70 ans

GUIDE DE L’EXAMEN MÉDICAL
PÉRIODIQUE
Adolescent - Adulte
NOVEMBRE 2004
Mise à jour : novembre 2006
Préparé par
Dre Guylène Thériault
Dre Cléo Mavriplis
UMF Gatineau
Recommandations
Maladies métaboliques et nutritionnelles
Glycémie (dépistage du diabète)
Cholestérol
Tension artérielle
Ostéoporose
TSH
Hemochromatose
Cancers
Sein
Côlon (recherche de sang dans les selles)
Col utérin
Prostate
Testicules
Poumon
Vessie
Ovaires
Pancréas
Oral
Peau
Thyroide
Maladies infectieuses
Chlamydia
Gonorrhée
Rubéole
HIV
Syphilis
Tuberculose
Bactériurie
Hepatites
Herpes
Human papilloma virus
Habitudes de vie
Tabac
Alcool
Diète
Obésité
Activité physique
Troubles de la vision ou de l’audition
Vision
Glaucome
Surdité
Santé mentale
Drogues
Dépression
Démence
Santé de la femme
Contraception
Acide folique préconception
Chimioprophylaxie pour le
cancer du sein
Hormonothérapie
Prévention des accidents
MCAS Aspirine (prévention primaire)
Dépistage
Vitamine E
Maladies vasculaires
Anévrysme de l’aorte abdominale
Sténose carotidienne
MVAS
Annexe 1
Annexe 2
Annexe 3
Annexe 4
Annexe 5
Feuilles synthèse des recommandation par sexe et groupe d’âge
Suggestions de feuilles de prise de données pour l’examen périodique adulte
Feuilles sommaires
Critères pour les recommandations des différents groupes
SCORE, ORAI
Pour chaque thème il y a la recommandation du Groupe d’étude canadien sur les
soins de santé préventifs et/ou celle de son équivalent américain.
Les recommandations de groupes de travail ou d’associations qui semblaient
pertinentes ont aussi été retranscrites. Pour assurer la fiabilité de la
retranscription la langue d’origine a été conservée
L’immunisation n’a pas été abordé. Le PIQ étant selon moi une excellente
référence (souvent mise à jour et fiable)
Les problématiques liées à la grossesse ou aux problèmes dentaires ne sont pas
couvertes
Remerciements à
Dr Gilles Brousseau pour les feuilles sommaires
Dre Guylaine Proulx, Dre Marie-Claude Dupras, Dre Helène Bureau et Dre
Louise Guay pour leurs commentaires
Patricia Rhéaume, Irène Veilleux et Pierre Lebrun pour leur support technique
GLYCÉMIE (dépistage du diabète)
CANADA
1) CTFPHC
2005: There is fair evidence to recommend screening adults with hypertension or
hyperlipidemia for type 2 diabetes mellitus to prevent cardiovascular events and death
(Recommandation B) There is good evidence to recommend lifedtyle interventions for
overweight individuals (BMI>25 or >22 if on asian descent) with impaired glucose tolerance
to reduce the incidence of progression to diabetes (Recommandation B) There is fair
evidence to recommend acarbose treatment for overweight individuals (as above) with
impaired glucose tolerance to prevent cardiovascular events and hypertension
(Recommandation B) There is insufficient evidence to recommend metformin or acarbose
treatment for overweight individuals with impaired glucose tolerance to prevent diabetes
progression (Recommandation I)
1993 : Good evidence to include dipstick screening for protein in the PHE of adults with
IDDM. (Recommandation A)
2) Association canadienne du diabète 2003
Le dépistage du diabète au moyen de l’épreuve de glycémie à jeun doit être fait tous les 3 ans
chez les personnes de 40 ans et plus (Catégorie D, consensus). Des mesures de la glycémie à
jeun ou de la glycémie 2 heures après l’ingestion de 75 g de glucose doivent être effectuées
plus fréquemment et/ou plus tôt chez les personnes qui présentent des facteurs de risque
additionnels de diabète (Catégorie D, consensus ).
ETATS-UNIS
1) USPSTF 2003
The USPSTF concludes that the evidence is insufficient to recommend for or against routinely
screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired
fasting glucose. (Recommandation I)
The USPSTF recommends screening for type 2 diabetes in adults with hypertension or
hyperlipidemia. (Recommandation B)
2) American diabetes association 2006
Screening to detect pre-diabetes (IFG or IGT) and diabetes should be considered in
individuals ≥ 45 years of age, particularly in those with a BMI ≥25 kg/m2. Screening should
also be considered for people who are <45 years of age and are overweight if they have
another risk factor for diabetes (• are habitually physically inactive • have a first-degree relative with diabetes • are members
of a high-risk ethnic population (e.g., African American, Latino, Native American, Asian American, Pacific Islander) • have delivered a baby
weighing >9 lb or have been diagnosed with GDM • are hypertensive (140/90 mmHg) • have an HDL cholesterol level <35 mg/dl (0.90
mmol/l) and/or a triglyceride level >250 mg/dl (2.82 mmol/l) • have PCOS • on previous testing, had IGT or IFG • have other clinical
conditions associated with insulin resistance (e.g. PCOS or acanthosis nigricans) • have a history of vascular disease)
should be carried out at 3-year intervals.
Repeat testing
CHOLESTÉROL
CANADA
1) CTFPHC 1994
Screening should be considered in all men aged 30 to 59 years; individual clinical judgement should be exercised
in all other cases (Recommandation C) For men 30 to 59 years old with a mean total cholesterol level of more
than 6.85 mmol/L or an LDL-C level of more than 4.50 mmol/L treatment is efficacious in reducing incidence of
CHD. (Recommandation B) For all other asymptomatic individuals the value of treatment has not been
demonstrated. (Recommandation C) Révision en cours?
2) The working group on hypercholesterolemia and other dyslipidemias (Canada)
2003: Routinely screen men over 40 years of age and women who are postmenopausal or over 50 years of age.
In addition screen those with: diabetes mellitus, risk factors such as hypertension, smoking or abdominal obesity;
a strong family history of premature cardiovascular disease; manifestation of hyperlipidemia or evidence of
symptomatic or asymptomatic atherosclerosis 2000 : Although there are no evidence-based recommendations
regarding the optimal frequency for screening, it is reasonable to suggest that asymptomatic patients be screened
every 5 years after the age of 40 for men and 50 for women
3) Association canadienne du diabete 2006
In adults, fasting lipids levels should be measured at the time of diagnosis of diabetes and then every 1 to 3 years
as clinically indicated.
ETATS-UNIS
1) USPSTF 2001
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians routinely screen men
aged 35 years and older and women aged 45 years and older for lipid disorders and treat abnormal lipids in
people who are at increased risk of coronary heart disease. (Recommendation A)
AAFP has same recommandation (strongly recommands)
The USPSTF recommends that clinicians routinely screen younger adults (men aged 20 to 35 and women aged
20 to 45) for lipid disorders if they have other risk factors for coronary heart disease (Recommandation B)
(Diabetes., A family history of cardiovascular disease before age 50 years in male relatives or age 60 years in
female relatives, A family history suggestive of familial hyper-lipidemia. Multiple coronary heart disease risk
factors (e.g., tobacco use, hypertension).
The optimal interval for screening is uncertain. On the basis of other guidelines and expert opinion, reasonable
options include every 5 years, shorter intervals for people who have lipid levels close to those warranting
therapy, and longer intervals for low-risk people who have had low or repeatedly normal lipid levels
An age to stop screening is not established.
Screening may be appropriate in older people who have never been screened, but repeated screening is less
important in older people because lipid levels are less likely to increase after age 65 years
2) NCEPP III 2001
NCEPP: National cholesterol education program (USA)
In all adults aged 20 years or older, a fasting lipoprotein profile should be obtained once every five years.
(rien de nouveau sur dépistage dans update 2004)The American Heart Association has the same
recommandation
3) AACE 2002
American association of clinical endocrinologists
Screening for dyslipidemia is warranted for all adults up to 75 years of age regardless of CAD risk status and for
adults more than 75 years old who have multiple CAD risk factors (if they have good quality of life and no other
major life-limiting disease).
For adult more than 20 years of age with no CAD risk factors the screening should be done every 5 years. (more
often if CAD risk factors exist)
TENSION ARTÉRIELLE
CANADA
1) CTFPHC 1994
Measurement of blood pressure (BP) level. Although not evaluated for its effectiveness, casefinding should be considered in all persons aged 21 to 64 years; Fair evidence to include in
periodic health examination . (Recommandation B)
Hypertension in the elderly: Screening for this condition can be confidently recommanded in
those aged 65 to 84 years.(Recommandation B) Efficacy in treatment in treatment has not
been demonstrated in those above 80. While definitive evidence for treatment of hypertension
in those over 85 is lacking, it seems unlikely that judicious treatment will be detrimental
2) Canadian hypertension society 2006
Mesurer la pression artérielle de tous les adultes à toutes les visites appropriées
ETATS-UNIS
1) USPSTF 2003
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians
screen adults aged 18 and older for high blood pressure. (Recommandation A) Evidence is
lacking to recommend an optimal interval for screening adults for high blood pressure
Measurement of blood pressure during office visits is also recommanded for adolescents
(Recommandation B)
2) JNC VII
(Joint national committee on prevention, detection, evaluation and treatment of high blood pressure)
2003: Annual screening of adults starting at 18 years of age. If BP is < 130/85 then every 2
years. If BP is 130-139/ 85-89 check annually. If BP 140-149/ 90-99 confirm within 2
months.
OSTÉOPOROSE
CANADA
1) CTFPHC 2004
Screening all postmenopausal women with a history of previous fracture, or who are 65 years
or older, or have a ORAI score of 9 or a SCORE score of 6 with BMD by DEXA to prevent
fragility fractures. (Recommandation B).For women without documented osteoporosis, there
is fair evidence that calcium and vitamin D supplementation alone prevents osteoporotic
fractures (Recommandation B)
2) Osteoporosis society of Canada 2002
Screening of all postmenopausal women or all men over age 50 is not justified according to
available data. However, measuring bone density in men and women after the age of 65,
recognizing that after this age fracture risk increases, is justifiable (level 3).
Evidence for the use of bone measurement in men and in non-Caucasian women is meager.
Existing data do not contradict the inferences already made (consensus).
Targeted case-finding strategies for those at increased risk (at least one major or 2 minor risk
factors) are recommended, and BMD measurement with central DXA at age 65 is
recommended (Grade A).
