Canada’s Breast Cancer Screening Policy Based on Flawed Study, Say Researchers

Isaac Teo wrote . . . . . . . . .

Thousands of Canadian women in their 40s may have died needlessly from breast cancer due to a lack of access to mammographies as a result of two “skewed” studies that informed guidelines recommending against screening for this age group, a team of researchers says.

In a commentary published in the Journal of Medical Screening on Nov. 23, researchers from five universities said they have new evidence that the Canadian National Breast Screening Study trials conducted in the 1980s were not randomized properly, leading to unreliable results.

Results at the time found that routine mammograms did not reduce deaths in women aged 40 to 49. A second trial involving women from 50 to 59 was also carried out with similar results.

The researchers from the University of Toronto, University of Ottawa, University of British Columbia, University of Alberta, and Harvard Medical School said they are concerned about “serious errors in trial design and conduct” and therefore the studies “should not influence breast screening policies.”

“The bottom line for Canadian women is that this study suppressed screening, especially for women 40-49, for decades and likely indirectly resulted in a lot of lives lost,” they wrote.

“The study’s influence on policy has had a substantial impact on breast cancer outcomes in Canada and may have contributed to the avoidable deaths of over 400 Canadian women each year.”

‘Major Flaws’ Introduced in Trial
Sheila Appavoo, co-author of the commentary and associate clinical professor in the University of Alberta’s (U of A) Faculty of Medicine & Dentistry, said two “major flaws” were introduced during the trial for the 40 to 49 age group.

First, the female volunteers were given clinical breast examinations by expert nurses before being placed into supposedly randomized groups for either mammography or no screening, noted Appavoo in an article in the U of A’s Folio publication on Nov. 23.

However, due to the limited access to mammography outside of the trial, the study staff “put more symptomatic women with lumps or pain into the mammography group than in the control group.”

Secondly, in cases where screening centres had difficulty finding enough volunteers, women were recruited from breast surgeons’ offices, making the probability of having asymptomatic women in the study very low.

“That’s why the study results showed you had more of a risk of dying if you had been screened than if you hadn’t been screened,” Appavoo said.

Due to the trial results, she said the Canadian Task Force on Preventive Health Care (Task Force) recommends routine mammography starting at age 50.

“Because the Canadian guidelines recommend not screening until 50, a lot of women are denied that requisition,” she said.

To date, the Task Force’s website states that for women aged 40 to 49 they recommend “not screening with mammography.”

“The decision to undergo screening is conditional on the relative value a woman places on possible benefits and harms from screening,” it says.

As for those who still wish to be screened, it says “care providers should engage in shared decision-making with women who express an interest in being screened.”

In their commentary, the researchers said the “subversion of randomization” and the “inclusion of many symptomatic women in a screening trial” were also built into the study for women aged between 50 and 59, skewing the results.

In an email statement to The Epoch Times, Dr. Brenda Wilson, co-chair of the Canadian Task Force on Preventive Health Care, said the Task Force integrates “the best available evidence into its guidelines” and that the recommendation to screen with mammography at age 50 is “conditional.”

“[The Task Force] does not strongly advise against screening, rather it advises health professionals and women to discuss the option and reach a decision that works for the individual,” wrote Wilson.

“When there are substantive changes to that evidence, the Task Force updates a full review of the body of evidence, including any new evidence.”

The researchers, on the other hand, said they have “direct eyewitness evidence” of the “flaws” in the studies, arguing the trials “were not reliably randomized controlled trials, nor were they truly trials of screening.”

“Their results should no longer be used in meta-analyses of screening nor to inform policies on breast cancer screening,” they said.

Source: The Epoch Times

Triage Protocols Made Public by Alberta Health Services

Jay Rosove wrote . . . . . . . . .

The term “triage” may be a scary one to hear, but Alberta’s health authorities are preparing its staff and the public for the possibility of that extreme measure.
When triage is declared health officials must decide which critically ill patients are eligible to receive care and which are not.

A 52-page document outlining how life and death decisions will be made if the province’s health-care system is overwhelmed past its breaking point has been posted publicly by Alberta Health Services.

The framework for the critical care triage protocol in Alberta describes the procedure that will be put into place when all available resources and mitigating steps for critical care have been exhausted.

“We’ve started the educational process,” AHS CEO Dr. Verna Yiu told reporters on Thursday.

According to the AHS triage framework, the decision to activate the protocol would be up to Dr. Yiu, “in consultation with the AHS Executive Leadership Team.”

“Basically this week was really sharing with our staff about what it is,” said Dr. Yiu, “and really setting up the infrastructure in place so that we – if we had to use it, again this would be an absolute, absolute last resort – that the staff are ready and trained and prepared.”

According to the AHS document, the critical care triage protocols are designed to “create an objective process to guide health-care professionals in making difficult determination of how to allocate resources to critically ill adult and pediatric patients when there are not enough critical care resources for everyone.”

WHEN TRIAGE MEASURES CAN BE TRIGGERED IN ALBERTA

The framework divides the province-wide triage measures into two possible phases, based on the severity of surging volumes of critical care patients.

