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Are you at Risk? Understanding Public Health Screening Guidelines in Ontario

If you live in Ontario, when do you get screened for cancer? What types of screens are routine? Which aren't?

Sometimes we can feel silly not knowing when to expect what with our healthcare. This simple post is designed to take the guess-work out of the current Public Health guidelines in Ontario for women.

Ontario public health screening guidelines
Ontario public health screening guidelines

Low risk individuals are ones who don't have any health conditions/diagnoses that need to be monitored, first degree relative with a genetic trait such as BRCA gene for breast cancer, history of smoking 20 years or more.

What are some factors that change when I should start screening?

Breast Cancer

If you are 30-69 years old you may be considered 'high risk' if you meet any of the below criteria:

  • Known carriers of a gene mutation that puts them at an increased risk for breast cancer

  • First degree relative of a carrier of a gene mutation who has declined genetic testing

  • Assessed as having a greater than 25 percent lifetime risk of breast cancer based on family history (assessment is done by a genetics clinic using IBIS or BOADICEA risk assessment tools)

  • Women who had chest radiation therapy (i.e. as a treatment for Hodgkin’s lymphoma) before the age of 30 and at least 8 years ago

So basically they're looking to see if you've had a lab test to prove you have a genetic predisposition to breast cancer, or if you're closely related to someone who does.

Should you have breast cancer genetic counselling?

Breast cancer (or the thought of getting any cancer truthfully) is scary. It feels like we should ALL have genetic testing so we can breath a sigh of relief! However, you truthfully don't qualify for this genetic screening in Ontario unless you meet one of the below items:

  • A first-degree relative who is a carrier of a breast cancer gene mutation

  • Two or more cases of breast cancer and/or ovarian cancer in first or second-degree relatives on the same side of the family

  • Personal history of breast cancer at 45 years of age or younger

  • Personal history of triple negative breast cancer < 60 years of age

  • Bilateral breast cancers

  • Both breast and ovarian cancer in the same woman

  • Serious ovarian cancer (invasive epithelial any grade, epithelial fallopian tube, peritoneal cancer)) at any age

  • Male breast cancer at any age

  • Breast and/or ovarian cancer in Ashkenazi Jewish families 

Can you get the genetic test anyway?

I know these guidelines feel cumbersome and sometimes you just want to test anyway. This is the only test I was able to find that is offered to patients in Ontario and could be initiated by you, however, you do need to have a healthcare provider sign off on the requisition.

Cervical Cancer

The isn't anything that would change how early you would start screening here. But, you can stop regular screening with Pap tests at the age of 70 if you have had 3 or more normal tests in the previous 10 years.

Colorectal Cancer

Similar with breast cancer, you qualify for earlier screening when you've had family or personal history with colorectal cancer:

  • a parent, sibling or child with colorectal cancer

  • a personal history of colorectal cancer

  • a personal history of non-cancerous (benign) polyps in the colon or rectum

  • inflammatory bowel disease (ulcerative colitis or Crohn’s disease)

  • inherited conditions, such as familial adenomatous polyposis (FAP) or Lynch syndrome (also called hereditary non-polyposis colorectal cancer, or HNPCC)

  • signs or symptoms of colorectal cancer

Osteoporosis Screening

You can be considered more at-risk for osteoporosis if one of the following applies to you:

Risk factors for early osteoporosis screening
2023 CMAJ Guidelines for earlier BMD assessment

One interesting thing to note is that if you want a bone mineral density test you are able to get one at whatever age you are. OHIP will cover you getting this 'baseline assessment', and then a second one 36 months later and every 5 years subsequently. If you are considered 'high risk' then you are able to get them more frequently.

Want to read more? Check out Cancer Care Ontario

Have you started Public Health Screenings?

  • No

  • Yes


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