Daily intake of calcium : Femme 19-50 ans 1000mg/jr (Grade A) Femme >50 ans 1500 mg/jr
(Grade A) Homme 19-50 ans 1000 mg/jr (Grade C) Homme >50 ans 1500 mg/jr (Grade C)
Daily intake of vitamin D : Femme 19-50 ans 400UI (Grade D) Femme >50 ans 800UI
(Grade A) Homme 19-50 ans 400UI (Grade D) Homme >50 ans 800UI (Grade A)
Eviter >4 tasses café/jr (Grade B)
ETATS-UNIS
1) USPSTF 2002
The U.S. Preventive Services Task Force (USPSTF) recommends that women aged 65 and
older be screened routinely for osteoporosis. The USPSTF recommends that routine screening
begin at age 60 for women at increased risk for osteoporotic fractures (Recommandation B)
(Lower body weight (weight < 70 kg ) is the single best predictor of low bone mineral density.There is less evidence to support the use of
other individual risk factors (for example, smoking, weight loss, family history, decreased physical activity, alcohol or caffeine use, or low
calcium and vitamin D intake) as a basis for identifying high-risk women younger than 65 . The best validated instruments include the 3-item
ORAI and the 6-item Simple Calculated Osteoporosis Risk Estimation tool (SCORE)) (voir annexe de la version papier ou SCORE
http://www.geocities.com/HotSprings/8741/score2.html et ORAI http://www.cmaj.ca/cgi/content/full/162/9/1289/T414 )
The USPSTF makes no recommendation for or against routine osteoporosis screening in
postmenopausal women who are younger than 60 or in women aged 60-64 who are not at
increased risk for osteoporotic fractures (Recommandation C)
No studies have evaluated the optimal intervals for repeated screening. Because of limitations
in the precision of testing, a minimum of 2 years may be needed to reliably measure a change
in bone mineral density; however, longer intervals may be adequate for repeated screening to
identify new cases of osteoporosis. Yield of repeated screening will be higher in older
women, those with lower BMD at baseline, and those with other risk factors for fracture
There are no data to determine the appropriate age to stop screening and few data on
osteoporosis treatment in women older than 85
2) National osteoporosis foundation 1999
Counsel all women on the risk of osteoporosis and related fractures. Advise all patients to consume adequate
amounts of calcium (at least 1220 mg/day, including supplements if necessary) and vitamin D (400 to 800 IU per
day for individuals at risk of deficiency). Recommand regular weight bearing and muscle strengthening exercice.
Avoid tobacco smoking and excessive alcool intake. Recommand BMD testing to all women 65 and older, to
younger postmenopausal women who have one or more risk factors (other than being white, postmenopausal and
female*), and to postmenopausal women who have suffered afragility fracture. ( *history of a fragility fracture in
a first degree relative, low body weight less than 127 pounds, current smoking, use of oral corticosteroid therapy
for more than 3 months)
TSH
CANADA
CTFPHC 1994
Poor evidence for either inclusion or exclusion of TSH screening (Recommandation C); due
to the high prevalence of thyroid disorders in peri-menopausal women, physicians should
maintain a high index of clinical suspicion.
ETATS-UNIS
USPSTF 2004
The USPSTF concludes the evidence is insufficient to recommend for or against routine
screening for thyroid disease in adults (Recommandation I)
HEMOCHROMATOSIS
ETATS-UNIS
USPSTF 2006
The U.S. Preventive Services Task Force (USPSTF) recommends against routine genetic
screening for hereditary hemochromatosis in the asymptomatic general population.
(Recommandation D)
CANCER DU SEIN
CANADA
1)CTFPHC
1998:There is good evidence for screening women aged 50-69 years by clinical examination and mammography
(Recommandation A). The best available data support screening every 1-2 years. 2001: Current evidence does
not support the recommendation that screening mammography be included in or excluded from the periodic
health examination of women aged 40-49 at average risk of breast cancer (Recommandation C) Upon reaching
the age of 40, Canadian women should be informed of the potential benefits and risks of screening
mammography and assisting in deciding at what age they wish to initiate it. Comparison of RCT results suggests
that, if done, frequent screening may be required (Mammography every 12-18 months) 2001: Because there is
fair evidence of no benefit, and good evidence of harm, there is fair evidence to recommend that routine teaching
of BSE be excluded from the periodic health examination of women aged 40–69 (Recommandation D)
2) Société canadienne du cancer
Si vous êtes âgée de 50 à 69 ans, passez une mammographie tous les 2 ans. Si vous avez entre 40 et 49 ans, discutez avec votre médecin de
votre risque personnel de cancer du sein ainsi que des avantages et inconvénients de la mammographie. Si vous avez 70 ans ou plus,
demandez à votre médecin ce qu’il vous conseille en matière de dépistage. Si vous avez plus de 40 ans, passez un examen clinique des seins,
effectué par un professionnel de la santé compétent, au moins une fois tous les 2 ans. Songez également à pratiquer l’auto-examen des seins
et signalez tout changement à votre médecin
ETATS-UNIS
1)USPSTF 2005
The USPSTF recommends that women whose family history is associated with an increased risk for deleterious
mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing
(Recommandation B) For non-Ashkenazi Jewish women, these patterns include 2 first-degree relatives with breast cancer, 1 of whom
received the diagnosis at age 50 years or younger; a combination of 3 or more first- or second-degree relatives with breast cancer regardless
of age at diagnosis; a combination of both breast and ovarian cancer among first- and second-degree relatives; a first-degree relative with
bilateral breast cancer; a combination of 2 or more first- or second-degree relatives with ovarian cancer regardless of age at diagnosis; a firstor second-degree relative with both breast and ovarian cancer at any age; and a history of breast cancer in a male relative. For women of
Ashkenazi Jewish heritage, an increased-risk family history includes any first-degree relative (or 2 second-degree relatives on the same side
of the family) with breast or ovarian cancer.
2)USPSTF 2002
U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without
clinical breast examination (CBE), every 1-2 years for women aged 40 and older. (Recommandation B) The
National Cancer Institute has basically the same recommandation on their Web site. Women who are at
increased risk for breast cancer (e.g., those with a family history of breast cancer in a mother or sister, a previous
breast biopsy revealing atypical hyperplasia, or first childbirth after age 30 are more likely to benefit from
regular mammography than women at lower risk. The recommendation for women to begin routine screening in
their 40s is strengthened by a family history of breast cancer having been diagnosed before menopause
The USPSTF did not find sufficient evidence to specify the optimal screening interval for women aged 40-49.
The USPSTF concluded that the evidence is also generalizable to women aged 70 and older if their life
expectancy is not compromised by comorbid disease.
The USPSTF concludes that the evidence is insufficient to recommend for or against teaching or performing
routine breast self-examination (BSE). (Recommandation I)
The
3) ACOG 2003
The following recommandations are based on limited and inconsistent scientific evidence (Level B) : Women
aged 40-49 years should have screening mammography every 1-2 years. Women aged 50 years and older should
have annual mammography. The following recommandations are based primarly on consensus and expert
opinion (level C) : Despite a lack of definitive data for or against breast self examination, breast self examination
has the potential to detect palpable breast cancer and can be recommanded. All women should have clinical
breast examination annually as part of the physical examination
4) ACPM 1996 (American college of preventive medicine)
There is inadequate evidence for or against mammography screening of women under age 50. Women between
ages 50 and 69 should have annual or biennial mammography. Women aged 70 or older should continue
undergoing mammography screening provided their health status permits breast cancer treatment .
5) American geriatrics society 2005
For women in average to better health, with a life expectancy of 5 or more years, it is appropriate to offer
screening mammography every one to two years to age 85. The recommandation should include an
individualized review of the potential benefits and harms of screening and patients personnal preferences.
Mammography screening beyond the age of 85 should be reserve for those women more likely to benefit by
virtue of execellent health and fonctionnal status, and for those who feel strongly that they will benefit from such
screening, either in peace of mind or improved quality of life. Clinical breat examination should be performed
periodically.
CANCER DU SEIN (suite)
COCHRANE 2006
Screening likely reduces breast cancer mortality. Based on all trials, the reduction is 20%, but as the effect is
lower in the highest quality trials, a more reasonable estimate is a 15% relative risk reduction. Based on the risk
level of women in these trials, the absolute risk reduction was 0.05%. Screening also leads to overdiagnosis and
overtreatment, with an estimated 30% increase, or an absolute risk increase of 0.5%. This means that for every
2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy
women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer
patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm.
Women invited to screening should be fully informed of both benefits and harms .
CANCER DU CÔLON (Recherche de sang occulte dans les selles)
CANADA
1) CTFPHC 2001
Good evidence to include screening with annual or biennial Hemoccult test in the periodic
health examination (PHE) of patients >50 (Recommandation A)
2) Canadian association of gastroenterologists 2004
Average risk: FOBT every two years. The AGA guidelines recommand screening yearly
using a guaiac-test with dietary restrictions or a immunochemical test for heme without
restrictions. The Canadian expert panel commissioned by Health Canada recommanded occult
blood testing every two years. Although yearly occult blood testing does increase the
detection of cancer, it was not felt that this justified the resulting considerable increase in
work load
Above average risk: 1) One first degree relative with cancer or adenomatous polyp at age
< 60 or two or more first degree relatives with polyp or colon cancer at any age: colonoscopy
every five years. Begin at age 40 or ten years earlier than the youngest diagnosis of polyp or
cancer in the family which ever comes first. 2) One first degree relative with cancer or
adenomatous polyp affected at age >60 or two or more second degree relatives with polyps or
cancer : average risk screening but begin at age forty
3) National committee on colorectal cancer sreening (Health Canada 2002)
Screening should be offered to adults 50-74 years old using FOBT. Individuals should be screened at least every
two years recognising that annual screening would have slight improvement in mortality reduction but require
increased resources
ETATS-UNIS
1) USPSTF 2002
The USPSTF strongly recommends that clinicians screen men and women 50 years of age or older for
colorectal cancer. (Recommandation A) The USPSTF found good evidence that periodic fecal occult
blood testing (FOBT) reduces mortality from colorectal cancer
2) American Gastroenterological Association 2003
Men and women at average risk should be offered screening beginning at age 50 years
Offer yearly screening with fecal occult blood test (FOBT) using a guaiac-based test with dietary restriction or
an immunochemical test without dietary restriction. Two samples from each of 3 consecutive stools should be
examined without rehydration. Patients with a positive test on any specimen should be followed up with
colonoscopy. People with a first-degree relative (parent, sibling, or child) with colon cancer or adenomatous
polyps diagnosed at age <60 years or 2 first degree relatives diagnosed with colorectal cancer at any age should
be advised to have screening colonoscopy starting at age 40 years or 10 years younger than the earliest diagnosis
in their family, which ever comes first, and repeated every 5 years People with a first degree relativewith colon
cancer or adenomatous polyp diagnosed at age ≥ 60 years or two second degree relatives with colorectal cancer
should be advised to be screened as average risk persons, but beginning at age 40 years. People with one second
degree relative or third degree relative with colorectal cancer should be advised to be screened as average risk
persons
COCHRANE 1998
Screening benefits include reduction in colorectal cancer mortality, possible reduction in cancer incidence
through detection and removal of colorectal adenomas and potentially, treatment of early colorectal cancers may
involve less invasive surgery.
