Supporting Patients

As a healthcare provider, your recommendation impacts your patient's decision to participate in cancer screening. The CancerCare Manitoba Screening Program Screening Guidelines aim to ensure individuals receive thegreatest benefit from cancer screening while minimizing the potential harms. We encourage healthcare providers to facilitate this discussion with patients to:

  • foster the patient's understanding of the test, its benefits and potential hards, and
  • support patient participation in the clinical decision - one that is informed and consistent with the individual's preferences and values.

To support your patient discussions we publish education and health promotion resources. Click here to order resources online. Below is a list of information to assist you in facilitating an informed decision-making process for each screening test.

Benefits of Cancer Screening

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.

Potential Harms of Cancer Screening

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

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

For more information about follow-up testing, click here.

Access

Clients can request a home screening test through ColonCheck by:

Pap Test Clinic Registration

CervixCheck partners with health care providers to offer increased access to Pap test services across Manitoba. Clinics may offer service by appointment, walk-in or both and are encouraged to do so as frequently as their resources allow.

By registering your Pap clinic with CervixCheck your Pap test services will be listed on our website. Your participation helps increase Pap test access for Manitoban women.

Note:

  • Notify CervixCheck if any of your Pap test clinic or contact details change.
  • The site contact will be contacted 1x per year to confirm all Pap test clinic information.
  • An email confirmation will be sent once your registration is received and posted on the website.

Pap Test Access:

Site Contact (this information will not be posted on the website):

All fields marked with an asterisk (*) are mandatory.
 

Colposcopy Clinics

Colposcopy referrals are required in the following cases:

  1. Patient has a visually abnormal cervix.
  2. Patient has a persistent low grade result.
  3. Patient has persistent unsatisfactory results due to obscuring blood or inflammation.
  4. Patient has a high grade cytology result.

Colposcopy identifies sub-clinical abnormalities of the cervix using a binocular scope with a high density light. Identification of abnormalities are based on epithelial density (white epithelium) and vascular patterns (punctation,etc.).

Using these parameters, an area of abnormality can be identified in order to direct a tissue biopsy by one of the following methods:

  1. laser surgery (uses an intense, narrow beam of light to remove abnormal cells),
  2. LEEP (loop electro surgical excision procedure; an electrical wire loop is inserted into the vagina where abnormal tissue is removed), or
  3. cone biopsy (the removal of a cone-shaped piece of tissue).

If you have a patient in need of a referral to colposcopy, below is a list of colposcopists to whom you can refer.

Colopscopy Services in Manitoba (pdf)

Brandon Clinic
620 Dennis Street, Brandon MB, R7A 5E7
F: 204-571-7216

Dr. O. Akintola
P: 204-728-4440

Dr. B. Helms
P: 204-728-4440

Dr. G. Parr
P: 204-571-7135

Dr. M. Rutherford
P: 204-571-7135

Dr. J. Sutter
P: 204-728-4440

Wheat City Clinic
Unit C1-1711 Kirkcaldy Drive, Brandon MB, R7A 0B9
P: 204-727-1711 ext 400
F: 204-717-0485

Dr. Shunmugam

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

Health Sciences Centre
RS425-810 Sherbrook Street, Winnipeg MB, R3A 1R8
P: 204-787-4936
F: 204-787-2314

Dr. A. Altman
Dr. E. Dean
Dr. S. Kean
Dr. R. Lotocki
Dr. S. Popowich
Dr. C. Robinson

Dr. M. Sinha
120 Marion Street, Winnipeg MB, R2H0T1
P: 204-237-6482
F: 204-237-6478

Manitoba Clinic
790 Sherbrook Street, Winnipeg MB, R3A 1M3

Dr. M. Bernier
P: 204-788-5701
F: 204-784-4124

Dr. M.L. Boroditsky
P: 204-788-5707
F: 204-784-4127

Dr. Corbett
P: 204-788-5503
F: 204-784-4130

Dr. H. Diamond
P: 204-788-5745
F: 204-784-4132

Dr. V. Lee
P: 204-788-5716
F: 204-784-4153

Dr. A. Maksymowicz
P: 204-788-5733
F: 204-784-4117

Dr. P.D. Debnath
Medicare Clinic
1287 Jefferson Avenue, Winnipeg MB, R2P 1S7
P: 204-414-1139
F: 204-414-3679 

Winnipeg Clinic
425 St. Mary Avenue, Winnipeg MB, R3C 0N2
F: 204-282-9404

Dr. Z. Al Moumen
P: 204-957-3232

Dr. D. Dubyna
P: 204-957-3233

Dr. G. Lefas
P: 204-957-3323

Dr. I. Masoud
P: 204-957-3313

Dr. A. Awadalla
DC Obstetrics & Gynecology
47 Marion Street, Winnipeg MB, R2H 0S8
P: 204-925-3600
F: 204-925-3616

Dr. H. Benning
St. Boniface Clinic, 343 Tache Avenue, Winnipeg MB, R2H 2A5
P: 204-925-9546
F: 855-366-3208

Dr. Klippenstein
Millenium Medical Centre
311 Balmoral Street
Winnipeg, MB R3C 4A5
P: 204-505-2977
F: 204-505-2980