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POSTPONED: Lung Cancer Screening and Smoking Reduction and Cessation in the Champlain Region

Please note that due to unforeseen circumstances, the Lung Cancer Screening and Smoking Reduction and Cessation conference planned at the Renfrew Groves Park Lodge GEM Hall on Thursday, February 22, 2018 is being postponed. Please stay tuned for a new date and time to be announced.

 

Champlain Regional Cancer Program Presents:  Lung Cancer Screening – An Interactive Learning Event

POSTPONED: Thursday, February 22, 2018 6:00 pm—8:00 pm

(Buffet Diner and Registration will start at 5:30 pm)

Groves Park Lodge GEM Hall 470 Raglan Street North Renfrew, On. K7V 1P5

Cost: $25.00

Register online Now!

www.cancerprimarycare.eventbrite.ca

For more information contact: cancerprimarycare@toh.ca

or  dial: 613-798-5555 x 15811

This program has been accredited by the College of Family Physicians of Canada and the Ontario Chapter for Mainpro+ credits.

Please share poster: Lung CME Poster2

Early Screening for Cardiovascular Abnormalities with Preparticipation Echocardiography: Feasibility study

 

Gleason, Kerkhof, Cilia, Lanya, Finnoff, Sugimoto, Corrado

Clin J Sport Medicine 2016; 0: 1-7

Sudden Cardiac Death (SCD) is estimated to occur between 1/40000 – 1/80000 of our young athletes. Although the incidence is uncommon, it remains a concern because the consequences are so tragic.  So how should we screen our young athletes? This article aims to address this.

The traditional H&P often leads to a significant number of false positives and false negatives. The ECG has been mandated by the European Society of Cardiology and the IOC. This has led to a reduction of SCD in Italy by 90% however this effect has not been duplicated in North America. This is likely due to the fact that the etiology of SCD in Europe is arrhythmogenic RV cardiomyopathy whereas in North America the most common cause is structure cardiomyopathy (eg. HOCM). This is not picked up by the standard ECG. There has been an attempt to increase the sensitivity of ECG findings by using the ‘Seattle criteria’, however, there still appears to be some deficits with this method.

The American Heart Association has encouraged the investigation of a feasible and clinically relevant method to meet the shortcomings of the traditional H&P and ECG.

The ESCAPE protocol (Early Screening for Cardiac Abnormality with Pre-participation Echocardiography) attempts to meet this need. Essentially a front-line physician (non-cardiologist) performs an Echo of the heart using a portable ECHO to look for structural abnormalities in their athletes. Three measurements are taken: septal to free wall ratio <1.3; a septal thickness of >15mm, and/or a hypertrophied LV.  It has been shown that there is no significant difference between a cardiologist and a non-cardiologist in gathering these measurements with accuracy.

This study chose to compare the time it takes to perform H&P vs ECG vs Echo as the primary outcome regarding feasibility. They found on average the H+P and ECG took approximately 4 min each and the ECHO averaged approximately 2min 17 sec which is statistically significant. The goal of the ECHO screen is to determine who needs a formal CV workup, not to diagnose HOCM. One of the limitations of this study was its small sample size of n=35. Some barriers to successful implementation of ECHO screening would be physician training, and accessibility to portable ECHOs. However, access to improved diagnostic modalities may improve in the future allowing our screens to be more cost effective, as well as more reliable and accurate.

In summary, the writers felt that the portable ECHO is feasible and accurate if used for CV screening in our athletes. Primary outcome of ‘physician time’ needed to screen is significantly less than that required of an H&P and/or ECG.  Secondary outcomes are also encouraging. This included a reduction of false positive and false negative rates of ECG’s and H&P’s that led to unnecessary testing and costs. They conclude that a directed physical exam, a rhythm strip, and a portable ECHO screen may be the answer to the question, “How do we as healthcare providers best screen athletes at risk for Sudden Cardiac Death?”

View original research (PDF): Early_screening_for_cardiovascular_abnormalities-99503

Article summarized and presented by:

Keith Morgan BSc, MD, CCFP

Sport and Exercise Medicine Fellow

University of Ottawa.

Advisor: Dr. Taryn Taylor, BKin, MSc, MD, CCFP (CAC SEM), Dip Sport & Exercise Medicine

Introducing an educational module on cancer screening of LGBTQ patients

Author: Alicia St.Hill Champlain Regional Cancer Program

Lesbian, Gay, Bisexual, Trans, Queer (LGBTQ) patients have lower screening rates.

