Supporting Patients

Reduced cancer mortality
Randomized controlled trials have demonstrated that early detection through routine screening can reduce mortality from colorectal cancer (FOBT) by up to 25% and from breast cancer (mammograms) by 20-30%. Observational data have shown up to an 80% decrease in cervical cancer mortality following the introduction of organized Pap screening.

Decreased cancer incidence
Diagnostic follow-up of abnormal cervical and colorectal screening test results can prevent those cancers by detecting, treating, or removing pre-cancerous cells.

Enhanced treatment options
Screening can detect cancer at an earlier stage, which may result in simpler treatment, more treatment options, and/or less need for radiation and chemotherapy.

False positives
False positive screening tests can result in unnecessary and potentially invasive follow-up.

False negatives
False negative screening tests can result in missed cancers, dysplasia, and potential delays in diagnosis and treatment.

Over diagnosis
Detecting conditions that may not have become clinically significant in a patient's lifetime (over diagnosis) may result in unnecessary intervention and/or treatment.

False reassurance
While cancer screening is effective in reducing mortality, interval cancers do occur. Encourage patients to revisit their healthcare provider if they notice any symptoms, even if their most recent screening test result was negative.

Distress
Although typically less invasive than a diagnostic test, the screening test may cause anxiety and/or discomfort or pain (mammogram and Pap), bleeding (Pap), and radiation exposure (mammogram). A follow-up (diagnostic) test for a patient with a positive screening result may result in unintended complications such as:

• Some cervical treatments (cold knife conisation and large loop excision of the transformation zone) may increase a woman's risk for pre-term delivery, low birth weight, cesarean section, and premature rupturing of membranes. 
• Colonoscopy may result in bleeding and perforation of the colon, and very rarely, death.

• Most women age 50-74 should have a screening mammogram every 2 years.
• Routine clinical breast exams and breast self-exams are notrecommended. Encourage women to know how their breasts normally look and feel.
• The balance of benefits and harms differs by age. Refer to the Canadian Task Force on Preventive Health Care Recommendations and Public Health Agency of Canada Aid for Breast Cancer (English | French) (pdf) to support decision making.
• Women at higher risk for breast cancer should have individualized assessment as general screening recommendations do not apply. Higher risk is based on factors such as:
  • previous diagnosis of breast cancer,
  • significant family history, and/or
  • mutations in the BRCA1/BRCA2 genes.
• The sensitivity of mammography is about 80% and the specificity is about 95%.

Follow-Up Tests

• Diagnostic mammogram
• Ultrasound
• MRI
• Biopsy
• Surgical consultation

To read more about further testing, click here.

Test Access

• Clients are encouraged to call 1-855-95-CHECK (24325) to make a screening mammogram appointment. No referral is required.
• Clinicians can also refer eligibile clients age 50-74 who are unlikely to make their own appointment. Clinicians can complete this form (pdf) and fax to BreastCheck.
• There are 4 fixed screening mammography clinics in Winnipeg, Thompson, Brandon and Morden/Winkler. To view when the BreastCheck mobile will be in or nearby your community, click here.

• Most females age 21-69 who have ever had sexual contact should have a Pap test every 3 years.
• Sexual contact can include oral, genital and/or rectal skin-to-skin contact, or sex with sex toys.
• 90% of HPV infections will spontaneously regress within 2 years.
• High grade lesions and cervical cancer are very rare in young women <21 years of age.
• There is a long latent period between exposure to HPV infection and the development of precancerous lesions and invasive cervical cancer.
• Annual screening offers little benefit over screening performed at 2 to 3 years intervals and exposes women to unnecessary risks and anxieties.
• The sensitivity of the Pap test is about 51% and the specificity is about 98%.

Follow-Up Tests

• Colposcopy - Manitoba Colposcopists/Colposcopy Clinics (pdf)
• Biopsy
• Loop Electrosurgical Excision Procedure (LEEP)
• Cryosurgery
• Laser surgery

To read more about results and follow-up tests, click here.

• Most people age 50-74 should do a home screening test (FOBT) every 2 years unless they have:
  • done an FOBT in the past two years, or
  • had a colonoscopy in the past 5 years.
• Evidence shows that screening regularly with the FOBT will lead to a reduction in mortality from colorectal cancer (CRC).
• A colonoscopy is recommended for any individual with a positive FOBT. As bleeding from cancers or adenomas may be intermittent, any positive result must be investigated. Further FOB testing for an indivdiual with a positive result is unwarranted and does not rule out serious pathology, even it it is negative.
• For the Hemoccult II Sensa, the sensitivity ranges from 64% - 85% and the specificity ranges from 87% - 95%.
• Double contrast barium enema or CT colonography may be an alternative in individuals with a positive FOBT if colonoscopy is refused, or are medically unsuitable for a colonoscopy or have had an unsuccessful colonoscopy.

Follow-Up Testing

Dauphin Medical Clinic
622-3rd Street SW, Dauphin MB, R7N1R5
P: 204-638-6445
F: 204-638-5670

Dr. K. Pernarowski

Clandeboye Medical Clinic
210-B Clandeboye Avenue, Selkirk MB, R1A 0X1
P: 204-808-9898
F: 204-808-9899

Dr. S. Ziaei Saba

The Pas Health Complex
Box 240, 111 Cook Avenue, The Pas MB, R9A 1K4
P: 204-623-9609
F: 204-1534

Dr. Z. Al Moumen

Northern Consultation Clinic
871 Thompson Drive South, Thompson MB, R8N 0C8
P: 204-677-5314
F: 204-677-5339

Dr. L. Azzam
Dr. A. Mustafa

C.W. Wiebe Medical Centre
385 Main Street, Winkler MB, R6W1J2
P: 204-325-4312
F: 204-325-4594

Dr. S. Alhayjaa*
Dr. A. Dyson*

*NOTE: Drs. Alhayjaa and Dyson perform colposcopies at Boundary Trails Health Centre, but all referrals, pre-op visits and post-op follow-ups are completed at C.W. Wiebe Medical Centre