Cancer |
We recommend prioritizing colorectal cancer screening outreach efforts for adults aged 45–74 yr experiencing disadvantages (strong recommendation, high-certainty evidence). | The CTFPHC recommends screening adults aged 50–59 yr for colorectal cancer with FOBT (either gFOBT or FIT) every 2 yr or flexible sigmoidoscopy every 10 yr (weak recommendation, moderate-quality evidence). The CTFPHC recommends screening adults aged 60–74 yr for colorectal cancer with FOBT (either gFOBT or FIT) every 2 yr or flexible sigmoidoscopy every 10 yr (strong recommendation, moderate-quality evidence) (2016). (39) | The USPSTF recommends screening for colorectal cancer in adults aged 45–49 yr (grade B recommendation). The USPSTF recommends screening for colorectal cancer in all adults aged 50–75 yr (grade A recommendation) (2021). (40) | |
We recommend offering HPV self-testing to people eligible for cervical cancer screening who are experiencing disadvantages (strong recommendation, high-certainty evidence). | For women aged 25–29 yr, the CTFPHC recommends routine screening for cervical cancer every 3 yr (weak recommendation, moderate-quality evidence). For women aged 30–69 yr, the CTFPHC recommends routine screening for cervical cancer every 3 yr (strong recommendation, high-quality evidence) (2013). (41) | The USPSTF recommends screening for cervical cancer every 3 yr with cervical cytology alone in women aged 21–29 yr. For women aged 30–65 yr, the USPSTF recommends screening every 3 yr with cervical cytology alone, every 5 yr with high-risk HPV testing alone, or every 5 yr with high-risk HPV testing in combination with cytology (co-testing) (grade A recommendation) (2018). (42) | |
We recommend prioritizing outreach efforts for lung cancer screening with LDCT in adults aged 50–80 yr with a 20 pack-year smoking history who are experiencing disadvantages (strong recommendation, high-certainty evidence). | For adults aged 55–74 yr with at least a 30 pack-year smoking history who currently smoke or quit less than 15 yr ago, the CTFPHC recommends annual screening with low-dose CT up to 3 consecutive times (weak recommendation, low-quality evidence) (2016). (43) | The USPSTF recommends annual screening for lung cancer with low-dose CT in adults aged 50–80 yr who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 yr. Screening should be discontinued once a person has not smoked for 15 yr or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery (grade B recommendation) (2021). (44) | |
Cardiovascular disease |
We recommend prioritized cardiovascular risk assessment, including BP measurement using validated tools, and shared decision-making about management options, including pharmacotherapy, for adults aged 40–75 yr experiencing disadvantages; this includes women and people with mental health conditions (strong recommendation, high-certainty evidence). | The CTFPHC recommends BP measurement at all appropriate primary care visits (strong recommendation, moderate-quality evidence). The CTFPHC recommends that BP be measured according to the current techniques described in CHEP recommendations for office and out-of-office (ambulatory) BP measurement (strong recommendation, moderate-quality evidence). For people who are found to have an elevated BP during screening, the CHEP criteria for assessment and diagnosis of hypertension should be applied to determine whether the patient meets diagnostic criteria for hypertension (strong recommendation, moderate-quality evidence) (2012). (45) | The USPSTF recommends that clinicians prescribe a statin for the primary prevention of cardiovascular disease for adults aged 40–75 yr who have 1 or more cardiovascular disease risk factors (i.e., dyslipidemia, diabetes, hypertension or smoking) and an estimated 10-yr risk of a cardiovascular event of ≥ 10% (2022). (46) The USPSTF recommends screening for hypertension in adults aged ≥ 18 yr with office BP measurement. The USPSTF recommends obtaining BP measurements outside of the clinical setting for diagnostic confirmation before starting treatment (grade A recommendation) (2021). (47) | C-CHANGE: C-CHANGE recommends that a cardiovascular risk assessment be completed every 5 yr for men and women aged 40–75 yr using the modified Framingham Risk Score or Cardiovascular Life Expectancy Model to guide therapy to reduce major cardiovascular events. A risk assessment might also be completed whenever a patient’s expected risk status changes (strong recommendation, high-quality evidence). Four approaches can be used to assess BP: AOBP (preferred method), non-AOBP, ambulatory BP and home BP monitoring (grade C–D recommendation, depending on BP method) (2022). (48) |
We recommend prioritized screening for diabetes in people at higher risk, including those aged ≥ 40 yr, who are experiencing disadvantages (strong recommendation, moderate-certainty evidence). | For adults at high risk of diabetes (determined with a validated risk calculator), the CTFPHC recommends routinely screening every 3–5 yr with HbA1C (weak recommendation; low-quality evidence). For adults at very high risk of diabetes (determined with a validated risk calculator), the CTFPHC recommends routine screening annually with HbA1C (weak recommendation, low-quality evidence) (2012). (49) | The USPSTF recommends screening for prediabetes and type 2 diabetes in adults aged 35–70 yr who have overweight or obesity. Clinicians should offer or refer patients with prediabetes to effective preventive interventions (grade B recommendation) (2021). (50) | C-CHANGE: Screening for diabetes using FPG or HbA1C or both should be performed every 3 yr in people aged ≥ 40 yr or at high risk, using a risk calculator. Earlier testing or more frequent follow-up (every 6–12 mo with either FPG or HbA1C or 2-hr plasma glucose in a 75 g oral blood glucose tolerance test should be considered in those at very high risk, using a risk calculator, or in people with additional risk factors for diabetes (grade D recommendation, consensus evidence) (2022). (48) |
Infectious conditions |
We recommend HIV screening, including by self-testing, for adults aged 19–79 yr who are experiencing disadvantages (strong recommendation, moderate-certainty evidence). | No published guideline for HIV screening | The USPSTF recommends screening for HIV infection in adolescents and adults aged 15–65 yr. Younger adolescents and older adults who are at increased risk of infection should also be screened (A recommendation). The USPSTF recommends screening for HIV infection in all pregnant people, including those who present in labour or at delivery whose HIV status is unknown (grade A recommendation) (2019). (51) | |
We recommend HCV screening for adults aged 19–79 yr who are experiencing disadvantages (strong recommendation, moderate-certainty evidence). | The CTFPHC recommends against screening for HCV in adults who are not at elevated risk (strong recommendation, very low-quality evidence) (2017). (52) | The USPSTF recommends screening for HCV infection in adults aged 18–79 yr (grade B recommendation) (2020). (53) | CASL: To increase the identification of the large proportion of people living with undiagnosed HCV, CASL recommends that screening be both risk based and target the birth cohort of people born from 1945 to 1975, which currently encompasses most people chronically infected with HCV in Canada (class of recommendation: 2a; level of evidence: C) (2018). (54) |
We recommend screening for latent TB infection with either a TST or IGRA in people with risk factors including recent immigration from a country with a high incidence (strong recommendation, moderate-certainty evidence). | No published guideline for TB screening | The USPSTF recommends screening for latent TB infection in populations at increased risk (grade B recommendation) (2023). (55) | CTS: The CTS strongly recommends both the TST and IGRA as acceptable alternatives for TB infection diagnosis* (good evidence) (8th edition, 2022). (56) CCIRH: The CCIRH recommends screening children, adolescents aged < 20 yr and refugees aged 20–50 yr from countries with a high incidence of TB, as soon as possible after their arrival in Canada, with a TST (high quality of evidence) (2011). (57) |
Substance use |
We recommend screening for tobacco use together with appropriate supports in adolescents and adults experiencing disadvantages (strong recommendation, moderate-certainty evidence). | The CTFPHC recommends asking children and youth (age 5–18 yr) or their parents or both about tobacco use and offering brief information and advice, as appropriate, during primary care visits (weak recommendation, low-quality evidence) (2017). (58) | The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioural interventions and FDA-approved pharmacotherapy for cessation to nonpregnant adults who use tobacco (grade A recommendation). The USPSTF recommends that clinicians ask all pregnant people about tobacco use, advise them to stop using tobacco and provide behavioural interventions for cessation to pregnant people who use tobacco (grade A recommendation) (2021). (59) The USPSTF recommends that primary care clinicians provide interventions, including education or brief counselling, to prevent initiation of tobacco use among school-aged children and adolescents (grade B recommendation) (2020). (60) | C-CHANGE: Tobacco use status of all patients should be updated on a regular basis and health care providers should clearly advise patients to quit smoking (grade A recommendation, level 1 evidence) (2022). (48) |
