10 mars 2025
Are we heading towards medical information under the influence?
We learn that Public Health Canada has suspended the work of an independent working group responsible for formulating recommendations on mammography screening. (CanTaskForce)
By Cancer Rose, March 7, 2025
Summary: Based on the best available scientific evidence, the Canadian Task Force on Health Care ( CTFPHC ) refused to lower the screening age from 50 to 40, stating that this would lead to more inconvenience for women, in particular significant over-diagnosis, i.e., the over-detection of lesions which are unnecessary for women to discover, but which are nonetheless heavily treated. The group was met with violent reactions from screening promoters.
The Canadian government abruptly suspended this work, seeking to intimidate members of the independent group GECSSP (also called CanTaskForce ), associated with the group Choosing Wisely, which works for better and wiser use of medical resources.
The role of CanTaskForce is to issue health recommendations for the good of the population and protect them from over-medicalization that could be harmful.
This blocking process by political decision-makers sends a very worrying message about evidence-based medicine. The opinions and convictions of patient groups funded by the pharmaceutical industry, waging an unbalanced media battle in favor of ever-earlier screening, disregarding all precautions, have the right to be quoted unreservedly and the right to muzzle any contradiction. Even worse, political decision-makers bow to them.
The context
It all started in 2023 when the American Preventive Care Task Force decided to lower the age at which screening should begin based on two arguments: an increase in breast cancers in younger women and an increase in the most aggressive cancers in black women. We have summarized this announcement and the reactions it provoked here: https://cancer-rose.fr/en/2023/05/16/lowering-the-age-for-starting-screening-but-at-what-cost/
Indeed, screening at younger and younger ages and increasing the number of mammographic examinations comes at a price, and women bear the heaviest price.
This measure could have more harmful effects than benefits, and above all, will not solve the problem of the most serious cancers, which in particular are missed by screening due to their aggressiveness and velocity.
Many adverse effects are to be expected for little or no benefit. Many scientists have warned.
Read here: https://cancer-rose.fr/en/2023/09/17/lowering-the-age-of-screening-a-pandoras-box/
Overdetection of lesions that are useless to find, overdiagnosis, has significant and definitive consequences on the health and life of a woman, and this phenomenon is increased in young women whose breasts are in constant variations due to the influence of hormonal cycles.
Moreover, this measure to lower the screening age is not based on new scientific evidence but on a modeling study and expert discussions, which would show that we have everything to gain by earlier screening. The problem is that modeling always works on paper. Still, reality sometimes brings us back down to earth …. Unfortunately, in medicine, too, once the rocket has been launched, we realize what we really caused decades later.
More cautious Canadian recommendations
A year later, Canada’s turn was to publish new recommendations with a known and transparent methodology, not based on discussions or models but on scientific bases, evidence, and literature reviews.
Read here: https://cancer-rose.fr/en/2024/05/30/the-canadian-guidelines-on-mammographic-screening-have-been-updated/
The GECSSP was created by the Public Health Agency of Canada (PHAC) specifically to develop guidelines in various areas for clinical practice.
This colossal work carried out by the Canadian Task Force on Preventive Health Care has resulted in temporary guidelines, available here, in the form of downloadable and very easy-to-understand decision-making tools for different age groups.
They are very well done, consisting of a visual pictogram and more detailed writing of information on the benefit/risk balance. For example here for the 50-59 age group, or the 60-69 age group. …
Regarding the much-debated age group of 40-50 years for breast cancer screening, the decision-making tool developed by the group is very cautious. It highlights the low benefit to be expected and emphasizes the need for women to make personal choices after being duly informed.
” For women aged 40 to 49 years,” the text says, ” based on current evidence (trials, observational studies, modeling and review of studies examining values and preferences), we suggest against systematic screening by mammography.
Given that individual values and preferences may differ, women aged 40 to 49 who wish to be screened after having been informed of the benefits and harms should be offered screening every two to three years. “
It is true that the scientific evidence does not support routine screening at this age and that a recent trial, the UK Age trial, supported this with its results published in 2020.
Reactions to these new Canadian recommendations have sometimes been very violent, arguing that they put women’s lives at risk.
