    • ↵§ Presents results with control group at moderate baseline risk.

    • ↵¶ The Stockholm and Gothenburg trials were considered quasi-randomized.33

    • ↵** The Stockholm trial was considered quasi-randomized.23

    • ↵†† Complete data were not available. Numerators or denominators were either unclear or not reported for all included studies.

    • ↵‡‡ Very serious concerns about risk of bias because randomization and allocation concealment were either not reported or had serious deficiencies.

    • ↵§§ Very serious concerns about risk of bias because randomization and allocation concealment were either not reported or had serious deficiencies and there were serious concerns about inconsistency, as heterogeneity may be moderate (I2 = 26%; p value = 0.24) and there were serious concerns about imprecision because, although the number of events and total population are large (> 300 threshold for events), the 95% CIs include the null and do cross appreciable benefit (RR 0.75).

    • ↵¶¶ Very serious concerns about risk of bias because randomization and allocation concealment were either not reported or had serious deficiencies and there were serious concerns about imprecision because, although the total population is large (> 2000), the 95% CIs include the null and do cross appreciable benefit (RR 0.75).

    • View popup
    Table 2:

    Estimated proportion of breast cancers overdiagnosed from screening*15

    Age of women at initial screen, yrYears after screeningBreast cancers estimated as overdiagnosed, %
    Invasive and in situ cancers, %Invasive cancers, %
    40 to 4954132
    205548
    50 to 5952516
    20165
    • ↵* Overdiagnosis by age was estimated using this calculation: The numerator is the difference in numbers of cancers in the mammography arm less those in the control arm; and the denominator is the number of screen-detected cancers in the mammography arm.39 Only the findings from the estimate on overdiagnosis from a Canadian randomized controlled trial39 are included because it provided an estimate by age and was appraised as being at moderate risk of bias.15

    • View popup
    Table 3:

    False-positives and unnecessary biopsies from an estimated cohort of women in a breast screening program for 7 years of screening*47

    Age range, yr
    Outcome40–4950–5960–6970–74
    Per 1000 women screened†
    FP mammography294294256219
    Biopsies on FP43373530
    Per 1 breast cancer death prevented
    FP mammography (based on 3 cycles of screening)†508392 (M)278141
    Biopsies on FP (based on 3 cycles of screening)†7450 (M)3819
    • Note: FP = false-positive, M = calculated using the moderate baseline risk for this age group.15

    • ↵* As the median duration of screening trials was 7 years (range 3–12 yr), the impact of this duration of screening on benefits and harms was used. The data are used to approximate a cohort of women entering the screening program.47 Although assumed, but not confirmed, the “initial screen” in the Canadian Partnership Against Cancer report is the first screen documented in the database and may not necessarily be the first “true” screen of a woman. This is especially true for data originating from Alberta.

    • ↵† Three cycles of screening for which women are screened every 2–3 years, for a total of 6–9 years of a screening period. Calculation: Initial screening cycle + 2 (subsequent screening cycle) to estimate harms occurring with 7 years of screening.

    • View popup
    Table 4:

    National and international guidelines on breast cancer screening

    OrganizationRecommendations
    Canadian Task Force on Preventive Health Care (current guideline, 2018)Recommendations apply to breast cancer screening for women aged 40 to 74 years who are not at increased risk of breast cancer:
    Mammography:
    • For women aged 40 to 49 years, we recommend not screening with mammography; the decision to undergo screening is conditional on the relative value a woman places on possible benefits and harms from screening (conditional recommendation; low-certainty evidence).

    • For women aged 50 to 69 years, we recommend screening with mammography every 2 to 3 years; the decision to undergo screening is conditional on the relative value that a woman places on possible benefits and harms from screening (conditional recommendation; very low-certainty evidence).

    • For women aged 70 to 74 years, we recommend screening with mammography every 2 to 3 years; the decision to undergo screening is conditional on the relative value that a woman places on possible benefits and harms from screening (conditional recommendation; very low-certainty evidence).

    Other screening modalities:
    Recommendations on using screening modalities other than mammography for breast cancer screening:
    • We recommend not using MRI, tomosynthesis or ultrasound to screen for breast cancer in women who are not at increased risk (strong recommendation; no evidence).

    • We recommend not performing clinical breast examinations to screen for breast cancer (conditional recommendation; no evidence).

    • We recommend not advising women to practise breast self-examination to screen for breast cancer (conditional recommendation; low-certainty evidence).

    Canadian Task Force on Preventive Health Care (2011)5Recommendations apply to women aged 40 to 74 years at average risk of breast cancer:
    Mammography:
    • For women aged 40–49 years, we recommend not routinely screening with mammography (weak recommendation; moderate-quality evidence).

    • For women aged 50–69 years, we recommend routinely screening with mammography every 2 to 3 years (weak recommendation; moderate-quality evidence).

    • For women aged 70–74 years, we recommend routinely screening with mammography every 2 to 3 years (weak recommendation; low-quality evidence).

    MRI:
    • We recommend not routinely screening with MRI scans (weak recommendation; no evidence).

    Clinical breast examination:
    • We recommend not routinely performing clinical breast examinations alone or in conjunction with mammography to screen for breast cancer (weak recommendation; low-quality evidence).

    Breast self-examination:
    • We recommend not advising women to routinely practise breast self-examination (weak recommendation; moderate-quality evidence).