We recommend screening for harmful alcohol use together with appropriate supports in adolescents and adults experiencing disadvantages (strong recommendation, moderate-certainty evidence). | No published guideline for alcohol use screening | The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults aged ≥ 18 yr, including pregnant women, and providing people engaged in risky or hazardous drinking with brief behavioural counselling interventions to reduce unhealthy alcohol use (grade B recommendation) (2018). (61) | |
We recommend screening for substance use together with appropriate supports in adolescents and adults experiencing disadvantages (strong recommendation, moderate-certainty evidence). | No published guideline for substance use screening | The USPSTF recommends screening by asking questions about unhealthy drug use in adults aged ≥ 18 yr. Screening should be implemented when services for accurate diagnosis, effective treatment and appropriate care can be offered or referred. (Screening refers to asking questions about unhealthy drug use, not testing biological specimens.) (Grade B recommendation) (2020). (62) | |
Mental health |
We recommend screening for depression together with appropriate supports in adolescents and adults experiencing disadvantages (strong recommendation, moderate-certainty evidence). | The CTFPHC recommends against instrument-based depression screening using a questionnaire with cut-off score to distinguish “screen positive” and “screen negative” administered to all people during pregnancy and the postpartum period (up to 1 yr after childbirth) (conditional recommendation, very low-certainty evidence) (2022). (63) | The USPSTF recommends screening for depression in the adult population, including pregnant and postpartum people, as well as older adults (grade B recommendation) (2023). (64) | CNMAT: The CNMAT recommends that screening be done in primary and secondary care settings in people with risk factors (psychosocial adversity, chronic medical conditions, high users of the medical system) when there are available resources and services for subsequent diagnostic assessment and management (2016). (65) |
Oral health |
We recommend screening for dental caries, education about oral health and referrals to dentists for children aged < 5 yr experiencing disadvantages (strong recommendation, moderate-certainty evidence). | The CTFPHC states there is good evidence that the following manoeuvres are effective in preventing dental caries: use of dentifrices containing fluoride, fluoridation of drinking water, fluoride supplements for patients in areas where there is a low level (≤ 0.3 ppm) of fluoride in the drinking water, professionally applied topical fluoride and use of fluoride mouth rinses for patients with very active decay or at a high risk of dental caries and selective use of professionally applied fissure sealants on permanent molar teeth† (1995). (66) | The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 mo for children whose water supply is deficient in fluoride (grade B recommendation). The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption (grade B recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening examinations for dental caries performed by primary care clinicians in children aged < 5 yr (I statement) (2021). (67) | |
Social risk |
We recommend screening for social risk factors, including poverty or the ability to afford basic necessities, and connection with resources and supports in all families with children (weak recommendation, moderate-certainty evidence). | No published guideline for poverty screening | No published guideline for poverty screening | |
We suggest screening for IPV and connection with resources, including legal advocacy, for people experiencing disadvantages (weak recommendation, moderate-certainty evidence). | No published guidelines for IPV screening | The USPSTF recommends that clinicians screen for IPV in women of reproductive age and provide or refer women who screen positive to ongoing support services (grade B recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for abuse and neglect in all older or vulnerable adults (I statement) (2018). (68) | |
Access to care providers |
We recommend prioritized connection to primary care, including automatic enrolment with choice of provider, for people experiencing disadvantages (strong recommendation, moderate-certainty evidence). | No published guideline for primary care access | No published guideline for primary care access | |
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