Harmful effects of screening include the physical complications of colonoscopy, disruption to lifestyle, stress
and discomfort of testing and investigations, and the anxiety caused by falsely positive screening tests.
Although screening benefits are likely to outweigh harms for populations at increased risk of colorectal cancer,
we need more information about the harmful effects of screening, the community's responses to screening and
screening costs for different health care systems before widespread screening can be recommended.
CANCER DU COL UTÉRIN
CANADA
CTFPHC 1992
Pap: Fair evidence to include in periodic health examination of sexually active women. (Recommandation B)
Annual screening is recommended following initiation of sexual activity or age 18; after 2 normal smears, screen
every 3 years to age 69. Consider increasing frequency for women with risk factors: age of first sexual
intercourse < 18 yrs, many sexual partners or consort with many partners, smoking or low socioeconomic status .
ETATS-UNIS
1) USPSTF 2003
The USPSTF strongly recommends screening for cervical cancer in women who have been sexually active and
have a cervix. (Recommandation A) Indirect evidence suggests most of the benefit can be obtained by
beginning screening within 3 years of onset of sexual activity or age 21 (which ever comes first) and screening at
least every 3 years. The USPSTF found no direct evidence that annual screening achieves better outcomes than
screening every 3 years. The American Cancer Society guidelines suggest waiting until age 30 before
lengthening the screening interval
Although there is little value in screening women who have never been sexually active, many U.S. organizations
recommend routine screening by age 18 or 21 for all women, based on the generally high prevalence of sexual
activity by that age in the U.S. and concerns that clinicians may not always obtain accurate sexual histories
The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they have
had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer
(Recommandation D). The USPSTF recommends against routine Pap smear screening in women who have had
a total hysterectomy for benign disease. (Recommandation D) The USPSTF concludes that the evidence is
insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer.
(Recommandation I) Newer Food and Drug Administration (FDA)-approved technologies, such as the liquidbased cytology (e.g., ThinPrep®), may have improved sensitivity over conventional Pap smear screening, but at
a considerably higher cost and possibly with lower specificity
2) ACOG 2003
First Screen
Women Up
to Age 30
Women Age 30 and Older
About three years after first
Annual cervical Three screening options:
sexual intercourse or by age 21, cytology testing.
1. Women who have had three negative results on
which ever comes first.
annual Pap tests can be rescreened with cytology
alone every two to three years.
2.
Annual cervical cytology testing.
3. Cytology with the addition of an HPV-DNA test. If
both the cervical cytology and the DNA tests are
negative, rescreening should occur no sooner than
three years.
Women of any age who are immunocompromised, are infected with HIV, or were exposed in utero to DES, have
an history of CIN 2 ou 3 should be screened annually.
Women who have undergone removal of the cervix for benign indications and have no prior history of CIN 2 ou
3 or worse may discontinue routine cytology testing. A women with a history of CIN 2 ou 3 should be monitored
annually until at least 3 consecutive negative cytology results are documented
Evidence is inconclusive to establish an upper age limit for cervical cancer screening. If screening is
discontinued, risk factors should be assessed during the annual examination to determine if reinitiating screening
is appropriate
3)American geriatrics society 2000
Regular pap smear screening at 1 to 3 year intervals until at least the age of 70 seems reasonable. Beyond age 70,
there is little evidence for or against screening women who have been regularly screened in previous years. An
older woman of any age who has never had a pap smear may be screened with at least two negative pap smears 1
year apart.
CANCER DE LA PROSTATE
CANADA
1) CTFPHC 1994
Digital Rectal Examination (DRE) : Poor evidence to include or exclude DRE from the periodic health
examination (PHE) for men over 50 years of age (Recommandation C)
Prostate specific antigen (PSA) : Exclusion is recommended on the basis of low positive predictive value and the
known risk of adverse affects associated with therapies of unproven effectiveness. Fair evidence to exclude
routine screening with PSA from the periodic health examination of asymptomatic men over 50 years of age.
(Recommandation D)
2) Canadian urological association 1996
The digital rectal examination (DRE) and prostate specific antigen (PSA) measurements increase the early
detection of clinically significant prostate cancer.
Men should be made aware of the potential benefits and risks of early detection so that they can make an
informed decision as to whether to have this test performed.
3) College des medecins du Quebec
Il n’est pas recommandé d’utiliser systématiquement le dosage de l’APS et/ou le toucher rectal seuls ou
combinés comme méthode de dépistage du cancer de la prostate, quel que soit l’âge du patient (catégorie D) Le
patient qui manifeste un intérêt ou des craintes relativement au cancer de la prostate devrait rcevoir du
counselling pour lui permettre de faire un choix éclairé. De fait, une incertitude persiste quant aux avantages et
aux inconvénients de dépistage chez les individus appartenant à l’un des groupes suivants ▪ les hommes agés de
50à 69 ans et jouissant d’une espérance de vie supérieur à 10 ans ▪ les hommes agés de 40 ans et plus d’origine
afro-américaine ou les hommes de 40 ans et plus dont au moins un parent de premier degré a souffert d’un
cancer de la prostate et qui jouissent d’une espérance de vie supérieure à 10 ans. Cependant les données actuelles
ne permettent pas d’affirmer que le dépisatge est plus efficace dans de telles circonsatnces (catégorie C)
ETATS-UNIS
1) USPSTF 2002
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is
insufficient to recommend for or against routine screening for prostate cancer using prostate
specific antigen (PSA) testing or digital rectal examination (DRE) (Recommandation I)
AAFP has the same recommandation
*(The USPSTF found good evidence that PSA screening can detect early-stage prostate cancer but mixed and
inconclusive evidence that early detection improves health outcomes. Screening is associated with important
harms, including frequent false-positive results and unnecessary anxiety, biopsies, and potential complications of
treatment of some cancers that may never have affected a patient's health. The USPSTF concludes that evidence
is insufficient to determine whether the benefits outweigh the harms for a screened population.)
2) American urological association 2006
The American Urological Association endorses the American Cancer Society’s policy as follows:
"Both prostate specific antigen and digital rectal examination should be offered annually, beginning at age 50
years, to men who have at least a 10 year life expectancy, and to younger men who are at high risk. Information
should be provided to patients regarding potential risks and benefits of intervention.
Men who choose to undergo screening should begin at age 50 years. However, men in high risk groups such as
those with a strong family predisposition (e.g., two or more affected first degree relatives) or African Americans
may begin at a younger age (e.g., 45 years).
CANCER DE LA PROSTATE (suite)
Cochrane 2006
Given that only two randomised controlled trials were included, and the high risk of bias of both trials, there is
insufficient evidence to either support or refute the routine use of mass, selective or opportunistic screening
compared to no screening for reducing prostate cancer mortality. Currently, no robust evidence from randomised
controlled trials is available regarding the impact of screening on quality of life, harms of screening, or its
economic value. Results from two ongoing large scale multicentre randomised controlled trials that will be
available in the next several years are required to make evidence-based decisions regarding prostate cancer
screening.
CANCER DES TESTICULES
CANADA
CTFPHC 1994
Insufficient evidence to include or exclude routine examination of testes either by physician
or by patient self-examination from the periodic examination. (Recommandation C)
ETATS-UNIS
USPSTF 2004
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening
for testicular cancer in asymptomatic adolescent and adult males. (Recommandation D)
CANCER DU POUMON
CANADA
CTFPH 2003
The CTFPHC concludes that there still is fair evidence to recommend against screening with
chest X-ray asymptomatic people for lung cancer using chest radiographic examination
(Recommandation D).
The CTF concludes that there is insufficient evidence (in quantity and/or quality) to make a
recommendation as to whether spiral CT scanning should be used for screening asymptomatic
people for lung cancer; however other factors may influence decision-making
(Recommandation I ).
ETATS-UNIS
USPSTF 2004
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is
insufficient to recommend for or against screening asymptomatic persons for lung cancer with
either low dose computerized tomography (LDCT), chest x-ray (CXR), sputum cytology, or a
combination of these tests. (Recommandation I)
The USPSTF found fair evidence that screening with LDCT, CXR, or sputum cytology can
detect lung cancer at an earlier stage than lung cancer would be detected in an unscreened
population; however, the USPSTF found poor evidence that any screening strategy for lung
cancer decreases mortality. Because of the invasive nature of diagnostic testing and the
possibility of a high number of false-positive tests in certain populations, there is potential for
significant harms from screening. Therefore, the USPSTF could not determine the balance
between the benefits and harms of screening for lung cancer.
Cochrane 2003
The current evidence does not support screening for lung cancer with chest radiography or
sputum cytology. Frequent chest x-ray screening might be harmful. Further, methodologically
rigorous trials are required.
AUTRES CANCERS
Vessie
CTFPHC 1993
Urine dipstick or microscopy for hematuria : Fair evidence to exclude from Periodic Health
Examination (PHE) for general population (Recommandation D); poor evidence to include
or exclude from the PHE for persons at high risk.* (Recommandation C )
(* High-risk groups are Males > 60 years of age who smoke or have smoked, and were employed in a trade that
may have exposed them to aromatic amines. )
USPSTF 2004
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening
for bladder cancer in adults. (Recommandation D)
Ovaires
CTFPHC 1994
Fair evidence to exclude screening for ovarian cancer by any means (ultrasound, pelvic exam,
serum markers) for pre- and post-menopausal women. (Recommandation D)
For High-Risk Women with >1 First-degree Relative with Ovarian Cancer : Insufficient
evidence to recommend for or against screening. (Recommandation C)
USPSTF 2004
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening
for ovarian cancer.(Recommandation D)
Pancréas
CTFPHC 1994
There is fair evidence that routine screening should be excluded from the periodic health
examination. (Recommandation D)
USPSTF 2004
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening
for pancreatic cancer in asymptomatic adults using abdominal palpation, ultrasonography, or
serologic markers. (Recommandation D)
Oral
CTFPHC 1999
Insufficient insufficient evidence to recommend inclusion or exclusion of screening for oral
cancer by clinical examination of asymptomatic patients (Recommandation C) For high risk
patients, annual examination by physician or dentist should be considered. Major risk factors
include a history of tobacco use and excessive alcohol consumption
USPSTF 2004
the evidence is insufficient to recommend for or against routinely screening adults for oral
cancer. (Recommandation I)
AUTRES CANCERS (suite)
Peau
CTFPHC 1994
Total body skin examination : There is poor evidence to include or exclude from the periodic
health examination (PHE) of the general population (Recommandation C ); there is fair
evidence for the inclusion of total body skin examination for a very select sub-group of
individuals. (Recommandation B)
(For individuals at significantly increased risk (i.e. family melanoma syndrome (MM) first degree relative with
melanoma) it is prudent to undertake regular examinations (dermatologists may be more accurate assessors).)