    United States Preventive Services Task Force (2016)88Biennial screening mammography for women aged 50 to 74 years (Grade B recommendation).
    The decision to start screening mammography in women before age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between 40 and 49 years of age (Grade C recommendation).
    For women aged 75 years or older, current evidence is insufficient to assess the balance of benefits and harms of screening mammography (I statement).
    For all women, current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis as a primary screening method for breast cancer (I statement).
    For women with dense breasts, current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer following a negative mammogram using breast ultrasonography, MRI, digital breast tomosynthesis, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement).
    American Cancer Society (2015)89Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years (strong recommendation).
    Women aged 45 to 54 years should be screened annually, transitioning to biennial screening at 55 years of age with the option to continue annual screening (qualified recommendations).
    Women between the ages of 40 and 44 years should have the opportunity to begin annual screening (qualified recommendation).
    Healthy women should continue screening mammography as long as they have a life expectancy of 10 years or longer (qualified recommendation).
    The American Cancer Society does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).
    UK National Health Service Breast Screening Programme (2015)90The UK National Screening Committee recommends that all eligible women aged 50 to 70 years be invited to breast cancer screening every 3 years.
    Eligible women, aged 50 to 70, receive an invitation letter explaining the program, as well as benefits and risks of breast screening:
    • Women do not always receive an invitation when they turn 50. They can expect their invitation within 3 years of their 50th birthday.

    • Women cannot walk in and request breast screening unless they are older than 70, when they can request screening every 3 years.

    Cancer Australia (2015)91It is recommended that women of all ages, and regardless of whether they attend mammographic screening, are aware of how their breasts normally look and feel and report any new or unusual changes promptly to their general practitioner.
    No one method for women to use when checking their breasts is recommended over another.
    It is recommended, to reduce the risk of death from breast cancer, that women aged 50–74 years attend the BreastScreen Australia Program for free 2-yearly screening mammograms, having considered the benefits and downsides.
    Mammographic screening is not recommended for women younger than 40 years of age.
    Women aged 40–49 years and 75 years and older are eligible to receive free screening mammograms through the BreastScreen Australia Program, but they do not receive an invitation to attend. In deciding whether to attend for screening mammography, women in these age groups should balance the potential benefits and downsides for them. For women of all ages who are at increased risk of developing breast cancer, it is recommended that an individualized surveillance program be developed in consultation with the woman’s general practitioner or specialist.
    • Note: MRI = magnetic resonance imaging.

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 190 (49)
CMAJ
Vol. 190, Issue 49
10 Dec 2018
  • Table of Contents
  • Index by author

Article extras

  • Ligne directrice (français)
  • BCU - Tool Page (English)
  • BCU - Tool Page (français)

Podcast

Subscribe to podcast
Download MP3

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Recommendations on screening for breast cancer in women aged 40–74 years who are not at increased risk for breast cancer
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
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, Brett D. Thombs
CMAJ Dec 2018, 190 (49) E1441-E1451; DOI: 10.1503/cmaj.180463

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
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, Brett D. Thombs
CMAJ Dec 2018, 190 (49) E1441-E1451; DOI: 10.1503/cmaj.180463
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Scope
    • Methods
    • Recommendations
    • Considerations for implementation
    • Other guidelines
    • Gaps in knowledge
    • Conclusion
    • Acknowledgements
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • Wise guidance and its challenges: the new Canadian recommendations on breast cancer screening
  • PubMed
  • Google Scholar

Cited By...

  • The cost-effectiveness of adding tomosynthesis to mammography-based breast cancer screening: an economic analysis
  • Trop tot ou trop tard?: Choisir le bon intervalle pour les tests de depistage
  • Too soon or too late?: Choosing the right screening test intervals
  • Depistage du cancer au Canada: Ce qui est in, ce qui est out, ce qui sen vient
  • Cancer screening in Canada: Whats in, whats out, whats coming
  • Ligne directrice sur le depistage de ladenocarcinome {oelig}sophagien chez les patients atteints de reflux gastro-{oelig}sophagien chronique
  • The cost-effectiveness of mammography-based female breast cancer screening in Canadian populations: a systematic review
  • Physician Perspectives on Mammography Screening for Average-Risk Women: "Like a Double-Edged Sword"
  • Response
  • Rethinking screening during and after COVID-19: Should things ever be the same again?
  • Guideline on screening for esophageal adenocarcinoma in patients with chronic gastroesophageal reflux disease
  • Arrogance of 'but all you need is a good index finger: A narrative ethics exploration of lack of universal funding of PSA screening in Canada
  • Balancing breast cancer screening limitations
  • The authors respond to: "Revamp governance of Canadian Task Force on Preventive Health Care"
  • Revamp governance of Canadian Task Force on Preventive Health Care
  • Supporting women at average risk to make informed decisions about mammography when there is no "right" answer: a qualitative citizen deliberation study
  • Mesurer ce qui importe vraiment: Le depistage en premiere ligne
  • Measuring what really matters: Screening in primary care
  • Quality of screening mammography
  • Physical examination in patient-centred care: Is the pendulum swinging too far the other way?
  • Clinical practice guidelines and the overuse of health care services: need for reform
  • Update on task force terminology and outreach activities: Advancing guideline usability for the Canadian primary care context
  • Mise a jour sur la terminologie et les activites de rayonnement du groupe detude: Accroitre lutilite des lignes directrices dans le contexte des soins primaires canadiens
  • Wise guidance and its challenges: the new Canadian recommendations on breast cancer screening
  • Google Scholar

More in this TOC Section

  • Recommendations for equitable COVID-19 pandemic recovery in Canada
  • Recommendation on screening for chlamydia and gonorrhea in primary care for individuals not known to be at high risk
  • Key populations for early COVID-19 immunization: preliminary guidance for policy
Show more Guideline

Similar Articles

Collections

  • Sections
    • Guidelines

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire