Preventative Care
Cervical Cancer Screening
A Pap test is a quick and simple screening tool that detects atypical and abnormal cell changes in the cervix that may lead to cancer. Cells can become abnormal and they die and renew, or when a women has contracted human papillomavirus (HPV) infection.
It does not test for other cancers in the reproductive organs or for sexually transmitted infections (STI) , however chlamydia and gonorrhea screening can be performed at the same time as your pap test.
Screening Guidelines
The Ontario Cervical Screening Program recommends that women who have been sexually active or are currently sexually active recieve a pap test every 3 years between the ages of 25-70. Pap tests can stop at the age of 70 you have had 3 or more normal tests in the last 10 years.
You should still receive cervical screening even if you:
- Feel healthy and are asymptomatic
- Are not currently sexually active
- Have only had one sexual partner
- Are in a same-sex relationship
- Are post-menopausal
- Have received the HPV vaccine
- Have no family history of cervical cancer
If you have received a hysterectomy, you should consult your family physician for guidance on cervical screening. A vault scrape, a specimen from the vagina, may be a necessary measure for preventative health care in women who have received a hysterectomy.
How Do I Prepare for a Pap Test?
Try to make your appointment on a day you are not menstruating. Do not have sex or use tampons, vaginal creams or medicine for 48 hours before the test. If these measures cannot be taken, still attend your appointment.
After My Pap Test
The Ontario Cervical Screening Program will notify you by mail if your test result is normal, abnormal or unsatisfactory and inform you of next steps.
Your doctor will also contact you in the event that your results show abnormal changes to your cervical cells. An abnormal test does not equate to cervical cancer. It may just mean that you require a repeated Pap test in 6 months, a human papillomavirus (HPV) test or be referred for a colposcopy (examination of the vagina, cervix and vulva).
Causes of an Abnormal Result
HPV is a common cause of cervical cell changes. HPV is a family of viruses that most people contract through sexual contact at some point in their lifetime. It is typically an asymptomatic virus and goes away naturally within 1 - 2 years. However, in some cases, the virus survives in the body and slowly leads to cancer through causing abnormal cervical cell changes. The HPV vaccine can protect against HPV infection.
Know Your Risk
Cancer Care Ontario offers an online risk assessment tool to help you educate yourself about certain family and personal factors that may be increasing or decreasing your risk for cervical cancer. At the conclusion of the assessment you will recieve personalized tips on how to lower your risk and become proactive in regards to your health and cancer prevention.
Breast Cancer Screening
According to Cancer Care Ontario, breast cancer was expected to be the most common cancer diagnosedin Ontarian women in 2018. The goal of breast cancer screening is to detect cancer in its early stages when its most treatable and less likely to have spread to surrounding tissue.
Screening Guidelines
The Ontario Breast Screening Program has developed screening recommendations depending on your age and possession of certain risk factors.
Average risk: Women who are age 50-74 years old should receive a mammogram every 2 years.
High risk: The High Risk Ontario Breast Screening Program screens women ages 30 - 69 who possess a confirmed risk of developing breast cancer. The program mandates that eligible women recieve a mammogram and breast magnetic resonance imaging (MRI) or screening breast ultrasound annually. When these tests are applied together, mammography and MRI are more effective at accurately detecting cancers in women with a genetic predispositions to breast cancer. If abnormalities are found in the results, follow up breast assessments and additional tests are coordinated.
Eligible women are women who have recieve a referral from their family physician, possess a valid OHIP number and possess one of the following risks:
- A gene mutation that increases the risk of breast cancer. For example: BRCA1, BRCA2, TP53, PTEN, CDH1
- A first degree relative of an individual with possesses a risk-increasing gene mutation, have already had genetic counselling and have chosen not to have genetic testing
- An IBIS or BOADICEA tool assessment that places you at a 25% or greater genetic and personal susceptibility of developing breast cancer
- Have had radiation therapy to the chest in treatment of another cancer or condition before age 30 and at least 8 years prior
Know Your Risk
Cancer Care Ontario offers a five minute online risk assessment toolto help you educate yourself about certain family and personal factors that may be increasing or decreasing your risk for breast cancer. At the conclusion of the assessment you will recieve personalized tips on how to lower your risk and become proactive in regards to your health and cancer prevention.
How to Get Screened
- Women ages 50 -74 can call the nearest Ontario Breast Screening Program location to make an appointment. A doctor's referral is not needed.
- If you think you may be at high risk forbreast cancer, talk to your doctor about a referral to the High Risk Ontario Breast Screening Program.
- If you are over 74 years old, you will need a referral for a mammogram from your family physician or nurse practitioner to be covered under OHIP.
How Do I Prepare for my Mammogram?
Preparation: To prepare, try to schedule your mammogram during a time when your breasts are not usually tender. Typically this is the week before and after your period. It is best to wear a two piece outfit to allow easy exposure to your chest. Do not use deodorants, antiperspirants, body lotions or talcum powders as the metals in these products can appear on the X-ray image.
What Can I Expect?
A registered medical radiation technologist specializing in mammography will place your breast on a special x-ray machine and initiate a plastic plate to compress on your breast. You will feel some harmless pressure on your breast tissue as the plates secure your breast in place while two images of each breast are taken. The technologist will check the pictures to ensure the image quality is sufficient to be read by the radiologist. If deemed necessary, additional pictures are taken.
Colorectal Cancer Screening
According to Ontario Cancer Statistics 2018, colorectal cancer is the second most commonly diagnosed cancer in Ontario. However, when detected early, 9 out 10 people can be cured.