Self-Exam : There is poor evidence to include or exclude in the periodic health examination.
(Recommandation C )
Avoidance of sun exposure and protective clothing : On the basis of epidemiologic data and
case-control studies, and prudence, there is fair evidence to include in the periodic health
examination. (Recommandation B )
Sunscreens (for prevention of squamous cell and basal cell carcinoma; and malignant
melanoma) : There is poor evidence for the inclusion or exclusion of advice on sunscreen use
in the PHE to prevent squamous cell carcinoma, basal cell carcinoma and malignant
melanoma. (Recommandation C)
USPSTF
2001 :The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is
insufficient to recommend for or against routine screening for skin cancer using a total-body
skin examination for the early detection of cutaneous melanoma, basal cell cancer, or
squamous cell skin cancer. (Recommandation I)
2003 :The U.S. Preventive Services Task Force concludes that the evidence is insufficient to
recommend for or against routine counseling by primary care clinicians to prevent skin
cancer. (Recommandation I)
AUTRES
The American Cancer Society recommends cancer check-up including skin examination
every 3 years for those aged 20-39 and annually after age 40. The American Academy of
Dermatology recommend annual screening for all patients.
Thyroide
USPSTF 1996
Routine screening for thyroid cancer using neck palpation or ultrasonography is not
recommended for asymptomatic children or adults.(Recommandation D)
There is insufficient evidence to recommend for or against screening persons with a history of
external head and neck irradiation in infancy or childhood, but recommendations for such
screening may be made on other grounds.(Recommandation C)
MALADIES INFECTIEUSES
Chlamydia
CANADA
1) CTFPHC 1996
Fair evidence to support annual screening of high-risk groups (Recommandation B)
(*High-risk groups are sexually active women less than 25 years of age, women with new sexual partners,
women or men with multiple sexual partners during the previous year, women who use nonbarrier contraceptive
methods and women who have symptoms of chlamydial infection (cervical friability, mucopurulent cervical
discharge or intermenstrual bleeding).)
Fair evidence to exclude routine screening of the general population (Recommandation D)
2) Santé Canada 1998 : Lignes directrices canadiennes pour les MTS
Personne à risque : hommes et femmes actifs sexuellement <25 ans
A risque élevé : contact avec un cas connu de MTS, jeune de la rue et/ou usage de drogues, relations sexuelles
non-protégées, nouveau ou >2 partenaires dans les 6 derniers mois, hommes qui ont des relations sexuelles avec
des hommes, diagnostic antérieur de MTS
3) Guide québecois de dépisatge des ITSS 2006
Depistage pour la ▪personne de 25 ans et moins ayant eu un nouveau partenaire sexuel, sans autre facteur de
risque ▪personne de 25 ans et moins ayant eu deux partenaires sexuels durant la dernière année ▪personne de 25
ans ou moins ayant contracté une ITSS au cours de l’année précédente ▪ femme demandant une interuuption de
grosesse ▪personne ayant eu plus de deux partenaires sexuels au cours des deux derniers mois ou plus de cinq
partenaires au cours de la dernière année ▪jeune de la rue ▪utilisateur de drogue, par injection ou non ▪homme
ayant des relations sexuelles avec d’autres hommes ▪personne ayant eu une relation sexuelle avec un nouveau
partenaire revenant d’un séjour dans une région où les ITS ou le VIH sont endémiques ▪personne ayant eu une
relation sexuelle avec un partenaire originaire d’un pays où les ITS ou le VIH sont endémiques ▪travailleur(se)
du sexe ▪personne demandant un dépisatge, même en l’absence de facteur de risque avoué après un counselling
pré-test ▪femme enceinte Dépistage à envisager : ▪nouveau-né dont l’un des parents a une ITSS ou est à risque
(*voir tableau en annexe ou http://www.masexualite.ca/professionnels/its-4.aspx )
ETATS-UNIS
1) USPSTF 2001
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians routinely screen all
sexually active women aged 25 years and younger, and other asymptomatic women at increased risk for
infection, for chlamydial infection (Recommandation A)
The USPSTF makes no recommendation for or against routinely screening asymptomatic low-risk women in the
general population for chlamydial infection. (Recommandation C)
The USPSTF concludes that the evidence is insufficient to recommend for or against routinely screening
asymptomatic men for chlamydial infection. (Recommandation I)
2) ACPM 2003
Assessment of risk factors for infection with Chlamydia trachomatis should be performed during every routine
healthcare contact of sexually active women. Sexually active women with risk factors should be screened
annually. Risk factors include age < 25 years, a new male sex partner or two or more partners during the
preceding year, inconsistent use of barrier contraception, history of a prior STD, African-american race and
cervival ectopy. All partners of women with positive test should be tested for chlamydia.
MALADIES INFECTIEUSES (suite)
Gonorrhée
CANADA
1) CTFPHC 1994
Gonorrhee : Fair evidence to provide counselling to prevent spread of gonorrhea. (Recommandation B)
good evidence to screen those at high-risk.* (Recommandation A) *High-risk groups include: individuals under
age 30 years with at least 2 sexual partners in the previous year or age  16 years at first intercourse, prostitutes,
sexual contacts of individuals known to have a sexually transmitted disease
2) Santé Canada 1998 : Lignes directrices canadiennes pour les MTS
Personne à risque : hommes et femmes actifs sexuellement <25 ans
A risque élevé : contact avec un cas connu de MTS, jeune de la rue et/ou usage de drogues, relations sexuelles
non-protégées, nouveau ou >2 partenaires dans les 6 derniers mois, hommes qui ont des relations sexuelles avec
des hommes, diagnostic antérieur de MTS
3) Guide québecois de dépisatge des ITSS 2006
Dépistage pour ▪personne ayant eu plus de deux partenaires sexuels au cours des deux derniers mois ou plus de
cinq partenaires au cours de la dernière année ▪jeune de la rue ▪utilisateur de drogue, par injection ou non
▪homme ayant des relations sexuelles avec d’autres hommes ▪personne ayant eu une relation sexuelle avec un
nouveau partenaire revenant d’un séjour dans une région où les ITS ou le VIH sont endémiques ▪personne ayant
eu une relation sexuelle avec un partenaire originaire d’un pays où les ITS ou le VIH sont endémiques
▪travailleur(se) du sexe ▪personne demandant un dépisatge, même en l’absence de facteur de risque avoué après
un counselling pré-test ▪femme enceinte. Dépistage à envisager : ▪personne de 25 ans et moins ayant eu deux
partenaires sexuels durant la dernière année ▪personne de 25 ans ou moins ayant contracté une ITSS au cours de
l’année précédente ▪ femme demandant une interuuption de grosesse ▪nouveau-né dont l’un des parents a une
ITSS ou est à risque (*voir tableau en annexe ou http://www.masexualite.ca/professionnels/its-4.aspx )
ETATS-UNIS
USPSTF 1996
Routine screening for Neisseria gonorrhoeae is recommended for: Asymptomatic women at high risk of
infection. (Recommandation B) High-risk groups include commercial sex workers, persons with a history of
repeated episodes of gonorrhea and young women(under age 25) with two or more sex partners in the last
year.(actual risk depends on local epidemiology)
Syphilis
CANADA
1) Santé Canada 1998 : Lignes directrices canadiennes pour les MTS
Risque élevé : ulcérations génitales ou MTS antérieures, contact avec des travailleurs du sexe, nouveau
partenaire au cours des 6 mois précédents, relations sexuelles avec une personne originaire d’un pays ou vivant
dans un pays ou la syphilis esy endémiques, contact avec un cas d’ulcération génitale
2) Guide québecois de dépisatge des ITSS 2006
Dépistage pour ▪personne ayant eu plus de deux partenaires sexuels au cours des deux derniers mois ou plus de
cinq partenaires au cours de la dernière année ▪jeune de la rue ▪utilisateur de drogue, par injection ou non
▪homme ayant des relations sexuelles avec d’autres hommes ▪personne ayant eu une relation sexuelle avec un
nouveau partenaire revenant d’un séjour dans une région où les ITS ou le VIH sont endémiques ▪personne ayant
eu une relation sexuelle avec un partenaire originaire d’un pays où les ITS ou le VIH sont endémiques
▪travailleur(se) du sexe ▪personne demandant un dépisatge, même en l’absence de facteur de risque avoué après
un counselling pré-test ▪femme enceinte. Dépistage à envisager : ▪personne de 25 ans et moins ayant eu deux
partenaires sexuels durant la dernière année ▪personne de 25 ans ou moins ayant contracté une ITSS au cours de
l’année précédente ▪ femme demandant une interuuption de grosesse ▪nouveau-né dont l’un des parents a une
ITSS ou est à risque (*voir tableau en annexe ou http://www.masexualite.ca/professionnels/its-4.aspx)
ETATS-UNIS
USPSTF 2004
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians screen persons at
increased risk for syphilis infection. (Recommendation A)
Populations at increased risk for syphilis infection (as determined by incident rates) include men who have sex
with men and engage in high-risk sexual behavior, commercial sex workers, persons who exchange sex for
drugs, and those in adult correctional facilities. There is no evidence to support an optimal screening frequency
in this population. Persons diagnosed with other sexually transmitted diseases (STDs) (i.e., chlamydia,
gonorrhea, genital herpes simplex, human papilloma virus, and HIV) may be more likely than others to engage
in high-risk behavior, placing them at increased risk for syphilis; however, there is no evidence that supports the
routine screening of individuals diagnosed with other STDs for syphilis infection. Clinicians should use clinical
judgment to individualize screening for syphilis infection based on local prevalence and other risk factors
MALADIES INFECTIEUSES (suite)
HIV
CANADA
1) CTFPHC 1991
Voluntary HIV testing : Good evidence to include offer of screening in PHE of asymptomatic people at high
risk. (Recommandation A)
2) Santé Canada 1998 : Lignes directrices canadiennes pour les MTS
Toutes les femmes enceintes devraient se voir offrir le test de dépistage du VIH et le counselling Risque élevé :
Les bébés nés de mères infectées par le VIH, Les jeunes et les adultes qui ont ▪ des relations sexueles nonprotégées ▪ des relations sexuelles avec une personne qu’on sait infectée par le VIH ▪ des multiples partenaires
