Mr. Chairman and members of the health committee, I would like to thank you for the opportunity to talk to you today about the role of pathology and laboratory testing in the diagnosis and treatment of lung cancer, a subject about which I am very passionate.
Although not always obvious to the patients and the public, pathologists are on the front line of cancer prevention and screening. My colleague Dr. Lam just presented to you some data about lung cancer screening. When a nodule is identified radiologically in the lung and there is a clinical and radiological suspicion that it may be cancerous, the nodule is sampled through biopsies and sent to pathology for microscopic examination.
Pathologic examination has been the gold standard for diagnosis of cancer for over a century. A screening program for lung cancer without a pathology diagnosis is like a detective story without a final answer.
Since I started working as a consultant pathologist and as a lung pathologist at the BC Cancer Agency in Vancouver approximately nine years ago, my role in lung cancer has changed dramatically. This change occurred around 2007, and it was due to the discoveries of drugs effective for only certain molecularly defined tumour types, for treatment that we now call “targeted therapy”. Medical oncologists require increasingly specific information about each individual lung tumour for treatment decision-making. In fact, drugs are developed with molecular tumour characteristics in mind. “One treatment fits all” is no longer the standard of care, and we are personalizing treatment for each lung cancer patient.
One of the most exciting parts of my daily work is testing tumours to identify the best treatment for the right patient at the right time. These tests, which predict tumours' response to a drug, are known as companion diagnostic tests. We are looking to identify characteristics of the tumour, or biomarkers, at a molecular level, and therefore these tests are also known as biomarker tests. Companion diagnostic tests help tailor treatment and provide better patient stratification, response prediction, and treatment monitoring. Companion diagnostic testing is a relatively new concept, but it is not specific to lung cancer. Usage of such tests is only going to increase in the era of personalized medicine, and they are already available for patients with other types of cancers.
One of the pioneer biomarkers in oncology, which we have been testing for in pathology since the early 1990s, is a tumour's receptor for estrogen. We are testing for this particular biomarker in all breast cancers with significant clinical impact. One of the most moving statements I have ever heard was from a young mother, a non-smoker diagnosed with lung cancer. She said she wished she had breast cancer, because at least then society would care.
There is so much we can learn from all the great work that breast cancer research has done over time in biomarker testing, but we need your help to ensure that we have the infrastructure and continuous support for other types of cancer research being done in our country.
In Canada the landscape of biomarker testing in lung cancer has been developed since 2009 by multidisciplinary national groups of medical oncologists and pathologists who have worked together to develop and implement a testing strategy for Canadian lung cancer patients. We took into consideration not only scientific results but also the economical reality of our health care system, and we have been very successful. This national approach to testing is simple and elegant, and it makes us, as Canadian lung physicians, proud to be able to collaborate with each other and with health care authorities in this way, and to see our work being cited by academic and private testing centres around the world.
For lung cancer in Canada, we currently clinically test for two biomarkers called EGFR and ALK to identify patients who will respond to several targeted therapies. I respectfully submitted data about my biomarker testing in lung cancer in Canada in a brief sent to your attention and for your review.
Additional drugs with companion diagnostic tests will soon be available for lung cancer patients, and that includes immunotherapy drugs. It is of very high importance that we have a testing system in place in the laboratories to be able to identify these patients efficiently and accurately. This shows once again the increasing importance of pathology in the lung cancer care team.
Given the fast advances in personalized medicine in lung cancer and its clinical impact on the survival and quality of life of our patients, we need to look at drugs and companion diagnostic tests as one entity and support these programs together scientifically, financially, and politically.
I would like to thank you for the opportunity to talk to you today.