When the usual number of critically ill patients is exceeded, and all available critical care surge beds is at 90 per cent or greater, the AHS triage guidelines state that should be considered a “Major Surge” and “Phase 1 Triage may be required.”

According to the AHS framework, Phase 1 triage would mean “eligibility assessment for entry into critical care are based on one year expected mortality of approximately greater than 80 per cent.”

In other words, the greater your likelihood of survival, the better chances you have of receiving care.

Phase 1 triage would not affect pediatric patients, however Phase 2 would.

The triage guidelines state that Phase 2 may be required in the event of a “Large Scale Surge.”

According to the framework, a large scale surge is when “critically ill patient demand exceeds available capacity and human resources,”

“All feasible strategies to maximize staffing resources, staffing functions, supplies and equipment and access to invasive mechanical ventilation will have been used prior to initiation of this triage phase,” the document reads. “Provincial occupancy of available critical care surge beds is 95 per cent or greater.”

In a Phase 2 triage scenario patients would receive eligibility assessments, and current critical care patients would receive a “discontinuation assessment.”

When the triage protocol is active, consent from patients or their families would not be required to withhold or withdraw care.

Vaccination status will not be a consideration on whether a patient is treated.

HOW CLOSE IS ALBERTA TO ACTIVATING TRIAGE?

Dr. Neeja Bakshi, a general internist with primary inpatient practice at Edmonton’s Royal Alexandra Hospital, told CTV News Edmonton on Friday she believes the province’s ICUs could “potentially” be overrun within the next 12 to 14 days.

“Whether or not that’s to be the time we have that means that’s going to be the time we have to enact the protocol is a bit of a moving target,” said Dr. Bakshi. “It depends on resources and how much we can try to do within the current system.”

“This is also why we are starting to educate the folks that might be involved in the triage protocols right now.”

As the fourth wave of COVID-19 surges across Alberta, the province has begun to implement extraordinary measures to make room for the daily average of 20 new patients being admitted into the province’s ICUs.

While Ontario has agreed to accept patients from Alberta, Dr. Yiu said on Thursday that AHS is also in conversation with other provinces about sending patients if needed as well.

‘We need to bend that curve’: Alberta could transfer ICU patients to Ontario as hospitalizations near 900
According to AHS, field hospitals in Edmonton and Calgary have also been prepared.

When asked about triage protocols and ICU care rationing, Dr. Yiu stopped short of making any predictions.

“From our perspective the numbers are changing daily and almost hourly… Things that were projected from last week already (are not) accurate this week,” she said. “It’s related to the fact that we are continuing to find additional capacity.

“But it comes at a cost. And that cost is that when we start reducing the procedures and postponing procedures. That’s how we’re finding a lot of the capacity.”

The AHS CEO stressed the importance of getting every eligible Albertan vaccinated in order to avoid extreme measures like triage.

“I just can’t say enough how important it is for Albertans to go out and get vaccinated,” she said.

On Friday, the province announced 80 per cent, or more than 3.1 million of eligible Albertans, have received at least one dose of a COVID-19 vaccine.

Alberta has 310 ICU beds including 137 surge beds, Dr. Yiu said. Eighty-six per cent of those beds are occupied – largely by COVID-19 patients.

Dr. Yiu said the province currently has over 600 ventilators and an additional 200 “less than optimal ventilators,” which “could be used.”

According to the province, there are 911 hospitalizations due to COVID-19 with 215 of those in ICUs, as of Friday.

Alberta has 19,201 active cases of COVID-19.

The province has seen 2,523 deaths related to COVID-19.

Source : CTV


Read more at Alberta Health Services

Critical Care Triage during Pandemic or Disaster – A Framework for Alberta . . . . .

More Than 100 Ontario Youth Sent to Hospital for Vaccine-related Heart Problems

Anthony Furey wrote . . . . . . . . .

A report quietly released last week by Public Health Ontario (PHO) tallies the number of people in the province who have presented to hospital with heart inflammation following mRNA vaccination, and it skews heavily towards young people.

As of Aug. 7, there were 106 incidents of myocarditis/pericarditis in Ontarians under the age of 25. That’s slightly more than half of the total of all such incidents.

Broken down further, 31 of these cases were in 12- to 17-year-olds and 75 were in 18- to 24-year-olds. The vast majority — 80% — were in males.

The report explains that PHO issued a directive in June for public health units to increase their surveillance of this side effect following reports from the United States and Israel of similar concerns unfolding in those countries.

“The reporting rate of myocarditis/pericarditis was higher following the second dose of mRNA vaccine than after the first, particularly for those receiving the Moderna vaccine as the second dose of the series (regardless of the product for the first dose),” the report explains.

PHO adds that the reporting rate for heart inflammation in those 18-24 was seven times higher with Moderna than with Pfizer. (The only vaccine currently used for 12- to 17-year-olds in Ontario is Pfizer.)

While PHO initially worked with reports of 314 such incidents, upon further investigation they narrowed that number down to just over 200.