sexuels ▪ des relations sexuelles anales ▪ partage des seringues ▪ déjà eu une hépatite ou une autre MTS , Les
jeunes de la rue, Des personnes originaires de oays ou le VIH est endémique
3) Guide québecois de dépisatge des ITSS 2006
Dépistage pour ▪personne ayant eu plus de deux partenaires sexuels au cours des deux derniers mois ou plus de
cinq partenaires au cours de la dernière année ▪jeune de la rue ▪utilisateur de drogue, par injection ou non
▪homme ayant des relations sexuelles avec d’autres hommes ▪personne ayant eu une relation sexuelle avec un
nouveau partenaire revenant d’un séjour dans une région où les ITS ou le VIH sont endémiques ▪personne ayant
eu une relation sexuelle avec un partenaire originaire d’un pays où les ITS ou le VIH sont endémiques
▪travailleur(se) du sexe ▪personne demandant un dépisatge, même en l’absence de facteur de risque avoué après
un counselling pré-test ▪femme enceinte ▪possibilité d’exposition sanguine accidentelle (tatouage ou percage
dans des conditions non-steriles, exposition en milieu de travail) ▪transfusion de sang ou de produits sanguins,
greffe de tissus ou d’organe Dépistage à envisager : ▪personne de 25 ans et moins ayant eu deux partenaires
sexuels durant la dernière année ▪personne de 25 ans ou moins ayant contracté une ITSS au cours de l’année
précédente ▪ femme demandant une interuuption de grosesse ▪nouveau-né dont l’un des parents a une ITSS ou
est à risque (*voir tableau en annexe ou http://www.masexualite.ca/professionnels/its-4.aspx)
ETATS-UNIS
USPSTF 2005
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians screen for human
immunodeficiency virus all adolescents and adults at increased risk for HIV infection (Recommandation A)
The USPSTF makes no recommendation for or against routinely screening for HIV adolescents and adults who
are not at increased risk for HIV infection (Recommandation C) The USPSTF recommends that clinicians
screen all pregnant women for HIV (Recommandation A)
Risk factors : men who have had sex with men after 1975; men and women having unprotected sex with multiple partners; past or present
injection drug users; men and women who exchange sex for money or drugs or have sex partners who do; individuals whose past or present
sex partners were HIV-infected, bisexual, or injection drug users; persons being treated for sexually transmitted diseases (STDs); and persons
with a history of blood transfusion between 1978 and 1985,persons who request an HIV test despite reporting no individual risk factors,
persons who report no individual risk factors but are seen in high-risk or high-prevalence clinical settings. High-risk settings include STD
clinics, correctional facilities, homeless shelters, tuberculosis clinics, clinics serving men who have sex with men, and adolescent health
clinics
MALADIES INFECTIEUSES (suite)
Hépatites
CANADA
HEPATITE B
1) Santé Canada 1998 : Lignes directrices canadiennes pour les MTS
Personne à risque : hommes et femmes actifs sexuellement <25 ans
A risque élevé : contact avec un cas connu de MTS, jeune de la rue et/ou usage de drogues, relations sexuelles
non-protégées, nouveau ou >2 partenaires dans les 6 derniers mois, hommes qui ont des relations sexuelles avec
des hommes, diagnostic antérieur de MTS
2) Guide québecois de dépistage des ITSS 2006
Dépistage pour ▪personne ayant eu plus de deux partenaires sexuels au cours des deux derniers mois ou plus de
cinq partenaires au cours de la dernière année ▪jeune de la rue ▪utilisateur de drogue, par injection ou non
▪homme ayant des relations sexuelles avec d’autres hommes ▪personne ayant eu une relation sexuelle avec un
nouveau partenaire revenant d’un séjour dans une région où les ITS ou le VIH sont endémiques ▪personne ayant
eu une relation sexuelle avec un partenaire originaire d’un pays où les ITS ou le VIH sont endémiques
▪travailleur(se) du sexe ▪personne demandant un dépistage, même en l’absence de facteur de risque avoué après
un counselling pré-test ▪femme enceinte ▪possibilité d’exposition sanguine accidentelle (tatouage ou percage
dans des conditions non-steriles, exposition en milieu de travail) ▪transfusion de sang ou de produits sanguins,
greffe de tissus ou d’organe Dépistage à envisager : ▪personne de 25 ans et moins ayant eu deux partenaires
sexuels durant la dernière année ▪personne de 25 ans ou moins ayant contracté une ITSS au cours de l’année
précédente ▪ femme demandant une interuuption de grosesse ▪nouveau-né dont l’un des parents a une ITSS ou
est à risque (*voir tableau en annexe ou http://www.masexualite.ca/professionnels/its-4.aspx)
HEPATITE C
1) Santé Canada 1998 : Lignes directrices canadiennes pour les MTS
Personne à risque : hommes et femmes actifs sexuellement <25 ans
A risque élevé : contact avec un cas connu de MTS, jeune de la rue et/ou usage de drogues, relations sexuelles
non-protégées, nouveau ou >2 partenaires dans les 6 derniers mois, hommes qui ont des relations sexuelles avec
des hommes, diagnostic antérieur de MTS (En particulier les UDI)
2) Guide québecois de dépistage des ITSS 2006
Dépistage pour : ▪utilisateur de drogue, par injection ou non ▪possibilité d’exposition sanguine accidentelle
(tatouage ou percage dans des conditions non-steriles, exposition en milieu de travail) ▪transfusion de sang ou de
produits sanguins, greffe de tissus ou d’organe ▪personne demandant un dépisatge, même en l’absence de
facteur de risque avoué après un counselling pré-test Dépistage à envisager : pour ▪personne ayant eu plus de
deux partenaires sexuels au cours des deux derniers mois ou plus de cinq partenaires au cours de la dernière
année ▪personne de 25 ans ou moins ayant contracté une ITSS au cours de l’année précédente ▪homme ayant
des relations sexuelles avec d’autres hommes ▪femme enceinte ▪nouveau-né dont l’un des parents a une ITSS
ou est à risque (*voir tableau en annexe ou http://www.masexualite.ca/professionnels/its-4.aspx)
ETATS-UNIS
USPSTF 2004
Recommends against routinely screening the general asymptomatic population for chronic
hepatitis B virus infection (Recommandation D)
Recommends against routine screening for hepatitis C virus (HCV) infection in asymptomatic
adults who are not at increased risk (general population) for infection. (Recommandation D)
Insufficient evidence to recommend for or against routine screening for HCV infection in
adults at high risk for infection (Recommandation I)
Herpes
USPSTF 2005
Recommends against routine serological screening for HSV in asymptomatic adolescents and
adults (Recommandation D)
MALADIES INFECTIEUSES (suite)
Human papilloma virus infection
CTFPHC 1995
HPV screening (beyond Papanicolaou testing for cervical cancer) : Fair evidence to exclude
from periodic health examination. (Recommandation D)
Rubéole
CTFPHC 1994
Screening for immunization status (serology or proof of vaccination) and immunization of women at risk. Fair
evidence to include in the periodic health examination of women of child-bearing age. (Recommandation B)
USPSTF 1996
Routine screening for rubella susceptibility by history of vaccination or by serology is recommended for all
women of childbearing age at their first clinical encounter.(Recommandation B) Susceptible nonpregnant
women should be offered rubella vaccination; susceptible pregnant women should be vaccinated immediately
after delivery. (Recommandation B)
Tuberculose
CTFPHC 1994
Tuberculose : Good evidence to support screening individuals at high-risk* (Recommandation A) Good
evidence to recommend INH prophylaxis to household contacts and skin test converters and persons with
underlying medical conditions like HIV that increase the risk of reactivation of infection (Recommandation A);
*High-risk groups include immigrants from endemic areas (Africa, Asia, Central America and certain countries
in South America and the Caribbean), Canadian-born aboriginals, close contacts of active cases, persons with
abnormal chest radiographs consistent with healed tuberculosis, and persons with underlying medical conditions
which increase their likelihood of reactivation of tuberculosis if infected (those with silicosis, jejunoilial by-pass,
hemodialysis, gastrectomy, malnutrition, intravenous drug users, alcohol abusers and especially those with
known or suspected infection with HIV).
USPSTF 1996
Screening for tuberculous infection with tuberculin skin testing is recommended for all persons at increased risk
of developping tuberculosis (Recommandation A)
Persons infected with HIV, close contacts of personswith known or suspected TB, persons with medical risk
factors associated with TB, immigrants from countries with high TB prevalence, medically underserved lowincome populations, alcoholics, injection drug users, residents of long-term care facility
Bactériurie
USPSTF 2004
Recommends against the routine screening of men and nonpregnant women for asymptomatic
bacteriuria (Recommandation D)
HABITUDES DE VIE
Tabac
CTFPHC 1994
Good evidence to support smoking cessation counselling (Recommandation A); nicotine
replacement therapy may be offered as an adjunct. (Recommandation A)
USPSTF 2003
The USPSTF strongly recommends that clinicians screen all adults for tobacco use and
provide tobacco cessation interventions for those who use tobacco products.
(Recommandation A) AAFP has same recommandation
Alcool
CTFPHC 1994
Fair evidence to include routine detection and counselling in periodic health examination.
(Recommandation B) by standardized questionnaire and/or patient inquiry
USPSTF 2004
The U.S. Preventive Services Task Force (USPSTF) recommends screening and behavioral
counseling interventions to reduce alcohol misuse by adults, including pregnant women, in
primary care settings. (Recommandation B)
the evidence is insufficient to recommend for or against screening and behavioral counseling
interventions to prevent or reduce alcohol misuse by adolescents in primary care settings.
(Recommandation I)
Activité physique
CANADA
CTFPHC 1994
Evidence for or against a recommendation to include physical activity counselling in the PHE
is lacking. (Recommandation C)
There is fair evidence to recommend that individuals engage in the regular practice of
moderate intensity physical activity. (Recommandation B)
There is good evidence to recommend lifestyle interventions for overweight individuals (body
mass index > 25 kg/m2, or > 22 kg/m2 if of Asian descent) with impaired glucose tolerance to
reduce the incidence of progression to diabetes (Recommendation B).
