CCFP priority topic 12 of 105
Cancer on the CCFP exam
7 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 7 key features for Cancer. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 7
Prevention advice
Raise ways to lower cancer risk at any visit, even one about something else.
CFPC skill Patient-centred approach, communicationPhase TreatmentSources Canadian Task Force on Preventive Health Care
On the exam
A worn-out caregiver who smokes, and stopped varenicline for nightmares, brings her husband in. Expect a short menu (pick several from a list) of what to offer her.
Pick what to offer her today.
Common mistakes
Saving it for another day because her husband is the patient. Or settling for cutting down, or a retry of the varenicline she could not take.
Approach
- Raise smoking now. A busy caregiver may not get a better moment.
- Advise her to stop. The Task Force says everyone who smokes should be encouraged to quit. It makes no case for cutting down.
- Offer a quit aid along with advice: nicotine replacement, varenicline, bupropion or cytisine. Add counselling if she wants it.
- If one drug failed or made her sick, offer another. Nicotine replacement is still on the table after varenicline.
- E-cigarettes: the Task Force suggests against them. Talk them through only if other aids failed, she will not try them, or she strongly prefers them.
- Raise other risks when they fit the visit: safer sex, and the human papillomavirus (HPV) vaccine.
Key feature 2 of 7
Screening
Offer the cancer tests that evidence backs for each patient's age and risk.
CFPC skill Clinical reasoning, selectivityPhase DiagnosisSources Canadian Task Force on Preventive Health Care
On the exam
A 64-year-old who smokes, 40 pack-years, treated for breast cancer 8 years ago. Expect one best answer for her lung plan.
Pick the lung screening plan.
Common mistakes
A chest X-ray, one scan only, or waiting until she quits. Her old breast cancer does not take her off the list.
Approach
- Lung: screen ages 55 to 74 with 30 or more pack-years who smoke now or quit less than 15 years ago. Pack-years are packs a day times years smoked.
- Use low-dose computed tomography (CT), once a year, up to 3 times in a row. Screen only where a centre is skilled at finding and treating early lung cancer.
- Never screen for lung cancer with a chest X-ray, with or without sputum tests.
- Bowel, ages 50 to 74: a stool test every 2 years, or flexible sigmoidoscopy every 10. The stool test can be guaiac or fecal immunochemical (FIT). Colonoscopy is not the screening test.
- Cervix, ages 25 to 69: every 3 years. Screening may stop at 70 if the last 3 Pap tests in 10 years were normal.
- These rules are for average risk. A strong family history, past polyps, a gene change or symptoms need their own plan.
| Cancer | Who | Test |
|---|---|---|
| Lung | 55 to 74, 30+ pack-years, smoking now or quit under 15 years | Low-dose CT yearly, up to 3 times. No chest X-ray. |
| Bowel | 50 to 74. Not 75 or older. | Stool test every 2 years, or sigmoidoscopy every 10 |
| Cervix | 25 to 69. Not under 25. | Pap test every 3 years |
| Breast (2024 draft) | 50 to 74. At 40 to 49 if she chooses it after hearing the trade-offs. | Mammogram every 2 to 3 years |
Key feature 3 of 7
Stay involved
Keep seeing patients through cancer treatment, working with the cancer team.
CFPC skill Patient-centred approach, professionalismPhase Follow-up, treatmentSources Choosing Wisely Canada
On the exam
A man starts treatment for colon cancer at a regional cancer centre. Expect a short menu (pick several from a list) of your jobs.
Pick what you keep doing.
Common mistakes
Handing everything to the cancer centre until treatment ends. Or the reverse: yearly colonoscopy or routine scans the cancer plan does not call for.
Approach
- Keep seeing him during treatment. Book visits; don't wait for him to call.
- Keep managing his other illnesses, his mood and his family, alongside the cancer team.
- Ask for the treatment and follow-up plan in writing. Know who to call with a problem.
- Follow-up after treatment can be done as well in primary care as in a cancer centre, and in a more patient-centred way.
- After colon cancer surgery, the colonoscopy interval follows the last findings. Yearly colonoscopy is not routine.
- In a well survivor, skip tests for recurrence unless finding it early would truly help.
Key feature 4 of 7
Life around the cancer
Ask with care how the cancer is changing the patient's life, and how they are managing.
CFPC skill Patient-centred approach, communicationPhase HistorySources Choosing Wisely Canada
On the exam
A single mother on chemotherapy comes in for a refill. Expect a short menu (pick several from a list) of things to ask.
Pick what to ask about.
Common mistakes
A visit about blood counts and refills only. She may not raise lost income, child care or fear unless you ask.
Approach
- Ask open questions: how is this changing your life, your work, your family?
- Ask about work and money: time off, lost income, benefits.
- Ask who helps at home, and who cares for her children on treatment days.
- Ask about mood, sleep, worry and fear that the cancer will come back.
- Ask how the people caring for her are holding up.
- Social or emotional distress is a reason to bring in palliative care, even during active treatment.
Key feature 5 of 7
Treatment side effects
Ask outright about the harms and late effects of cancer treatment.
CFPC skill Clinical reasoningPhase History, follow-upSources Health Canada
On the exam
A woman 8 years past breast cancer, now on letrozole, comes in for a cold. Expect a short menu (pick several from a list) of effects to ask about.
Pick the effects to ask about.
Common mistakes
Asking about effects that ended with chemotherapy, such as nausea, mouth sores or low counts. Or asking about tamoxifen's list, such as bleeding from the womb, when she takes letrozole.
Approach
- Match your questions to the treatment she had, and when. Most acute chemotherapy effects settle within weeks.
- Ask about the drug she takes now. Letrozole often causes joint pain and stiffness, and it thins bones.
- Ask about lasting effects: numb or tingling feet, bowel changes, tiredness, memory, sex and mood.
- Ask in plain words. Many patients don't link a symptom to their treatment, or fear it will stop the drug.
- Tell the cancer team about effects that may change the plan.
Key feature 6 of 7
New symptom, old cancer
When someone treated for cancer long ago has a new symptom, consider that it is back or has spread.
CFPC skill Clinical reasoningPhase Hypothesis generationSources Choosing Wisely Canada
On the exam
A 71-year-old woman, treated for breast cancer years ago, has 6 weeks of mid-back pain that wakes her. One vertebra is tender; no fever. Expect one best answer for the cause.
Pick the most likely cause.
Common mistakes
Calling it a strain because it began with a lift. Shingles, polymyalgia (aching, stiff shoulders and hips), a disc and kidney infection don't fit pain over one bone with no fever.
Approach
- Think of spread for any new, lasting symptom after cancer, however long ago it was treated.
- Pain at night and tenderness over one bone are warning signs in someone with a cancer history.
- Choosing Wisely lists suspected cancer among the red flags that justify imaging for back pain.
- Check for weakness, numbness and bladder or bowel change.
- New shortness of breath, headache or confusion after cancer also need recurrence on the list.
- In a survivor with no symptoms, routine tests for recurrence rarely help. A new symptom changes that.
Key feature 7 of 7
Honest prognosis
Talk about the likely course of the cancer truthfully, and admit what is uncertain.
CFPC skill Communication, professionalismPhase Treatment, follow-upSources Choosing Wisely Canada
On the exam
A man whose cancer has spread asks how long he has. Expect one best answer for your reply.
Pick the most honest reply.
Common mistakes
A firm number of months, or false hope that treatment will fix it. Sending every question back to the oncologist is wrong too.
Approach
- Ask what he knows and what he wants to know before you give numbers.
- Give a range, not a date. Say plainly when you don't know.
- Make sure he and his family know enough about the prognosis before choosing treatments.
- Start advance care planning early, and return to it as things change.
- Offer palliative care for distress alongside cancer treatment. Early palliative care can help some patients live longer.
- Before a burdensome treatment near the end of life, check that it fits his goals.
Flashcards
Answer it first, then check.
KF 1She stopped varenicline for nightmares. Which quit aid now?
Nicotine replacement, with counselling. Bupropion and cytisine are other aids the Task Force recommends. Source: Canadian Task Force on Preventive Health Care
KF 2She is 62, has 35 pack-years and quit 10 years ago. Screen her lungs?
Yes. Low-dose CT once a year, up to 3 times. She quit less than 15 years ago. Source: Canadian Task Force on Preventive Health Care
KF 2Which bowel screening test for a 55-year-old at average risk?
A stool test every 2 years, or flexible sigmoidoscopy every 10. Not colonoscopy. Source: Canadian Task Force on Preventive Health Care
KF 2A healthy 58-year-old man asks for a PSA test. What does the Task Force say?
It advises against prostate-specific antigen (PSA) screening at every age. At 55 to 69 the advice is weak. Source: Canadian Task Force on Preventive Health Care
KF 3Treatment is over. Who can do the follow-up?
Primary care can, as well as a cancer centre can, and in a more patient-centred way. Source: Choosing Wisely Canada
KF 5Eight years after chemotherapy, is nausea a late effect to ask about?
No. Nausea ends with treatment. Ask about lasting effects, such as numb feet, tiredness or low mood.
KF 6Night pain over one vertebra, and breast cancer years ago. Is it a strain?
Don't settle for that. Think of spread to bone. Suspected cancer is a red flag for imaging. Source: Choosing Wisely Canada
KF 7He asks how long he has, and you can't be sure. What do you say?
That you don't know for sure. Give a range if you can, and keep the talk going.
FAQ
Which breast screening advice should I know?
The Task Force's 2024 update is still a draft. It suggests a mammogram every 2 to 3 years from 50 to 74, and from 40 for women who choose it.
Does a past cancer change screening for other cancers?
Usually not. A woman treated for breast cancer still gets lung, bowel and cervical screening if she qualifies. A gene change that runs in families needs its own plan. With cancer that has spread, routine screening rarely helps.
Where does the exam test pain control in cancer?
The CFPC sends cancer pain to the Chronic Disease and Palliative Care topics, and low mood to Depression. This page covers the rest of cancer care in family practice.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Published prevention guidelinesCanadian Task Force on Preventive Health Care
- Choosing Wisely recommendationsChoosing Wisely Canada
- Drug Product DatabaseHealth Canada