A tool to avoid unnecessary check-ups

The systematic performance of an annual health check is not a recommended practice for people who are healthy, asymptomatic and with no recent change in their state of health, says Quebec’s Institut national d'excellence en santé et services sociaux (INESSS) in its checklists for screening cancers, chronic diseases and sexually transmitted and blood-borne infections (ITSS), published in July 2024 and revised on Sept. 11, 2024. The INESSS institute, which promotes clinical excellence and the efficient use of resources, says unnecessary health check-ups lead to “a sub-optimal use of medical resources and an unnecessary overload of the healthcare system, without improving the quality or length of life of individuals.”This revised checklist (downloadable in French below) will help frontline clinicians:to quickly identify situations where no screening test is required before a consultationconfirm situations or individuals for whom a screening test may be appropriatefacilitate the transmission of educational information on the various screening tests covered in the checklistTo quickly identify when the tool should be used, clinicians must first ensure that the person is of age, asymptomatic, free of chronic disease, with no personal history of cancer and not pregnant. They can then use an algorithm to determine which screening tests to order.For people aged 50 or over, there are a number of screenings to consider, such as type 2 diabetes, cervical cancer, dyslipidemia, colorectal cancer, breast cancer and osteoporosis.Read: Our Clinical Guidelines LibraryFor adults under 50, certain factors need to be taken into account:Type 2 diabetes: screen every one to five years in the presence of at least two risk factors, including age (45 or over), a family history of diabetes, a personal history of high blood sugar and a body mass index greater than or equal to 30kg/m2Cervical cancer: every two to three years (Pap test) or every five years (HPV test from age 25) in people aged 21 or over with a cervixDyslipidemia: every five years in people aged 40 or overColorectal cancer: every two years, or every five to 10 years depending on the level of risk, in the presence of a family history of colorectal cancer.The INESSS then summarizes the examinations required for a complete evaluation to confirm eligibility for screening. Here are the main points:Cardiovascular risk assessmentages 40 to 75every five years, based on a non-fasting lipid profile using the INESSS CVR calculatorpreventive options (physical activity, diet) can be presentedrecommend blood pressure monitoringType 2 diabetesComplete the FINDRISC questionnaire.If the score is greater than or equal to 15 points, screening is recommended using a glycated hemoglobin (HbA1c) blood test.If necessary, propose interventions to support the adoption of healthy lifestyle habits, in collaboration with the interprofessional team.Recommend blood pressure monitoring.Colorectal cancerAge 50 to 74; or 74 and under with a family history of colorectal cancer (CRC)Depending on risk level, screening via FOBT test every two years (or 10 years after a screening colonoscopy) or via colonoscopy every five yearsScreening excluded for people with a personal history of CRC or polyps or inflammatory bowel disease, or a personal or family history of a genetic syndrome that predisposes to CRCLung cancerIn a person aged 55 to 74: who smokes and has done so continuously or discontinuously for at least 20 years; or who has smoked in the past continuously or discontinuously for at least 20 years; or who has quit smoking less than 15 years ago.Low-dose axial CT screeningPresent smoking cessation as the first effective means of reducing the risk of developing cancerInform the patient about pharmacological aids and support servicesOsteoporosisWomen aged 65 and overMale aged 70 or overHistory of fragility fracture at age 40 or over; otherwise, complete FRAX questionnaireIf FRAX ≥ 20% OR history: further evaluation is recommended to assess suitability for treatmentIf FRAX ≥ 10% AND < 20%: bone densitometry is recommended to refine fracture risk assessment Cervical cancerAge 25 to 65 (if HPV test available)Age 21 to 65 (if HPV test not available)Depending on the test available, cervical cancer screening is carried out after an informed decision by the patient.Inform that vaccination against oncogenic HPV is available, sometimes free of charge, as part of the Québec Immunization Program.For this screening, the INESSS reminds us that the introduction of the HPV test to replace the Pap test as the first screening test for cervical cancer will take place gradually between 2023 and 2025.Breast cancerAge 50 to 74, asymptomatic, with no increased risk of breast cancerEligible under the breast cancer screening program and having received a letter of invitation.In the absence of a letter, the person must confirm eligibility with his or her regional service coordination center.Mammography screening after an informed decision by the patientProstate cancerSystematic screening not recommendedThe checklist also lists all contraindications to the application of INESSS medical protocols, as well as a non-exhaustive list of complementary resources. The screening aid is available here in French: Aide-mémoire: dépistage des cancers, maladies chroniques et ITSS

A tool to avoid unnecessary check-ups

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