Here are a few examples:
https://lactualite.com/actualites/un-groupe-dexperts-ne-suggere-toujours-pas-le-depistage-du-cancer-du-sein-a-40-ans/
https://www.ledevoir.com/opinion/idees/814148/appel-modernisation-depistage-cancer-sein-canada
https://theconversation.com/les-nouvelles-lignes-directrices-sur-le-cancer-du-sein-qui-deconseillent-le-depistage-chez-les-femmes-de-40-ans-sont-elles-mal-fondees-231758
The impact of opinion leaders and patient associations
Patient groups funded by the pharmaceutical industry have always been very active in discrediting the working group CanTaskForce, and they certainly rub their hands now that the federal Health Minister Mark Holland has called a halt to it.
The minister announced :
March 4, 2025 | Ottawa, ON | Public Health Agency of Canada
Today, the Honourable Mark Holland, Minister of Health, made the following statement:
I am announcing a temporary pause of the work of the Canadian Task Force on Preventative Health Care.
I would like to thank the members of the Task Force for their dedication to this important work. The Task Force has an important mandate and its work includes updates to guidelines in several areas, including breast cancer screening, cervical cancer screening, interventions for tobacco cessation and screening for depression in children and adults. The External Expert Review of the Canadian Task Force on Preventive Health Care, launched in October 2024, is studying the Task Force’s governance, mandate and processes. This review is advancing quickly and is expected to conclude at the end of March.
I recently met with the Chair of the External Expert Review panel and I was informed that the panel has concluded their evidence gathering and are now finalizing a robust set of recommendations to modernize and improve the Task Force.
I also continue to hear important feedback directly from Canadians and key leaders in the area who raise their concerns on the existing guidance and process of the Task Force.
Considering these concerns, I have asked the Public Health Agency of Canada to pause the Task Force’s work until the External Expert Review panel finalizes its work and its recommendations can be fully assessed.
The panel will make these recommendations to the Public Health Agency of Canada to modernize the work of the Task Force and ensure it provides evidence-based clinical practice guidelines to primary care providers.
This will ensure preventive health care guidelines meet the needs of Canada’s health care system and support the well-being of Canadians.
The Honourable Mark Holland, P.C., M.P.
Among the most outspoken opponents regarding CanTaskForce’s precautionary guidelines are Dr. Paula Gordon, a breast radiologist in Vancouver and professor at the University of British Columbia, and Dr. Jean Seely, Head of Breast Imaging at the Ottawa Hospital and full professor at the University of Ottawa’s Faculty of Medicine.
Both were very active at the time in the Canadian press and on Twitter, among others, denouncing what they called outdated recommendations and casting opprobrium on the working group. Once again, the CanTaskGroup conducted colossal research and synthesized the most exhaustive scientific data possible. The major clinical trial in the UK, published three years earlier, supported the view that there was no benefit for young women.
Below is a presentation we produced for a conference on the conflicts of interest of major players in mammography screening in Canada. We leave it to the reader to judge and appreciate the close links between opinion leaders and the imaging industry as far as these links are declared.
The Minister’s request to the Public Health Agency to temporarily suspend the work of the independent working group is highly unusual. No one seems to know what this means at the moment. Does it mean appointing other experts who are less rigorous on scientific data and respond more favorably to the demands of lobbies and patient groups? Does it mean rendering obsolete all the work on recommendations that has already been done? Only time will tell.
Response
So far, the independent working group has issued a statement,
Pause in work of Canadian Task Force on Preventive Health Care jeopardizes many clinical practice guidelines
March 4, 2025
The Canadian Task Force on Preventive Health Care (Task Force) has been instructed by federal Health Minister Minster Mark Holland to pause work on developing clinical practice guidelines for primary care clinicians in Canada.
This pause could jeopardize work on five guidelines nearing submission in 2025 for publication in a peer-reviewed journal. In addition to breast cancer screening, guideline topics in late-stage development include recommendations on tobacco cessation, screening for adult depression and depression in children and youth, and cervical cancer screening.
“We are concerned that this unexpected pause will jeopardize five important guidelines that provide guidance to primary care clinicians in Canada, from recommendations on quitting smoking to depression in adults and children and youth, cervical cancer screening, and of course breast cancer screening,” says Dr. Guylene Theriault, Chair of the Task Force. “These guidelines are the result of years of work by scientific experts in evidence review.”
This pause could negate years of work on the many guidelines in active development which are supported by scientific experts in evidence review and guideline development. In addition to the topics above, lung cancer screening, prostate cancer, falls prevention in older adults are other guidelines currently underway that will be paused.
The Public Health Agency of Canada (PHAC), which funds the Task Force, created an External Expert Review (EER) Panel “to study the governance, mandate, and scientific review processes of the Canadian Task Force on Preventive Health Care (Task Force).”