Screening Guidelines
Cancer Care Ontario outlines the following screening recommendations depending on your age and genetic predisposition.
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If you are age 50-74 with no first degree
family history of colorectal cancer, completion of a fecal immunochemcial test (FIT) every 2 years is recommened.
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If you are any age with a first degree family member diagnosed with colorectal cancer prior to age 60, completion of a colonoscopy every 5 years is recommended, starting at age 50 or 10 years earlier than when your family member was diagnosed
(whichever comes first). - If you are any age with a first degree family member diagnosed with colorectal cancer after age 60, completion of a colonoscopy every 10 years is recommended, starting at age 50.
Know Your Risk
Cancer Care Ontario offers a five minute online risk assessment tool to help you educate yourself about certain family and personal factors that may be increasing or decreasing your risk for colorectal cancer. At the conclusion of the assessment you will recieve personalized
tips on how to lower your risk and become proactive in regards to your health and cancer prevention.
Important Information about FIT
- It only takes a few minutes and requires only one sample collection
- You can eat and take medications as normal (including vitamin C and blood thinnners).
- If you are bleeding from diagnosed hemorrhoids, have underwent dental work that resulted in bleeding or are menstruating, do not complete your FIT test until you have stopped bleeding for at least 3 days. If you are bleeding more often than every 3 days, discuss with your provider if a FIT test is right for you.
- It is recommended that you remove any built-in toilet cleaners prior to completing your test.
- Try to complete your FIT test as soon as possible after receiving it and within 6 months of when it was ordered for you, as well as check the expiry date printed on the tube. If your FIT is expiring soon, ensure you sent your completed fit to the lab at least 2 weeks prior to the expiry date.
- Within 2 days of your sample collection, you can mail it to LifeLabs using the postage-paid envelope included in your FIT package or drop it off to a LifeLabs Patient Service Centre near you. It is important that the sample reaches the lab as soon as possible to prevent specimen inadequacy for testing.
- Cancer Care Ontario will mail you a letter with your test result and your doctor will be copied.
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If there are any issues with your FIT, such as loss or damage,
call LifeLabs at 1-833-676-1426.
FIT Instructions
Click here to access FIT instructions.
Abnormal Test Results
An abnormal test result does not necessarily indicate that you have colorectal cancer or precancerous polyps. A limitation of the test is it cannotdifferentiate between different sources of blood (i.e hemorrhoids or menstruation), therefore it is essential that you schedule a colonoscopy within 8 weeks. An abnormal FIT result could mean you have colorectal cancer, even if you are asymptomatic, have had normal FIT results previously or lack family history.
If your test is normal, you should still get screened every 2 years using FIT until the age of 74.
Colonoscopy
A colonoscopy is a test in which a specialist uses a long flexible scope with a camera at the end to examine the entirety of the colon. The physician will perform a biopsy if any abnormalities are detected, as well as remove precancerous polyps. These polyps will be sent to the lab for assessment and the results will be forwarded to both the colonoscopy specialist and your family physician.
What Can I Expect From the Colonoscopy Experience?
Preparing For Your Colonoscopy
In order to provide proper visualization of your colon lining, it is important that you follow the laxative regime prescribed to you the day before your colonoscopy. This bowel preparation will allow a clear view of the lining of your colon. You will also receive instructions on permissible food and medications. It is also important that you arrange for somebody to pick you up after your colonoscopy as you will be receiving sedation that will make it unsafe for you to drive or take public transit alone.
After Your Colonoscopy
Bloating can be expected for the hours after your procedure. Resuming your regular activities will aid you in passing gas. You can also resume your normal diet and medication. It is normal to see a small amount of blood in your first stool.
Depending on the type and size of polyps removed (if any), you may need to have 'post-polypectomy surveillance'. This entails scheduling follow-up colonoscopies to monitor the state of any growths in your colon.
What are the Possible Risks and Complications of a Colonoscopy?
An integral part of patient centered care is informed decision making. As with any procedure, there are possible risks. However the risks of the procedure are often greatly outweighed by the advantage of preventative care. A colonoscopy and repeated follow up colonoscopy is often recommended for individuals with a higher risk for colorectal cancer. Possible complications include:
- An adverse reaction to the sedative
- Bleeding caused by the removal of polyps
- Perforation of the colon requiring surgical repair (very rare)
Flexible Sigmoidoscopy
A flexible sigmoidoscopy is another screening method for colorectal cancer. It is similar to a colonoscopy in the sense that the specialist uses a flexible tube with a camera attached to examine the rectum and sigmoid colon (the lower part of the colon). They also remove polyps for lab testing. However, unlike a colonoscopy, you do not require sedation and there is n oneed to change your diet prior to the procedure.
Do I Qualify for a Flexible Sigmoidoscopy?
You qualify to receive a flexible sigmoidoscopy as your method of colorectal cancer screening if:
- You are age 50 to 74.
- You are at average risk of getting colorectal cancer meaning you do not have a first-degree relative diagnosed with the disease, you do not have a personal history of precancerous polyps and you do not have inflammatory bowel disease involving the colon.
- You do not have any symptoms that could be linked to colorectal cancer.
- You are due for a colorectal cancer screenging, meaning you have not completed the FIT in the past two years, or flexible sigmoidoscopy or colonoscopy in the past 10 years.
How Do I Receive a Flexible Sigmoidoscopy?
To receive a flexible sigmoioscopy, you and your doctor have to determine if this is the best test for you based on your clinical history. Your doctor will then fill out a requisition for you to receive an appointment with the specialist.
* Information and guidelines have been provided by Cancer Care Ontario