ETATS-UNIS
USPSTF 2002
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is
insufficient to recommend for or against behavioral counseling in primary care settings to
promote physical activity. (Recommandation I)
AAFP
The AAFP recognizes that regular physical activity is desirable. The effectiveness of
physician's advice and counseling in this area is uncertain.
HABITUDES DE VIE (suite)
Diète
CTFPHC 1994
Fair evidence to provide general dietary advice (Recommandation B) There is good evidence
to recommend lifestyle interventions for overweight individuals (body mass index > 25 kg/m2,
or > 22 kg/m2 if of Asian descent) with impaired glucose tolerance to reduce the incidence of
progression to diabetes (Recommendation B).
USPSTF 2003
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is
insufficient to recommend for or against routine behavioral counseling to promote a healthy
diet in unselected patients in primary care settings. (Recommandation I)
The USPSTF recommends intensive behavioral dietary counseling for adult patients with
hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic
disease. Intensive counseling can be delivered by primary care clinicians or by referral to
other specialists, such as nutritionists or dietitians (Recommandation B)
Obésité
CANADA
CTFPHC 1998
Because of lack of evidence supporting long-term effectiveness of weight-reduction
interventions, there is insufficient evidence to recommend for or against BMI measurement in
the periodic health examination of the general population (Recommandation C )
There is fair evidence to recommend BMI measurement in the periodic health examination of
obese adults with obesity-related disease (Recommandation B )
There is insufficient evidence to recommend for or against weight-reduction therapy in obese
adults without obesity-related disease (Recommandation C )
There is fair evidence to recommend weight-reduction therapy in obese adults with obesityrelated disease (Recommandation B )
CTFPHC 2005
There is good evidence to recommend lifestyle interventions for overweight individuals (body
mass index > 25 kg/m2, or > 22 kg/m2 if of Asian descent) with impaired glucose tolerance to
reduce the incidence of progression to diabetes (Recommandation B)
There is fair evidence to recommend acarbose treatment for overweight individuals (as
described above) with impaired glucose tolerance to prevent cardiovascular events and
hypertension (Recommandation B)
There is insufficient evidence to recommend metformin or acarbose treatment for overweight
individuals (as described above) with impaired glucose tolerance to prevent diabetes
progression (Recommandation I)
ETATS-UNIS
USPSTF 2005
The evidence is insufficient to recommend for or against routine screening for overweight in
children and adolescents as a means to prevent adverse health outcomes(Recommandation I)
USPSTF 2003
The USPSTF recommends that clinicians screen all adult patients for obesity and offer
intensive counseling and behavioral interventions to promote sustained weight loss for obese
adults.(Recommandation B)
AAFP
The AAFP recommends screening for obesity by measuring height and weight periodically
for all patients
PRÉVENTION DES ACCIDENTS
CTFPHC 1993
Individual counselling for :
Don’t drink and drive (Grade C)
Use helmets when riding bicycles on roadway (Grade C)
In the home, make guns inacessible ; keep ammunition and gun separately (GradeC)
Use of seatbelt and/or child restraints (Grade B )
Use of helmet when riding motorcycle or all-terrain vehicles (Grade C)
In elderly
Monitor elderly patients for medical impairment (balance, medication, gait abnormalities) (Grade C)
Couselling regarding use of saferty aid in hazardous areas such as stairs, bathtubs (Grade C)
USPSTF 1996
Periodic counseling of the parents of children on measures to reduce the risk of unintentional household and
recreational injuries is recommended. (Grade B) ; Mesures to reduce the risk of unintentionnal injuries from
residential fires and hot tap water, drowning, poisoning, bicycling, firearms and falls is recommanded
Counseling to prevent household and recreational injuries is also recommended for adolescents and adults based
on the proven efficacy of risk reduction, although the effectiveness of counseling these patients to prevent
injuries has not been adequately evaluated. (Grade C)
Persons with alcohol or drug problems should be identified, counseled and monitored. Those who use alcohol or
illicit drugs should be warned against engaging in potentially dangerous activities while intoxicated.(Grade B)
Counseling elderly patients on specific measures to prevent falls is recommended based on fair evidence that
these measures reduce the risk of falls (Grade B) although the effectiveness of counseling elders to prevent falls
has not been adequately evaluated. (Grade C)
More intensive individualized multi-factorial intervention is recommended for high-risk elderly patients in
settings where adequate resources to deliver such services are available.(Grade B)
There is insufficient evidence to recommend for or against the use of external hip protectors to prevent fall
injuries.
The following counseling to all patients, and the parents of young patients, is recommended:
 Use occupant restraints (lap/shoulder safety belts and child safety seats). (Grade B)
 Wear helmets when riding motorcycles. (Grade C)
 Refrain from driving while under the influence of alcohol or other drugs (Grade C)
There is currently insufficient evidence to recommend for or against counseling to prevent pedestrian injuries
(Grade C)
AAFP
The AAFP recommends counseling all parents and patients more than 2 years old regarding accidental injury
prevention including, as appropriate: child safety seats lap and shoulder belt use, bicycle safety, motorcycle
helmet use, smoke detectors, poison control center number, and driving while intoxicated.
PRÉVENTION DES ACCIDENTS (suite)
Personnes agées
American geriatrics society
Routine Care of Older Persons (not presenting after a fall)
 Clinicians caring for older persons should ask about fall history annually
 Those patients who report a single fall should undergo a balance and gait screening. This is done by
observing the ability to stand up from a chair without using arms, walk several paces and return. ( i.e.
the "get up and go test")
 Those having difficulty require further assessment and appropriate intervention such as referral to
physical and or occupational therapy.
Evaluation of Older Persons Presenting with One or More Falls or Having Abnormalities Gait and or Balance or
who report Recurrent Falls:
 History of the fall circumstances, medications (prescribed and over the counter), acute or chronic
medical problems, and mobility levels
 An examination of vision, muscle strength, gait, balance, and neurological function including lower
extremity peripheral nerves, proprioception, reflexes,cortical and extrapyramidal and cerebellar
functions should be done. An assessment of cognitive function and a basic cardiovascular evaluation
including heart rate and rhythm, orthostatic pulse and blood pressure should be done.,
Single interventions:
 Exercise:
a. Although exercise has many proven benefits, the optimum type, duration and intensity to
prevent falls remains unclear (B).
b. Physical therapy, exercise and balance training should be offered to older persons who have
recurrent falls (B).
c. Tai Chi C'uan is said to improve balance, it requires further evaluation before before it can be
recommended (C).
 Environmental Modification:
a. Older persons at increased risk for falls should have an environmental assessment done of their
home by an OT or other qualified professional
(B).
 Medications:
a. Patients, who have fallen, should have their medications reviewed especially those on more
than four prescribed meds or those taking psychotropic meds (C). (There is no clear difference
in risk for falls between long term and short-term benzodiazepines).
 Assistive devices:
a. There is no clear evidence that use of assistive devices alone such as bed alarms, canes, and
walkers have demonstrated benefits in preventing falls. While assistive devices may be
effective elements of a multifactorial intervention program, their isolated use without attention
to other risk factors cannot be recommended (C).
b. Hip protectors do not appear to reduce the risk of falls (Class I), but have been shown to be
effective in preventing fractures in high-risk individuals.
 Behavioral and Educational Programs:
a. When used as an isolated intervention, health and behavioral education does not reduce falls
(B).
Other Potential Interventions:
 Visual/sensory loss: deficits in sight and sensation have been linked to a higher incidence of falls
resulting in hip fractures. Identification of these deficits and appropriate intervention may be
preventative.
 Footwear interventions: there are no experimental studies of footwear examining falls as an outcome.
There are, however trials looking at intermediate outcomes such as balance and sway from specific
footwear interventions. For women, use of waling shoes was better than barefoot. For men, stability was
best with high mid-sole hardness and low mid-sole thickness.
MCAS
Aspirine prévention primaire
CTFPHC 1994
(Recommandation C)
USPSTF 2002
(Recommandation A)
The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians
discuss aspirin chemoprevention with adults who are at increased risk for coronary heart
disease (CHD). Discussions with patients should address both the potential benefits and harms
of aspirin therapy. Rationale: The USPSTF found good evidence that aspirin decreases the incidence of
coronary heart disease in adults who are at increased risk for heart disease. They also found good evidence that
aspirin increases the incidence of gastrointestinal bleeding and fair evidence that aspirin increases the incidence
of hemorrhagic strokes. The USPSTF concluded that the balance of benefits and harms is most favorable in
patients at high risk of CHD (5-year risk of greater than or equal to 3 percent) but is also influenced by patient
preferences. Men older than 40 years, postmenopausal women, and younger people with risk factors for coronary
heart disease (eg, hypertension, diabetes, or smoking) are at increased risk for heart disease and may wish to
consider aspirin therapy. Table 1 shows how estimates of the type and magnitude of benefits and harms
associated with aspirin therapy vary with an individual's underlying risk for coronary heart disease. Although
balance of benefits and harms is most favorable in high-risk people (5-year risk greater than 3 percent), some
people at lower risk may consider the potential benefits of aspirin to be sufficient to outweigh the potential
harms.
Five-year risks of 1%, 3% and 5% are equivalent to 10-year risks of 2%, 6%, and 10%.
Most participants in the primary prevention trials of aspirin therapy have been men between 40 and 75 years of
age. Current estimates of benefits and harms may not be as reliable for women and older men. Doses of
approximately 75 mg per day appear as effective as higher doses; whether doses below 75 mg per day are
effective has not been established. Enteric-coated or buffered preparations do not clearly reduce adverse
gastrointestinal effects of aspirin. Uncontrolled hypertension and concomitant use of other nonsteroidal antiinflammatory agents or anticoagulants increase risk for serious bleeding.
Table 1. Estimates of Benefits and Harms of Asprin Therapy Given for 5 Years to 1,000 Individuals with
Various Levels of Baseline Risk for Coronary Heart Disease*
Baseline risk for coronary heart disease over 5 years: 1%
Total mortality: No effect
CHD events**: 1-4 avoided
Hemorrhagic strokes***: 0-2 caused
Major gastrointestinal bleeding events****: 2-4 caused
Baseline risk for coronary heart disease over 5 years: 3%
Total mortality: No effect
CHD events**: 4-12 avoided
Hemorrhagic strokes***: 0-2 caused
Major gastrointestinal bleeding events****: 2-4 caused
Baseline risk for coronary heart disease over 5 years: 5%
Total mortality: No effect
CHD events**: 6-20 avoided
Hemorrhagic strokes***: 0-2 caused
Major gastrointestinal bleeding events****: 2-4 caused
* These estimates are based on a relative risk reduction of 28% for coronary heart disease events in aspirintreated patients. They assume risk reductions do not vary significantly by age.** Nonfatal acute myocardial
infarction and fatal coronary heart disease. *** Data from secondary prevention trials suggest that increases in
hemorrhagic stroke may be offset by reduction in other types of stroke in patients at very high risk for
cardiovascular disease (CVD) (greater than or equal to 10% 5-year risk).**** Rates may be 2 to 3 times higher
in people older than 70 years.
MCAS (suite)
Aspirine prevention secondaire
Diabetes
Association canadienne du diabetes 2003
Unless contraindicated, low-dose ASA therapy (80 to 325 mg/day) is recommended in all
patients with diabetes with evidence of CVD, as well as for those individuals with
atherosclerotic risk factors that increase their likelihood of CV events (Grade A)
American diabetes association 2002
Use aspirin therapy (75–162 mg/day) as a secondary prevention strategy in diabetic men and
women with a history of myocardial infarction, vascular bypass procedure, stroke or transient
ischemic attack, peripheral vascular disease, claudication, and/or angina. (Grade A)
Use aspirin therapy (75–162 mg/day) as a primary prevention strategy in men and women
with type 2 diabetes at increased cardiovascular risk, including those over 40 years of age or
who have additional risk factors (family history of CVD, hypertension, smoking,
dyslipidemia, albuminuria). (Grade A)
Hypertension
Canadian hypertension society 2006
On devrait fortement envisager l’ajout d’une faible dose d’AAS chez les patients hypertendus
(cote A chez les patients agés de plus de 50 ans). La prudence est de mise si la pression
artérielle n’est pas maitrisée
Cochrane 2004
For primary prevention in patients with elevated blood pressure, anti-platelet therapy with
ASA cannot be recommended since the magnitude of benefit, a reduction in myocardial
infarction, is negated by a harm of similar magnitude, an increase in major haemorrhage. For
secondary prevention in patients with elevated blood pressure (ATC meta-analysis: APTC
1994) antiplatelet therapy is recommended because the magnitude of the absolute benefit is
many times greater. Warfarin therapy alone or in combination with aspirin in patients with
elevated blood pressure cannot be recommended because of lack of demonstrated benefit.
Glycoprotein IIb/IIIa inhibitors as well as ticlopidine and clopidogrel have not been
sufficiently evaluated in patients with elevated blood pressure.
Further trials of antithrombotic therapy with complete documentation of all benefits and
harms are required in patients with elevated blood pressure.
Dépistage MCAS
USPSTF 2004
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening
with resting electrocardiography (ECG), exercise treadmill test (ETT), or electron-beam
computerized tomography (EBCT) scanning for coronary calcium for either the presence of
severe coronary artery stenosis (CAS) or the prediction of coronary heart disease (CHD)
events in adults at low risk for CHD events. (Recommandation D)
The USPSTF found insufficient evidence to recommend for or against routine screening with
ECG, ETT, or EBCT scanning for coronary calcium for either the presence of severe CAS or
the prediction of CHD events in adults at increased risk for CHD events.
(Recommandation I)
Vitamine E
CTFPHC 2003
Primary prevention of CVD : The CTF concludes that there is insufficient evidence to
recommend for or against the use of routine vitamin E supplementation for the primary
prevention of CVD events in the general population and in male smokers
( Recommandation I).
Secondary prevention of CVD in patients with established CVD or risk factors for CVD : The
CTF concludes that there is good evidence to recommend against the use of vitamin E for the
secondary prevention of CVD in patients with established CVD or risk factors for CVD
(Recommandation D)
MALADIES VASCULAIRES
Anévrysme de l’aorte abdominale
CTFPHC 1994
Palpation abdominale ou échographie : Poor evidence to include or exclude in periodic health
examination of asymptomatic individuals (Recommandation C) but screening may be
considered for individuals at high risk. (males over the age of 60 who are smokers with hypertension,
claudication, evidence of other vascular disease or a positive family history of AAA)
USPSTF 2005
Recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography
in men aged 65 to 75 who have ever smoked. (Recommandation B)
Makes no recommendation for or against screening for AAA in men aged 65 to 75 who have
never smoked. (Recommandation C)
Recommends against routine screening for AAA in women (Recommandation D)
Sténose carotidienne
CTFPHC 1994
Neck auscultation : Fair evidence not to include in periodic health examination of
asymptomatic individuals. (Recommandation D)
USPSTF 1996
There is insufficient evidence to recommend for or against screening asymptomatic persons
for carotid artery stenosis using the physical examination or carotid ultrasound
(Recommandation C)
For selected high-risk patients, a recommendation to discuss the potential benefits of
screening and carotid endarterectomy may be made on other grounds
MVAS
USPSTF 1996
Routine screening for peripheral arterial disease in asymptomatic persons is not recommended
(Recommandation D)
Clinicians should be alert to symptoms of peripheral arterial disease in persons at increased
risk, and should evaluate patients who have clinical evidence of vascular disease.
TROUBLES DE LA VISION OU DE L’AUDITION
Vision
CTFPHC 1995
Snellen in elderly : Fair evidence to include in the periodic health examination (PHE)
(Recommandation B)
USPSTF 1996
Snellen in elderly (Recommandation B) Optimal frequency not known.
AAFP
The AAFP recommends screening for visual difficulties in elderly adults by performing
Snellen acuity testing.
Glaucome
CTFPHC 1995
Screening in elderly :Insufficient evidence to include in or exclude from the PHE
(Recommandation C)
USPSTF 2005
There is insufficient evidence to recommend for or against screening adults for glaucoma
(Recommandation I) The uncertainty of the magnitude of benefit from early treatment and
given the known harms of screening and early treatment, the USPSTF could not determine the
balance between the benefits and harms of screening for glaucoma.
AUTRES
The American Academy of Ophthalmology recommends a comprehensive eye examination
by an ophthalmologist (including examination of the optic disc and tonometry) for all adults
beginning around age 40, and periodic reexamination thereafter
Periodic examination every 3-5 years is also recommended for younger black men and
women (age 20-39), due to their higher risk of glaucoma
The American Optometric Association recommends regular optometric evaluations
(including tonometry) for all adults, and advises primary care clinicians to screen for
glaucoma (with ophthalmoscopy and/or tonometry) in high-risk groups, including persons
over 50, blacks, diabetics or hypertensives, relatives of glaucoma patients, and others with
specific health concerns or medical conditions
Surdité
CTFPHC 1994
Fair evidence to screen the elderly for hearing impairment. (Recommandation B)
USPSTF 1996
Screening for older adults for hearing impairment is recommended through:
 Periodically questioning them about their hearing. (Recommandation B)
 Counseling them about the availability of hearing aid devices.
 Making referrals for abnormalities when appropriate.
There is insufficient evidence to recommend for or against routinely screening asymptomatic
working-age adults for hearing impairment. Recommendations against such screening, except
for those exposed to excessive occupational noise levels, may be made on other ground
SANTÉ MENTALE
Drogues
USPSTF 2003
There is insufficient evidence to recommend for or against routine screening for drug abuse
with standardized questionnaires or biologic assays (Recommandation C) Including
questions about drug use and drug-related problems when taking a history from all adolescent
and adult patients may be recommended on other grounds.
Dépression
CTFPHC 2005
There is fair evidence to recommend screening adults in the general population for depression
in primary care settings that have integrated programs for feedback to patients and access to
case management or mental health care (Recommandation B)
There is insufficient evidence to recommend for or against screening adults in the general
population for depression in primary care settings where effective follow-up and treatment are
not available (Recommandation I)
USPSTF
2002: The U.S. Preventive Services Task Force (USPSTF) recommends screening adults for
depression in clinical practices that have systems in place to assure accurate diagnosis,
effective treatment, and follow-up. (Recommandation B)
2004 : Concludes that the evidence is insufficient to recommend for or against routine
screening by primary care clinicians to detect suicide risk in the general population
(Recommandation I)
Démence
CTFPHC 2001
There is insufficient evidence to recommend for, or against, screening for cognitive
impairment in the absence of dementia, (Recommandation C)
Memory complaints should be evaluated and the individual followed to assess progression
(Recommandation B)
When caregivers or informants describe cognitive decline in an individual, these observations
should be taken very seriously: cognitive assessment and careful follow-up are indicated
(Recommandation A)
USPSTF 2003
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is
insufficient to recommend for or against routine screening for dementia in older adults.
