Cancer

Guidelines on Cervical Cancer Screening in Québec

Population targeted by the screening

All women who are sexually active or were in the past.

Sexual activities include all types of genital contact, with or without vaginal penetration, with male or female partners.

At what age should screening begin?

The recommended age to begin screening is 21.

However, screening can be delayed for women who have not yet had sexual activity at this age. Exceptionally and based on the clinical context, screening may begin earlier, for example, among immunodepressed young women.

How often should one have a screening test?

The recommended interval between screening tests is two to three years.

At what age should screening be stopped?

Among women who have had screening tests regularly, screening may cease at the age of 65 if the results of the last two tests conducted in the previous 10 years were neg…

Groupe de travail sur les lignes directrices pour le dépistage du cancer du col utérin au Québec

Presence of asbestos fibres in indoor and outdoor air in the city of Thetford Mines: estimation of lung cancer and mesothelioma risks

In the autumn of 2007, the Association des victimes de l'amiante du Québec (AVAQ – a Québec association for asbestos victims) and the Ministère du Développement durable, de l'Environnement et des Parcs du Québec (MDDEP – Québec ministry of sustainable development, the environment and parks) published studies on the asbestos concentrations measured in indoor and outdoor air in Thetford Mines. The findings motivated the public health authorities in Chaudière-Appalaches and Estrie to request the assistance of the Institut national de santé publique du Québec (INSPQ – Québec institute of public health) to conduct an assessment of the risk of lung cancer and mesothelioma of the pleura in this population.

Asbestos is divided into two families: amphiboles (crocidolite, amosite, tremolite, actinolite and anthophyllite) and serpentines (chrysotile). The three main diseases associated asbestos exposure are asbestosis, lung cancer and mesothelioma of the pleu…

Presence of asbestos fibres in indoor and outdoor air in the city of Thetford Mines: estimation of lung cancer and mesothelioma risks - Summary

In the autumn of 2007, the Association des victimes de l'amiante du Québec (AVAQ – a Québec association for asbestos victims) and the Ministère du Développement durable, de l'Environnement et des Parcs du Québec (MDDEP – Québec ministry of sustainable development, the environment and parks) published studies on the asbestos concentrations measured in indoor and outdoor air in Thetford Mines. The findings motivated the public health authorities in Chaudière-Appalaches and Estrie to request the assistance of the Institut national de santé publique du Québec (INSPQ – Québec institute of public health) to conduct an assessment of the risk of lung cancer and mesothelioma of the pleura in this population.

Asbestos is divided into two families: amphiboles (crocidolite, amosite, tremolite, actinolite and anthophyllite) and serpentines (chrysotile). The three main diseases associated asbestos exposure are asbestosis, lung cancer and mesothelioma of the pleu…

Asbestos: Current Knowledge on the Exposure and Diseases of Workers and the General Population in Québec from 2003 to 2009

This document reports on the Québec data acquired since 2003 on asbestos exposure and asbestos-related diseases, both among workers and in the general population. However, the aim is not to update the knowledge on asbestos as such. This report also summarizes the status of the Québec surveillance system for asbestos exposures and asbestos-related diseases, which will be introduced by the Institut national de santé publique du Québec (INSPQ), as a result of the adoption of the Policy concerning the increased and safe use of chrysotile asbestos in Québec.

The most recent data (2004) on environmental exposure to asbestos in outdoor air identified no asbestos fibres in Montréal and in the city of Québec. However, in Thetford Mines, the average airborne asbestos concentration was 0.0043 fibre/ml (f/ml) by transmission electron microscopy (TEM). This concentration was 215 times higher than that obtained in the air outside buildings involved in litigation regarding the re…

Cancer risk assessment for workers exposed to nitrosamines in a warehouse of finished rubber products in the Eastern Townships (Québec, Canada)

This risk assessment was undertaken at the request of Dr. Louise Soulière, director of public health and evaluation at the Agence de la santé et des services sociaux de l'Estrie.

The objective of this work is to assess whether workers in a warehouse of finished rubber products in the Eastern Townships are at risk of contracting cancer because of the presence of nitrosamines in the workplace ambient air and, in the case of a non-zero risk, to suggest a threshold limit not to be exceeded in order to make the risk negligible.