There have in total been 202 emergency room visits across all age groups for such issues following vaccination, with 146 leading to hospitalization. Three of these have led to ICU admission.

When it comes to older age brackets, there were 54 persons aged 25-39 included in the tally and 44 persons aged 40 and over.

When broken down by the number of overall people who have received the vaccines, the reporting rate for this side effect is 7.4 per million for Pfizer and 20 per million for Moderna.

The highlights section of the PHO report conclude with a note that “COVID-19 vaccines continue to be recommended and are highly effective at preventing symptomatic infection and severe outcomes from COVID-19 disease, which is also associated with a risk of myocarditis.”

Source : Toronto Sun

Vegan Bacon Mayo Launched in Canada

Nicole Axworthy wrote . . . . . . . . .

Condiment brand Hellmann’s just launched three new flavors of vegan mayonnaise across Canada for a limited time. The brand—which currently offers original Vegan Mayo—is adding to its lineup with Baconnaise, Garlic, and Chipotle flavors. The three options are available at supermarket chains Metro and Sobeys across Canada but only until September.

Hellmann’s Vegan Baconnaise offers a smoky, umami flavor and can be used as a condiment for vegan burgers, French fries, potatoes, or pizza. The Vegan Garlic Mayo offers a creamy taste of fresh garlic that can compliment vegan burgers or sandwiches, and the Vegan Chipotle Mayo can be used as a dip for sweet potato fries.

To promote its new Vegan Baconnaise, Hellmann’s is giving away coupons for free products to residents of Canada if they have the name “bacon” on their social media accounts, live on a “bacon” street, or have “bacon” in their name.

Hellmann’s promoted the products in a similar way when it launched the three new flavors of vegan mayo at retailers across the United Kingdom earlier this year. There, the brand gave away 250 jars to any UK resident who could prove that their last name is “Bacon.” Hellman’s also sent 80 jars of the vegan Baconnaise to residents who live on Bacon street across the UK.

The launch of vegan mayo

Hellmann’s launched its first vegan mayo in 2016—then called “Vegan Carefully Crafted Dressing & Sandwich Spread”—as an alternative to its traditional Hellmann’s mayonnaise but made without the eggs. Prior to launching its vegan mayo, Hellmann’s parent company Unilever filed a lawsuit in 2014 against San Francisco-based food tech company Hampton Creek (now known as Eat Just) alleging that its product Just Mayo violated the standard of identity of mayonnaise as it did not contain eggs.

After a long legal battle over the usage of the word “mayo,” Hellmann’s dropped the lawsuit and obtained vegan certification for its own vegan product from Vegan Action—the national non-profit organization responsible for certifying many of the vegan products in grocery stores. Despite its fight with Eat Just over its usage of “mayo,” Hellmann’s added vegan labeling to make it easier for consumers to identify its eggless mayo product.

In 2016, the vegan-certified spread (which Unilever sells under its “Best Foods” brand in some regions) launched in the United States and Canada before debuting in the United Kingdom in 2018 with new “Vegan Mayo” branding.

More vegan mayo flavors

Since the launch of its Vegan Mayo, Hellman’s has offered several limited-edition vegan flavors. Last year, the brand created rainbow-hued, “millennial-inspired” vegan mayo flavors in honor of vegan campaign Veganuary. Each flavor got its hue from plant sources, including spirulina (blue), beets (pink), turmeric (yellow), and basil (green).

The flavors were only available at the Vegan Rain-Bao pop-up truck for two days in January in London, England, where Hellmann’s served up a variety of vegan bao (Chinese buns) to determine which mayo flavor was most popular for a potential limited-time retail launch in the future.

Source: Veg News

Canadian Company Announces “First Canadian-Made Plant-Based Egg Substitute”

Canadian food tech company Nabati has filed patents for a liquid egg alternative in Canada, the United States, and Australia. The company says it also has plans to file in Europe and China.

According to Nabati, the product will be the first and only egg alternative to be manufactured in Canada. It says that extensive research and development was required to create the plant-based egg, and the patents will allow it to protect its formulation and production process.

The liquid egg substitute will be sold under the name Nabati Plant Eggz and is free of soy, gluten, and cholesterol. It is also high in fibre, protein, and vitamins, including vitamin B12. It is expected to be available later this year.

Recently, Nabati announced it was planning to expand across the globe, starting with Europe and Asia. The company has been going from strength to strength in recent months, with its chick’n burger nominated as the best product of 2020 and its cheese now on the menu at Mucho Burrito. In March, it raised $7.7 million in funding and announced plans to go public.

“Nabati is proud to be the first Canadian company to develop a plant-based egg alternative, perfect for scrambling or making omelettes with,” said Nabati CEO Ahmad Yehya. “Our product uses lupin and pea protein to provide the right consistency, taste, and texture. It was important to us to create a formulation that was free of soy and gluten, which many people avoid in their diets. We are committed to creating healthy, plant-based alternatives that everyone can enjoy.”

Source: Vegconmist