(Recommandation I)
Violence familiale
USPSTF 2004
insufficient evidence to recommend for or against routine screening of parents or guardians
for the physical abuse or neglect of children, of women for intimate partner violence, or of
older adults or their caregivers for elder abuse (Recommandation I)
SANTÉ DE LA FEMME (divers)
Contraception
CTFPHC 1994
Physicians who see adolescents should advise those who are sexually active about the correct
use of appropriate contraception (Recommandation B) (Révision en cours )
Oral contraceptive has been identified as the method of choice for adolescents in combination with a condom to
protect against sexually transmitted diseases
USPSTF 1996
Periodic counseling about effective contraceptive methods is recommended for all women and
men at risk for unintended pregnancy. (Recommandation B) Counseling should be based on
information from a careful sexual history and should take into account the individual preferences, abilities, and
risks of each patient. Sexually active patients should also receive information on measures to prevent sexually
transmitted diseases
Acide folique en préconception
CTFPHC 1994
Good evidence to advise all women capable of becoming pregnant to increase their
consumption of folic acid to 0.4 mg/day. Supplementation appears to be the most effective
and practical way to achieve this goal. (Recommandation A)
USPSTF 1996
It is recommanded that all women planning pregnancy take folic acid at a dose of 0.4-0.8 mg,
beginning at least 1 month prior to conception and continuing trough the first trimester, to
reduse the risk of neural tube defects (Recommandation A)
Taking 0.4 mg of folic acid is also recommanded for all women capable of becoming
pregnant, to reduce the risks of neural tube defects in unplanned pregnancy
(Recommandation B)
Chimioprophylaxie contre le cancer du sein
CTFPHC 2001
There is fair evidence to recommend counseling high risk women about the potential benefits
and risks of using tamoxifen to reduce the likelihood of breast cancer, and hence support
individual choice. (Recommandation B) (High Risk Women (e.g. 1.66% or more on Gail Index)
Screening using the Gail Index has not been evaluated for general use
National Cancer Institute: The model is applicable to women 40 years or older who receive regular
mammography. (possible de calculer le risque à http://bcra.nci.nih.gov/brc/ )
USPSTF 2002
The USPSTF recommends that clinicians discuss chemoprevention with women at high risk
for breast cancer and at low risk for adverse effects of chemoprevention. Clinicians should
inform patients of the potential benefits and harms of chemoprevention(Recommandation B)
Hormonothérapie
CTFPHC 2004
Recommends against the use of combined estrogen-progestin therapy and estrogen-only
therapy for the primary prevention of chronic disease in menopausal women
(Recommandation D) For women who wish to alleviate menopausal symptoms using hormone
replacement therapy (HRT), a discussion between the woman and her physician about the potential benefits and
risks of HRT is warranted. (Voir aussi le site de la SOGC : www.sogc.org)
USPSTF 2005
The U.S. Preventive Services Task Force (USPSTF) recommends against the routine use of
combined estrogen and progestin for the prevention of chronic conditions in postmenopausal
women (Recommandation D) The USPSTF recommends against the routine use of
unopposed estrogen for the prevention of chronic conditions in postmenopausal women who
have had a hysterectomy (Recommandation D) (Voir aussi le site du WHI : www.whi.org)
Liste des sites web
EMP général
Canadian task force
Site: http://www.ctfphc.org/
Livre de 1994: http://www.hc-sc.gc.ca/hppb/soinsdesante/pdf/soins98/s7c50f.pdf
US task force
http://www.ahrq.gov/clinic/uspstfix.htm
American college of preventive medicine
http://www.acpm.org/pol_practice.htm
Glycémie
Association canadienne du diabète
http://www.diabetes.ca/cpgfrancais/default.aspx
American diabetes association
http://care.diabetesjournals.org/content/vol29/suppl_1/
Cholestérol
Canadian guidelines
http://www.cmaj.ca/cgi/data/169/9/921/DC1/1
NCEPP III
http://www.nhlbi.nih.gov/guidelines/cholesterol/
American heart association
http://www.americanheart.org/presenter.jhtml?identifier=548
American association of clinical endocrinologists
http://www.aace.com/clin/guidelines/lipids.pdf
Hypertension
Canadian hypertension society
www.hypertension.ca/chep/recommandations2006/CHEP_06_BookletFullText_
vf.pdf
Société québécoise d’hypertension artérielle
http://www.hypertension.qc.ca/docs/guide_SQHTA_2002.pdf
JNC 7
http://www.nhlbi.nih.gov/guidelines/hypertension/
Ostéoporose
Osteoporosis society of Canada (guidelines 2002)
http://www.cmaj.ca/content/vol167/10_suppl/index.shtml
Liste des sites web (suite)
Cancer du sein
Société canadienne du cancer
http://www.cancer.ca/ccs/internet/standard/0,3182,3172_10175_74567690_langIdfr,00.html
National cancer institute
http://www.cancer.gov/newscenter/mammstatement31jan02
ACOG
ACOG Practice Bulletin. Obstetrics and Gynecology. Avril 2003 vol 101 pp821-32
American geriatrics society
http://www.americangeriatrics.org/education/cp_index.shtml
Cancer du côlon
Canadian association of gastroenterologists
http://www.cagacg.org/guidelines/pdf/Colorectal%20cancer%20screening%202004.pdf
National committee on colorectal cancer sreening
http://www.hc-sc.gc.ca/pphb-dgspsp/publicat/ncccs-cndcc/pdf/ccstechrep_e.pdf
American Gastroenterological Association
http://www2.us.elsevierhealth.com/inst/serve?action=searchDB&searchDBfor=art&
artType=abs&id=agast1240544&nav=abs&special=hilite&query=[articletitle](colore
ctal+cancer+screening,surveillance,)
Cancer du col utérin
American cancer society
http://www.cancer.org/docroot/PED/content/PED_2_3X_ACS_Cancer_Detection_G
uidelines_36.asp?sitearea=PED
ACOG (American college of obstetricians and gynecologists)
ACOG Practice Bulletin. Obstetrics and Gynecology aout 2003 vol 102. pp417-27
American geriatrics society
http://www.americangeriatrics.org/products/positionpapers/cer_carc_2000.shtml
Cancer de la prostate
Canadian urological association
http://www.cua.org/
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Genitourinary/Prost
ate/PSAScreening/PositionsofOtherMedicalOrganizationsonScreeningforProstateCa
ncerwithPSA.htm
American urological association
http:www.urologyhealth.org/adult/index.cfm?cat=09&topic=250
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Genitourinary/Prost
ate/PSAScreening/PositionsofOtherMedicalOrganizationsonScreeningforProstateCa
ncerwithPSA.htm
Prevention des accidents
American geriatrics society
http://www.americangeriatrics.org/products/positionpapers/abstract.shtml
Maladies infectieuses
Guide québecois de dépistage des ITSS 2006
http://www.masexualite.ca/professionnels/its-4.aspx
Lignes directrices canadiennes pour les MTS 1998
http://www.phac-aspc.gc.ca/publicat/std-mts98/index_f.html
ANNEXE 1
Feuilles synthèse des recommandations
Par sexe et groupe d’âge
Les recommandations A ou B du Canada et/ou des Etats-Unis qui
s’adressait à une population générale adulte ont été incluses.
Toutefois si une recommandation d’un organisme autre semblait
pertinente et importante la manœuvre a quand même été incluse
dans la liste. Chaque item est suivie des recommandations
canadienne et américaine. La première valeur est celle du CTFPHC.
Elle est suivie de celle du USPSTF. Lorsque qu’il n’y a pas de
recommandation un * apparaît. Pour les recommandations des
autres associations se référer au document de base
Adolescents
20-35 ans
35-50 ans
50-70 ans
> 70 ans
ANNEXE 2
Suggestion de feuilles de prise de données pour l’examen
périodique adolescent-adulte
Adolescents
20-35 ans
35-50 ans
50-70 ans
> 70 ans
ANNEXE 3
Suggestion de feuilles sommaires
ANNEXE 4
Critères pour les recommandations des divers groupes
Recommandations des différents groupes
CTFPHC
(Canadian Task force on preventive health care)
Grade A: good evidence to recommend the clinical preventive action.
Grade B: fair evidence to recommend the clinical preventive action.
Grade C: the existing evidence is conflicting and does not allow making a recommendation for or against
use of the clinical preventive action, however other factors may influence decision-making
Grade D: fair evidence to recommend against the clinical preventive action.
Grade E: good evidence to recommend against the clinical preventive action.
Grade I: insufficient evidence (in quantity and/or quality) to make a recommendation, however other
factors may influence decision-making
I: Evidence from randomized controlled trial(s)
II-1: Evidence from controlled trial(s) without randomization
II-2: Evidence from cohort or case-control analytic studies, preferably from more than one centre or
research group
II-3: Evidence from comparisons between times or places with or without the intervention; dramatic results
in uncontrolled experiments could be included here
III: Opinions of respected authorities, based on clinical experience; descriptive studies or reports of expert
committees
USPSTF
(US preventive services task force)
A.— The USPSTF strongly recommends that clinicians provide [the service] to eligible
patients. The USPSTF found good evidence that [the service] improves important health
outcomes and concludes that benefits substantially outweigh harms.
B.— The USPSTF recommends that clinicians provide [this service] to eligible patients.
The USPSTF found at least fair evidence that [the service] improves important health
outcomes and concludes that benefits outweigh harms.
C.— The USPSTF makes no recommendation for or against routine provision of [the
service]. The USPSTF found at least fair evidence that [the service] can improve health
outcomes but concludes that the balance of benefits and harms is too close to justify a
general recommendation.
D.— The USPSTF recommends against routinely providing [the service] to asymptomatic
patients. The USPSTF found at least fair evidence that [the service] is ineffective or that
harms outweigh benefits.
I.— The USPSTF concludes that the evidence is insufficient to recommend for or against
routinely providing [the service]. Evidence that the [service] is effective is lacking, of poor
quality, or conflicting and the balance of benefits and harms cannot be determined
Recommandations (suite)
Association canadienne du diabète et
La société de l’ostéoporose du Canada
Catégorie A: Les meilleures données probantes étaient de niveau 1
Catégorie B : Les meilleures données probantes étaient de niveau 2
Catégorie C : Les meilleures données probantes étaient de niveau 3
Catégorie D : Les meilleures données probantes étaient de niveau 4 ou il y a eu consensus
Pour le diagnostic
Niveau 1 : études répondent à 5 critères prédéfinis sur 5
Niveau 2 : études répondent à 4 critères
Niveau 3 : études répondent à 3 critères
Niveau 4 : études répondent à 1 ou 2 critères
American geriatrics society
Class I: Evidence from At least one randomized controlled trial or meta-analysis of
randomized controlled trials.
Class II: Evidence from at least one controlled study without randomization or evidence or
evidence from at least one other type of quasi experimental study.
Class III: Evidence from non-experimental studies, such as comparative studies, correlation
studies and case-controlled studies.
Class IV: Evidence from expert committee reports or opinions and/or clinical experience of
respected authorities.
The strength of the recommendations is classified as follows:
A.
Directly based on Class I evidence.
B.
Directly based on Class II evidence or extrapolated recommendation from Class I
evidence
C.
Directly based on Class III evidence or extrapolated recommendation from Class I or
II evidence.
D.
Directly based on Class IV evidence or extrapolated recommendation from Class I, II,
or III evidence.
AAFP: American Academy of Family Physicians
SR: Strongly Recommend: Good quality evidence exists which demonstrates substantial net
benefit over harm; the intervention is perceived to be cost effective and acceptable to nearly
all patients.
R: Recommend: Although evidence exists which demonstrates net benefit, either the benefit
is only moderate in magnitude or the evidence supporting a substantial benefit is only fair.
The intervention is perceived to be cost effective and acceptable to most patients.
NR : No Recommendation Either For or Against: Either good or fair evidence exist of at least
a small net benefit. Cost-effectiveness may not be known or patients may be divided about
acceptability of the intervention.
RA : Recommend Against: Good or fair evidence which demonstrates no net benefit over
harm.
I : Insufficient Evidence to Recommend Either for or Against: No evidence of even fair
quality exists or the existing evidence is conflicting
I-HB : Healthy Behavior is identified as desirable but the effectiveness of physician's advice
and counseling is uncertain.
ANNEXE 5
SCORE
ORAI
TABLEAU DU GUIDE DE DEPISTAGE DES ITSS
Copié du guide québécois de dépistage des ITSS 2006