The methodology used involves estimating workers' exposure to nitrosamines in the warehouse; assessing the carcinogenic potential for humans of the main nitrosamine molecules found in that environment; estimating the dose-cancer excess relationship based on epidemiological studies published so far and estimating the cancer risk associated with such exposure. This will allow suggesting an occupational exposure limit aimed at preventing the type of c…

Cancer among Aboriginal people living on reserves and in Northern villages in Québec, 1984-2004 : incidence and mortality

To our knowledge no data on cancer incidence and mortality among the Aboriginal population of Québec has been published. The only known reference was in a study examining the creation of a cancer registry during a specific period of the 1970s and 1980s. The study found that cancer was virtually non-existent within this population. Indeed, between 1969 and 1989 only 180 cases were reported in Nunavik, though the numbers tended to increase each year during that period. Studies in Canada and the United States suggest that the profile of Aboriginal populations is different from the general population. This small population group shows a low cancer incidence and a low cancer mortality rate.

Notwithstanding these low rates, an increase in cancer (incidence and mortality) has been observed. The change in lifestyle of these populations may prompt the emergence of chronic pathologies, including cancer, which has previously been present mainly in non- Aboriginal populations. This chan…

Suitability and feasibility of a colorectal cancer screening program in Québec: Executive summary and conclusions of the report of the scientific committee established by the Institut national de santé publique du Québec

Randomized comparative trials have shown that screening can reduce the mortality from colorectal cancer. However, due to difficulties of implementation, as observed in various countries, the expected benefits might not be achieved. The Committee recommends that the following conditions be met prior to implementing a provincial program:

Accessibility to colonoscopic examinations should be governed by the implementation of clinical, quality and performance standards that will be applied to all clienteles in all services offering this examination in Québec.

Individuals with a high risk of colorectal cancer, primarily those identified by a family history of colorectal cancer, should be so informed, and they should have access to screening that corresponds to their specific risk.

A demonstration project to show the feasibility of a program targeting average-risk individuals should be carried out before implementing a program at the provincial level.

The ef…

Recommendations on optimizing cervical cancer screening in Québec

In 2007, the Comité sur l'immunisation du Québec (CIQ) recommended the establishment of a human papillomavirus (HPV) immunization program with the main objective of reducing the incidence of cervical cancer. In its recommendation paper, the CIQ pointed out the importance of measuring the impact of such a program and the necessary complementarity that should exist between the immunization program and cancer screening activities. However, it was not within the organization's mandate to issue specific recommendations regarding screening.

The present recommendation paper is an extension of the CIQ's recommendations. Its objectives are to clarify the relevance of cervical cancer screening now that vaccination is on its way, to document the current weaknesses in screening, and most of all, to identify the conditions, strategies and means to maximize the effectiveness and efficiency of cervical cancer screening in Québec.

The analysis of current screening weaknesses was bas…

Breast Cancer Mortality Reduction after Initiation of a Screening Program: Consistency of Effect Estimates Obtained Using Different Approaches

Effect on breast cancer mortality of a mammography screening program initiated in 1998 was assessed. Two effect estimates were obtained for each of three groups: participants, eligible women and all women of the target age group including those with prior breast cancer diagnosis. Methods: Four approaches were used: 1) observed and projected breast cancer mortality trends for 1998-2004 were compared, 2) breast cancer mortality in the first five years of the program (1998-2003) was compared to mortality for the five years prior to program initiation (1992-1997) restricting numerators of rates to breast cancer deaths occurring among incident cases, 3) observed number of breast cancer deaths among 523,830 program participants was compared to expected number based on breast cancer incidence and survival of non-participants, 4) nested case-control study (873 cases, 8730 controls) was done within the 1,054,620 women eligible for screening. Results: A…

Équipe d'évaluation du PQDCS

Evaluation of the performance of designated screening centers of the Programme québécois de dépistage du cancer du sein (PQDCS): description of the methods

The evaluation of the Programme québécois de dépistage du cancer du sein (PQDCS) is based primarily on the analysis of performance indicators as defined in the PQDCS guidelines. Methods were initially developed to measure performance indicators at the provincial level and then in individual regions. The goal of this report is to develop an approach for the measurement and comparison of performance indicators at the screening centre level.

The indicators selected to evaluate the performance of individual centres are: the detection rate, recall rate, and number of false positives per screen detected cancer. These indicators are estimated separately for initial and subsequent screens. The percentage of in situ cancers, the percentage of small invasive cancers, and the percentage of lymph nodenegative invasive cancers were also selected. To evaluate a centre's performance, these indicator measurements were compared to the measurements for Quebec as a whole, as well as w…

Équipe d'évaluation du PQDCS