Excellent summary of breast cancer recommendations

Your messaging in the January issue of Canadian Family Physician is great¹; we should have a shared decision-making discussion with our patients about mammogram screening. Dr Ed Kucharski, I see that you are Regional Primary Care Cancer Screening Lead at Ontario Health–Cancer Care Ontario. It has concerned me that the messaging from Cancer Care Ontario regarding breast cancer screening has been “get your mammogram” rather than “discuss with your primary care provider.” Dr Elizabeth Del Giudice, I note you are from Sunnybrook Hospital in Toronto, Ont, and there was just a full-page advertisement in The Globe and Mail from the Louise Temerty Breast Cancer Centre in Sunnybrook Hospital entitled, “Are you walking around with undetected cancer?”

I know how challenging it is to change the narrative here, but I would really like to see Cancer Care Ontario’s messaging changed at the very least. Any thoughts on this?

In addition, the “conditional recommendation” is not explained and we do not come across it that often in the Grading of Recommendations Assessment, Development and Evaluation system.

Finally, the recommendation to screen high-risk patients with colonoscopy is certainly what everyone is doing, but it is not what the Canadian Task Force on Preventive Health Care recommends²; they state, “We recommend not using colonoscopy as a screening test for colorectal cancer. (Weak recommendation; low-quality evidence).”

Thanks for this summary; it highlights the key issues!

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