Frequently Asked Questions (FAQs) on Cancer Screening

Cancer screening means getting tested to find cancer early, before symptoms appear. Early detection can help reduce complications, provide more treatment options, and improve chances of survival. While there are many benefits to screening, there are also some limitations. Understanding both is important for making informed choices.

Despite the significant benefits, in certain cases, there are some risks and drawbacks associated with cancer screening:

• Discomfort – some screening tests can be inconvenient or uncomfortable for some people. However, screening can have such a significant impact on a person’s health that screening should be strongly considered despite the potential discomfort.   
• Worry/stress - anxiety and stress related to the procedure and while waiting for the results can be difficult for some people.  
• False positives – sometimes a result will show potential cancer or a higher likelihood of cancer that is not true, resulting in unnecessary worry, stress and additional testing/procedures. This may deter some from screening in the future. 
• False negative – a result can occasionally come back incorrectly negative, and a cancer can be missed.  Each test has its limitations and screening tests are not 100% accurate.
• Trauma associations – for example, a Pap test can be a sensitive and potentially triggering experience for some people. Canadian Forces Health Services is committed to providing trauma-informed care to ensure that members are empowered in deciding on screening and how that screening is done.
• “The low doses of radiation used for imaging tests might increase a person’s cancer risk slightly, but it’s important to put this risk into perspective.” (Ref: Understanding Radiation Risk from Imaging Tests | American Cancer Society) People are exposed to small amounts of ionizing radiation that exist in the natural environment every day. The benefits of screening for most people outweigh this small risk.

If you have concerns or questions about cancer screening, please contact your Care Delivery Unit (CDU) to speak with your healthcare provider.

Currently there are three common screening programs in Canada (breast, cervical and colorectal) with lung cancer screening just starting to be delivered. For screening programs to be implemented they need to meet certain criteria, such as: it is a significant health problem (causes deaths or serious disease); there is a test to detect it before it causes symptoms; there are treatment options for the disease in its early phase; and, it needs to be cost-effective. The cancer screening programs currently available in Canada meet these criteria.

Prevention behaviours, such as not smoking, choosing to eat healthy foods and choosing to limit alcohol consumption in line with Canada’s low-risk drinking guidelines, are important for reducing cancer risk. In addition, early detection through cancer screening (before symptoms occur) is a powerful population health intervention to improve patient outcomes. 

Beginning in February 2025, Canadian Forces Health Services will send confidential, automated emails to Canadian Armed Forces (CAF) members who fall within the appropriate age, sex identified in the health record, or risk-factor demographics to advise them that they are eligible for cancer screening.  For example, anyone 50 years of age or older can be screened for colorectal cancer. CAF members who receive this email are encouraged to make an appointment with their Canadian Forces Health Services primary care provider to discuss and take the necessary steps to complete cancer screening. 

Canadian Armed Forces (CAF) members’ medical records and personal information are securely stored within the Canadian Forces Health Information System (CFHIS) which is the CAF’s electronic health record system.  Information in CFHIS is accessible only to authorized Canadian Forces Health Services or Department of National Defence/CAF personnel to generate automated emails based on demographics.  Members can rest assured that their personal health information is safeguarded in CFHIS and will not be compromised by this process. 

All diagnostic imaging for cancer screening in the Canadian Armed Forces (such as mammography and Computed Tomography scans) will be referred to local imaging centres that can support these services. Cancer screening for cervical cancer (such as a Pap test) and colorectal cancer (collected at-home stool sample) can generally be completed via Canadian Forces Health Services clinics.  

Canadian Forces Health Services (CFHS) is committed to the care and support of Canadian Armed Forces (CAF) members. Currently, unless a CAF member visits primary care and discusses cancer screening with their CFHS healthcare provider, there is no mechanism in place to advise patients that they are eligible for cancer screening. Since life is busy, these email reminders can help CAF members take advantage of timely and effective cancer screening – leading to improved health outcomes for patients. 