You can do a great deal to improve screening rates by:

  • creating a welcoming and inclusive environment
  • learning about cancer screening information and considerations for your LGBTQ clients
  • learning NEW information about transgender screening

This module, created by the Canadian Cancer Society in collaboration with the Toronto Central Regional Cancer Program, is designed for you to explore LGBTQ screening issues and barriers, and to provide culturally and clinically competent cancer screening services to your patients.

This module is eligible for 0.5 (half hour) Mainpro-M2 credit.

To access the module, please click on the below.

http://www.rainbowhealthontario.ca/wp-content/uploads/2015/01/CME-LGBTQCancerScreening-English-final.pdf

PLEASE NOTE:

The presentation references Canadian Cancer Society screening guidelines. Ontario guidelines differ for the following slides:

  • Slide 27, the cervical screening age-eligible population is 21-69, not 70.

Slide 28, the Ontario Breast Screening Program age-eligible population is age 50-74.  At age 75, not 70, a conversation a doctor about future screening is recommended.

Image Source: Canadian Cancer Society www.cancer.ca

Image Source: Canadian Cancer Society http://www.cancer.ca

The Role of Quality Breast Imaging in Screening and Assessment

By Dr. Jean Seely, Regional Breast Imaging Lead, Champlain Regional Cancer Program

The Ontario Breast Screening Program (OBSP) is an organized provincial screening program funded by the Ministry of Health and Long Term Care (MOHLTC) and administered by Cancer Care Ontario (CCO) and the Regional Cancer Program. The mission of the OBSP is to reduce mortality from breast cancer by delivering high-quality breast screening to Ontario women 50 years and older.

The OBSP:

  • provides high-quality mammograms in sites accredited by the Canadian Association of Radiologists (CAR)
  • sends results of the screening mammogram within 2 weeks to patients and to their family physician or other primary care provider
  • provides assistance to arrange referrals or additional tests if needed
  • sends a reminder letter to patients when it is time to return for their next screening mammogram.

There are 13 OBSP screening sites and 7 OBSP assessment centres in the Champlain LHIN. Both the Arnprior and Queensway Carleton Hospitals are in the process of becoming OBSP assessment centres. This will further expedite care of patients with screen- detected abnormalities.

High-quality mammography

There is a commitment to high-quality mammography in the OBSP. A rigorous process is in place by which all OBSP sites must maintain quality assurance. The results of all screening studies are carefully monitored to ensure the highest quality and compliance with National Practice Guidelines.

All OBSP screening and assessment centres require accreditation by the Canadian Association of Radiology Mammography Accreditation Program (CAR MAP). A list of CAR MAP accredited sites in Champlain region can be found on the CAR website. http://www.car.ca/en/accreditation/accredited-centres.aspx

CAR MAP is a 20-year-old program that ensures that the quality of mammography images meet the highest guidelines. It is a voluntary program that offers radiologists the opportunity for peer review and evaluation of a facility’s staff qualifications, equipment performance, quality control and quality assurance programs, image quality, breast radiation dose, and processor quality control where applicable. Facilities successfully completing the CAR requirements are granted accreditation for a three-year period, with annual updates.

The OBSP requires that sufficient volumes of screening mammography must be done at each site (1500 mammograms annually). However, the OBSP may approve sites with lower volumes to provide increased access and outreach to more remote communities. In these cases, a specific agreement, including quality indicators, is required.

The MOHLTC has directed CCO and the College of Physicians and Surgeons of Ontario to form the Ontario Quality Management Partnership in order to develop and implement comprehensive quality management programs. Mammography, colonoscopy, and pathology in Ontario will be included in this program.

Results: OBSP High Risk Screening Program (as of November 2013):

  • 594 high risk patients have been screened with MRI
  • 7 cancers detected
  • 1 interval cancer found
  • 79.3%  BIRADS 1 & 2 (benign)
  • 3.9%  BIRADS 3 (probably benign)
  • 12.3  % BIRADS 4 & 5 (recommended for biopsy)

Digital mammography

All OBSP sites in the Champlain LHIN use digital mammography units. Digital mammography offers several advantages over film-screen mammography:

  • highest cancer detection rates in younger women and in women with dense breasts
  • overall lower radiation doses
  • easier transfer of images by CD or digital imaging repository (DIR)
  • faster access to diagnostic imaging tests.

A recent CCO study on computed radiography (CR) showed that CR has lower cancer detection rates and should not be recommended for screening.