“The Task Force has been very much anticipating the insights and recommendations of the External Expert Review panel on how to improve guideline development to support clinicians and the health of Canadians,” says Dr. Theriault. “We welcome their recommendations which may take time to implement, but are surprised by this announcement from the Minister.”
Task Force members are volunteers supported by staff with expertise in a variety of areas, from evidence synthesis and guideline development to patient partnership and development of clinician and patient tools to support guidelines. The Task Force is an independent body with the role of providing conflict free evidence-based guidelines on prevention and screening for primary care providers in Canada.
To support the group, please sign the open letter circulating online: https://docs.google.com/forms/d/e/1FAIpQLSd8tSA1UIvXTlaVa89S1GZrXfKHkNPcOEmxdM5Nb5Sftn5Zuw/viewform
But another initiative is emerging, and the group is responding with a coalition of healthcare professionals through an open letter:
here: https://www.canad i ancoalitionforevidencebasedhealthcare.ca/
The text says: We are a collective of healthcare professionals , partners , and engaged citizens committed to shaping policies and healthcare practices grounded in the best available evidence . United by a shared vision, we advocate for decision-making free from commercial bias and vested interests, ensuring that patient care and public health remain rooted in integrity, science, and transparency.
And here: https://www.canadiancoalitionforevidencebasedhealthcare.ca/letter-in-support-of-the-ctfphc
The coalition is made up of 850 people who signed the letter in support of the Canadian Task Force on Preventive Health Care (CTFPHC) and who condemn the decision of Minister Mark Holland-
And here is the letter: https://docs.google.com/document/d/1DsvdROGL6qI3whlcDZVoKG_g_zvJnn-S7R36S-RWPu8/edit?tab=t.0
Dr. René Wittmer , family physician, president of Choisir avec soin Québec and of the working group on best practices at the Collège québécois des médecins de famille, Assistant clinical professor at the Université de Montréal and Dr. Geneviève Bois, family physician, president of the Collège québécois des médecins de famille, Assistant clinical professor at the Université de Montréal reacted in La Presse –
The first extremely shocking element is that the group is presented as a “controversial” group in a dispatch when, as stated above, the CTFPHC was created by the Public Health Agency of Canada (PHAC) specifically to develop guidelines in various areas for clinical practice. We also join in their concern and indignation:
“Suspending the work of the GECSSP is to disregard the expertise of family doctors in primary care, methodology, and screening. It also denies the importance of recommendations and tools adapted to the reality of primary care practice to the detriment of quality care for all. In this fragile context, the suspension of the GECSSP opens the door to increased care commercialization and a proliferation of direct-to-consumer marketing for tests and treatments that are of little value or even harmful in some cases. However, “doing more” does not necessarily mean “doing better.” GECSSP’s recommendations safeguard against practices driven by financial and political interests rather than science and public health.”
Also, read the position of Choisir avec Soin Québec –
To conclude
This decision by the Canadian Minister of Health against an independent group of experts working for independence and fair public information is not a sign of a willingness to serve scientific truth. The message sent is disastrous: if scientific truth does not align with economic interests and the will of pressure groups, then it is lying and must be twisted.
And how many women’s health will be sacrificed on the altar of self-perception, of intuitive but false convictions that screening will save lives? How many women will be over-diagnosed and heavily treated unnecessarily, having been persuaded to save their lives?
Read here: https://cancer-rose.fr/en/2023/09/08/screenings-dont-extend-lifespan/
We won’t be able to beat breast cancer as long as we’re convinced that the grail lies in detecting “smaller and smaller” instead of understanding how cancer threatens, how it can be controlled, and which women are at risk.
We’re witnessing what three decades of frantic screening have already clearly shown us: the failure of this screening, an exponentially rising incidence, an over-detection of non-threatening lesions that are useless to detect, and a decrease in the most serious forms that don’t match the over-detection of minor forms.
This is because screening cannot detect these deadly cancers early enough.
In a few decades, we’ll discover, stunned and disappointed, that results are not there, so we’ll lower the age to 38, as some specialists are already doing with their patients, without any information whatsoever.
Then why not 30? And decades later, after a new explosion of unnecessary surgical procedures, we’ll find ourselves once again facing the same facts of screening that doesn’t work because the genius of cancer is more complex.
The annoying thing about the truth of the facts is that even if you don’t look for it, it eventually finds you.
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