Ultimately, the decision to take part in cancer screening is a personal choice, but healthcare providers can offer support and advice so members can make an informed decision. When a member receives a screening reminder email, the next step is to schedule an appointment with their primary care provider to discuss their situation and health details and whether screening is right for them. 

Cancer is common in Canada. The most common cancers in Canada are generally also the most common among Canadian Armed Forces (CAF) members (serving and retired). Approximately 43% and 45% of Canadian women and men respectively will develop cancer in their lifetime. The most common cancers among Canadians are colorectal and lung cancer. Additionally, breast cancer is one of the most common cancers among women and people with breasts^{Footnote 1}  and prostate cancer is one of the most common cancers among men and those assigned male at birth. These are similarly common cancers among CAF personnel, who also have comparable to slightly lower risk of dying from cancer when compared to the Canadian general population.

Beyond prevention, early detection through screening to detect cancer early (before symptoms) is the most powerful population health intervention to improve patient outcomes. Cancer screening not only saves lives, but early detection can help reduce complications, provide more treatment options, and improve chances of survival.

While some Canadian Armed Forces members may have individual risk factors that support earlier screening, the following recommendations are for average-risk persons with no current symptoms.

These recommendations are in keeping with existing Federal/Provincial/Territorial recommendations and were reviewed by the Canadian Forces Health Services Cancer prevention working group:

• Breast cancer: Starting at age 40, women and people with breasts^{Footnote 1}    should book with primary care to discuss when to start screening/available options; universal screening recommended as of age 50;
• Colorectal cancer: Starting at age 50, book with primary care to discuss when to start screening/available options, universal screening recommended as of age 50;
• Cervical cancer: Starting at age 21, those with a cervix should book with primary care to discuss when to start screening/available options; universal screening recommended as of age 25; and
• Lung cancer: Starting at age 50, book with primary care to discuss screening for anyone who has smoked (current/former).

In contrast to breast, cervical, and colorectal cancer (where screening is based on age and assigned biological sex identified in the health record), lung cancer screening is targeted to a high-risk population based on age and total years of tobacco smoking history.

Members should contact (call or email) their Care Delivery Unit (CDU) to book an appointment with their primary healthcare provider. We ask for members’ patience when attempting to book an appointment, as CDU personnel are managing multiple priorities within clinics and will do their best to respond in a timely manner to all requests.

If you are experiencing concerning health symptoms, don’t wait for the next scheduled screening - get care immediately. For example, if you find a lump in your breast or see blood in your stool, you should seek help right away at sick parade. Don’t delay seeking medical advice if you have potential symptoms — it could save your life.

The health and wellness of our members are extremely important to the Canadian Armed Forces (CAF) and the CAF works to provide the best possible healthcare for those who are ill or injured. This includes cancer care by appropriate medical and surgical cancer specialists.  In addition, comprehensive medical and dental services are available to CAF members including mental health services and support. The CAF offers a variety of benefits for members and their families during a time of illness and injury. This includes but is not limited to: paid health and hospital coverage; social work services; paid sick leave for the member while undergoing treatment and recovering; home care; and rehabilitation care. Additionally, the CAF offers a Return to Duty program for members when medically appropriate, and compassionate leave can be granted in the case of a CAF member caring for their critically ill spouse.

If you are in need of any support or care please contact your Care Delivery Unit. 

If you have questions regarding cancer screening, please speak with your Primary Care provider or visit the CAF cancer screening website.

Some provinces have reduced the age to start breast cancer screening to 40 years, others to 45 years, while some remain at 50 years. This decision is often based on several factors including resource availability and scientific review by health authorities. CAF members can access breast cancer screening starting at 40 years of age and are recommended for screening at 50 years of age. Those interested in screening starting between the ages of 40 and 49 are encouraged to speak to their healthcare provider, to discuss risks and benefits so they can make an informed decision.  

