⚠️ Important: This is a quick reference only. The Canadian Task Force on Preventive Health Care (CTFPHC) has been under review, and some of its recommendations — breast screening in particular — remain contested, with several provinces starting screening earlier than the national guideline. Provincial programs may differ from the guidance below.
Always verify against CTFPHC and your provincial program. Lab test coverage varies by province — check your provincial health insurance schedule.
Cancer Screening
Breast Cancer Screening
CTFPHC (2018, draft update 2024) • Provincial programs
Every 2–3 years50–74 (from 40 with shared decision)Under review
🔄Frequency: Mammography every 2–3 years. Provincial programs typically invite every 2 years.
👤Eligibility: Age 50–74 (active invitation). Women aged 40–49 may access screening through shared decision-making. Ontario lowered self-referral age to 40 in 2024. No referral needed for provincial screening programs.
⚠️Note: CTFPHC guidelines are under major review after criticism for not recommending screening from age 40. Many provinces and clinicians already screen from 40. Check your provincial program for current eligibility.
Cervical Cancer Screening
CTFPHC (2013, update pending) • Provincial programs
Every 3 years (Pap) or 5 years (HPV)25–69Under review
🔄Frequency: Pap test every 3 years (CTFPHC's 2013 guideline — still the only formally published CTFPHC recommendation). Provinces are moving to HPV primary screening every 5 years as their own program decision — Ontario switched in March 2025. Self-collection being introduced provincially.
👤Eligibility: Age 25–69 (CTFPHC). Some provinces still start at 21. Anyone with a cervix, regardless of HPV vaccination status.
⚠️Note: The CTFPHC cervical guidelines are from 2013 and criticised for not yet recommending HPV primary screening. Australia and the UK switched to HPV-first in 2017. Check your province for current protocol — it's changing rapidly.
Colorectal Cancer Screening
CTFPHC (2016)
Every 2 years (FIT) or 10 years (colonoscopy)50–74
🔄Frequency: FIT (fecal immunochemical test) every 2 years, or flexible sigmoidoscopy every 10 years. Colonoscopy not recommended as primary screening for average-risk patients.
👤Eligibility: Age 50–74, average risk. High-risk patients (family history, IBD, genetic syndromes) follow different protocols with colonoscopy — refer to gastroenterology guidelines.
⚕️Provincial programs: Most provinces mail FIT kits to eligible residents. Encourage participation — CRC is the 3rd most common cancer in Canada and screening reduces mortality significantly.
Lung Cancer Screening
CTFPHC (2016) • Provincial programs expanding
Annual LDCT55–74≥ 30 pack-years
🔄Frequency: Annual low-dose CT (LDCT). BC and Ontario run established, expanding province-wide programs (Ontario's own eligibility uses a 20 pack-year threshold, not 30). Alberta currently runs a regional pilot (Calgary, Edmonton, Grande Prairie), not a province-wide program.
👤Eligibility: Age 55–74, current or former smoker (quit within 15 years), 30+ pack-year smoking history. Use the pack-year calculator to assess eligibility.
⚠️Note: Not all provinces fund LDCT screening yet. Check your provincial cancer agency for current availability and referral pathway.
Prostate Cancer Screening (PSA)
CTFPHC (2014)
Not routinely recommended
⚠️CTFPHC recommendation: Routine PSA screening is not recommended for men of any age. The harms of screening (overdiagnosis, overtreatment, biopsy complications) outweigh the benefits at a population level.
⚕️In practice: If a patient requests PSA testing, informed shared decision-making is essential. Discuss the risk of false positives, overdiagnosis, and the fact that most screen-detected prostate cancers will not cause harm in the patient's lifetime. Document the discussion.
Common Lab Test Restrictions
Vitamin D Testing
Choosing Wisely Canada • Provincial lab policies
Restricted in most provinces
⚕️Criteria: Publicly funded vitamin D testing is restricted to patients with specific clinical indications in most provinces: osteoporosis/osteopenia, malabsorption (coeliac, IBD, bariatric surgery), chronic kidney disease, medications affecting vitamin D (anticonvulsants, corticosteroids), rickets. Routine screening in healthy patients is not covered.
