The Canadian Guide to Clinical Preventive Health Care

996 pp. Canadian Task Force on the Periodic Health Examination, Health Canada. 1994. $69.95. ISBN 0-660-15732-2

This book is an excellent reference guide for current recommendations concerning preventive health care measures. The information has been collected and examined for the past 16 years by the Canadian Task Force on the Periodic Health Examination (not to be confused with the "annual health exam"!), established in 1976 by the conference of deputy ministers of health of Canada. The mandate of the task force is to "determine how the periodic health examination might enhance or protect the health of Canadians and to recommend a plan for all persons living in Canada." This book reports current recommendations on 81 health care issues (e.g., screening for abdominal aortic aneurysm, breast cancer and diabetes mellitus in adults). The topics chosen for review are practical and common in everyday medical practice.

The task force developed a careful methodologic system for weighing the scientific evidence for and against the effectiveness of an intervention in the prevention of a disease or disorder. Recommendations are based on clinical studies rather than "common practice."

In some cases, insufficient evidence is available to make a strong recommendation for inclusion or exclusion. This can be frustrating, yet, at the same time, it is interesting that screening procedures that have formed part of our basic examinations (e.g., the digital rectal examination for prostate cancer in men 50 to 70 years of age) have been found to be inefficacious.

An outline of the methods employed by the task force is given as well as a discussion of the many variables that must be considered in preventive health care.

Each chapter follows the same format, which makes it quick and easy to find the information sought. Each chapter ends with a conclusion and recommendation, suggestions for further research in the area, the sources of information, selected references and summary tables of the recommendations and evidence. Full reference lists are available from the task force. Topics can be found easily through the table of contents or the index of topics.

The book offers a huge amount of information, but the careful organization allows the reader to narrow in on the question at hand very quickly. The text is short and to the point.

Given the continuing introduction of new screening methods and frequent updates in recommendations, it is difficult to predict just how long the recommendations in this book can be considered "current." It is an expensive book if its usefulness to practitioners could soon lapse.

Catherine Younger-Lewis, MD, CCFP
Health Services
Carleton University
Ottawa, Ont.

CMAJ July 15, 1995 (vol 153, no 2) / JAMC le 15 juill. 1995 (vol 153, no 2)