A mammogram consists of X-rays of the breast. These X-rays use low-dose radiation to visualize the breast tissue. The dose of radiation is very low (0.4 millisieverts) for two views of a breast and is less than the annual background exposure of natural radiation for an average Canadian (1.8 mSv).

People assigned male at birth have a very low risk of developing breast/chest cancer and account for about 1% of all breast/chest cancers diagnosed. People assigned male at birth who have a family history of breast cancer (BRCA 1 or 2) gene mutation may be at increased risk and should speak to their healthcare provider.  However, if a person assigned male at birth receives feminizing hormones for five years or more, it is recommended for them to have routine breast/chest cancer screening. 

Transgender males who have not had top surgery remain at risk and are recommended to have routine breast/chest cancer screening.

For most people it doesn’t hurt, but it can be slightly uncomfortable. If you are concerned about pain during a mammogram, speak to the Diagnostic Imaging clinic where you will be receiving your mammogram to discuss options. 

Yes, you can start getting a screening mammogram at 40 years of age. However, it is recommended to discuss the benefits and harms of early screening with your healthcare provider to ensure you are making an informed decision. Also, in some provinces, you will need a requisition to access your first mammogram under the age of 50 years.

Yes, in some provinces patients can self-refer into a provincial (civilian) breast screening program, or if they have had one previous mammogram, they can return to the diagnostic imaging centre that performs mammograms every two years, without a Canadian Armed Forces (CAF) requisition. However, if you are accessing screening this way, please ensure your Care Delivery Unit (CDU) healthcare provider is sent a copy of your results. You can contact your CDU to get the fax number and other relevant details to share with the mammogram clinic. Remember, if you access screening programs in this manner, Canadian Forces Health Services (CFHS) will not automatically receive a copy of the results to include in your medical record. Since CAF members are often posted between provinces, taking steps to make sure the CFHS medical record is up to date is the best way to ensure continuity of care. 

In the past, experts suggested that breast self-exams be done in a certain way each month. Newer research, however, showed that this is not a good screening method, nor did it reduce deaths from breast cancer. However, everyone should be aware of what is normal for their breasts even if they get regular screening tests. Some people find their own breast cancer by noticing changes in the look and feel of their breasts.

Yes. If you have breast implants, it is still recommended for you to have routine breast cancer screening. You will still get a mammogram; however, the technologist will use special techniques, called implant displacement techniques, to view the breast tissue under the implants. Additional images may also be needed to examine as much of the breast tissue under the implants as possible. It will be important to inform your healthcare provider that you have implants when booking your mammogram, to ensure they add the relevant information to your requisition. 

Yes, even if you've been immunized for the human papillomavirus (HPV), it's important to get regular cervical cancer screenings. The HPV vaccine protects against the most common types of the virus that can cause cervical cancer, but it doesn't protect against all types. Regular screenings, like Pap tests or HPV tests, are essential for detecting any abnormal changes in the cervix early, regardless of vaccination status. Screening and vaccination together offer the best protection.

If you are an individual who has a neovagina, discuss the potential exams and screening you may require with a trusted healthcare provider. This specialized medical field is evolving, and new research may identify individual cancer screening needs specific to you.

People with a cervix should get cervical cancer screening.  If you have had a total hysterectomy (which includes removal of your cervix) and do not have a history of high-grade cervical cell changes/cervical cancer, you no longer need cervical cancer screening. However, it is important to review your medical chart and cervical screening history first with your healthcare provider. 

If you have had a total hysterectomy (which includes removal of your cervix) and do not have a history of high-grade cervical cell changes/cervical cancer, you no longer need cervical cancer screening. However, it is important to review your medical chart and cervical screening history with your healthcare provider. Those with a cervix should receive cervical cancer screening. 