🏛️Provinces with restrictions: Ontario, Alberta, BC, Saskatchewan, Manitoba, Newfoundland & Labrador all have criteria-based ordering. In Alberta, a special requisition form is required.
⚠️Choosing Wisely: "Don't perform population-based screening for vitamin D deficiency." Supplement empirically in high-risk patients rather than testing first.
HbA1c — Diabetes Screening & Monitoring
Diabetes Canada (2018) • CTFPHC (2012)
🔄Screening: CTFPHC recommends screening for type 2 diabetes every 3–5 years using FPG or HbA1c in adults at high risk (using a validated risk calculator such as FINDRISC or CANRISK). Diabetes Canada recommends screening every 3 years from age 40 (or earlier if risk factors present).
🔄Monitoring: For established diabetes, HbA1c every 3 months if not at target, or every 6 months if stable. No strict provincial frequency cap in most provinces, but clinical appropriateness applies.
TSH / Thyroid Testing
Choosing Wisely Canada
⚕️Best practice: Order TSH alone as the initial screen. Add free T4 only if TSH is abnormal. Don't routinely order free T3 — it's rarely needed in primary care. Don't repeat TSH before 6 weeks after a dose change in thyroid replacement therapy.
Iron Studies
Choosing Wisely Canada
⚕️Best practice: Order ferritin alone for initial iron deficiency screening. Full iron studies (serum iron, TIBC, transferrin saturation) only if ferritin is equivocal or if iron overload is suspected. Don't routinely order full iron panels as a first-line test.
Choosing Wisely Canada — Key Recommendations
Don't perform population-based screening for vitamin D deficiency. Supplement empirically in high-risk patients.
Don't order routine pre-operative lab tests (CBC, electrolytes, coagulation) for low-risk surgeries in healthy patients without clinical indication.
Don't screen with Pap smears before age 21 or after age 69, or annually — follow provincial guidelines for interval.
Don't order annual ECGs or other cardiac screening for asymptomatic, low-risk patients.
Don't order imaging for low back pain within the first 6 weeks unless red flags are present (trauma, neurological deficits, suspected cancer, infection, cauda equina).
Don't prescribe antibiotics for uncomplicated upper respiratory infections (most are viral).
Don't repeat TSH within 6 weeks of a thyroid medication dose change.
Other Preventive Screening
Fragility Fractures / Osteoporosis
CTFPHC (2023) • Osteoporosis Canada
👤Who to screen: CTFPHC recommends bone density testing (DEXA) for women aged 65+ and men aged 70+. Screen earlier if risk factors: previous fracture, corticosteroid use, early menopause, family history of hip fracture, low body weight, smoking, excess alcohol.
🔄Frequency: Repeat DEXA generally every 2–3 years if monitoring treatment, or every 5–10 years if initial scan is normal and low risk.
⚕️Tool: Use FRAX (Fracture Risk Assessment Tool) to calculate 10-year fracture probability and guide treatment decisions.
Depression Screening
CTFPHC (2025 update)
⚕️Recommendation: The 2025 CTFPHC update recommends against routine screening of all adults for depression using a questionnaire with a screen-positive/negative cut-off (a strong recommendation, citing very-low-certainty evidence of benefit and a real risk of false positives). Stay alert to mood and mental health in conversation with patients instead of applying a blanket screening tool. This CTFPHC recommendation is about universal population screening — it doesn't change how you'd use a tool like the PHQ-9 or perinatal EPDS when a patient already has symptoms or a specific risk factor prompting assessment.
Hepatitis C Screening
CTFPHC (2017)
👤Who to screen: Adults at high risk — born between 1945–1975 (baby boomer cohort), injection drug use (current or past), received blood products before 1992, born in a high-prevalence country, incarceration history, HIV positive.
⚕️Note: Hepatitis C is now curable with direct-acting antivirals (DAAs). One-time screening of the baby boomer cohort is strongly recommended.