Yes, even if you have had only one sexual partner, you may have been exposed to the human papillomavirus (HPV) and it is recommended that you be screened for cervical cancer. Cervical cancer takes many years to develop. If you were exposed to HPV in the past and the infection has persisted, it can potentially cause cell changes that results in cancer over time. 

Yes, going through menopause does not reduce the risk of developing cervical cancer. In fact, most cervical cancers diagnosed in Canada occur in women/people with a cervix between the ages of 30 and 59 years.   

This is dependent on many factors and should be discussed with your healthcare provider. Typically, if you have a cervix, it is recommended that you be screened until you are 70 to 74 years of age. It may be recommended that you continue screening past this age if you have a history of cervical cell changes (i.e., abnormal result) or a history of cervical cancer.  

The research around lung screening is largely based on tobacco smoke exposure. Tobacco smoke, particularly cigarette smoke, contains many toxic chemicals and carcinogens and exposure over time can result in cancer. More research is required to review the effects of cannabis smoke, which is why only tobacco smoke is considered for lung cancer screening at this time. 

Studies were conducted on chest X-ray screening in the past. Some of these studies found earlier detection of lung cancer but it did not result in a decrease in the number of deaths (mortality) from lung cancer. However, studies that used low-dose Computed Tomography scans did present a benefit, particularly by detecting the cancers early enough to reduce the chance of dying.

While exposures other than tobacco smoke can increase the risk of developing lung cancer, smoking remains the leading cause of lung cancer in Canada. If you are concerned about your exposures and developing lung cancer, speak to your healthcare provider to discuss these concerns. 

Smokeless tobacco products, such as dipping and chewing tobacco, are primarily associated with cancers of the esophagus, mouth and throat, and pancreas. Individuals who chew tobacco products are encouraged to discuss nicotine use cessation options with their healthcare provider. Dental and primary care providers within Canadian Forces Health Services are trained to discuss the many health risks associated with smokeless tobacco use.

Tobacco smoke contains many toxic and carcinogenic chemicals that can cause cells in the body to change over time. This can occur even without the cells getting direct exposure to the smoke, such as in the lungs. Additionally, there is research that shows that people with a cervix who smoke have more difficulty clearing the human papillomavirus from their bodies; this is the virus that causes the majority of cervical cancers. 

A low-dose Computed Tomography (CT) scan, performed in lung cancer screening, uses significantly less radiation (about one fifth) than a regular CT scan. This reduces the risk of exposure to radiation over time. The amount of radiation used during one low-dose CT scan (1.4 millisieverts) is less than the average background radiation someone is exposed to in a year in Canada (1.8 millisieverts).

While both procedures can be uncomfortable, they’re generally well tolerated. The benefits of early cancer detection far outweigh the temporary discomfort.

• A sigmoidoscopy examines the lower part of the colon. During the procedure, you may feel pressure, cramping, or bloating, especially as air is introduced to expand the colon for better visibility. Discomfort is usually mild and temporary, and many people don’t require sedation.
• A colonoscopy examines the entire colon. It’s more extensive, and most people are given sedatives or anesthesia, so they generally don't feel discomfort during the procedure itself. You may experience mild cramping or gas after the procedure, but these sensations typically go away quickly.

While there is the potential for harm with either test, the risks are relatively low compared to the benefits. Some potential harms include discomfort and a small chance of perforating the bowel (accidental hole put in the bowel) or bleeding. Speak to your care provider if you have concerns.  

The recommended screening test for most people is the fecal/stool test. If results are positive a colonoscopy may be needed for further investigation and management (e.g., removal of potential polyps).

• A Fecal Immunochemical Test (FIT) detects hidden (not visible to the naked eye) blood in the stool, which can be an early sign of colorectal cancer or polyps. This is a non-invasive, at-home test done by collecting a stool (fecal) sample and sending it to a lab. 

• A Fecal Occult Blood Test (FOBT) is similar to the FIT, where it also looks for hidden blood in the stool. In many provinces the FOBT has been replaced by the FIT.