Well beyond my understanding.
Evidence of meeting #67 for Health in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was testing.
A recording is available from Parliament.
Evidence of meeting #67 for Health in the 41st Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was testing.
A recording is available from Parliament.
5:05 p.m.
Voices
Oh, oh!
5:05 p.m.
Oncological Pathologist, Department of Pathology, BC Cancer Agency, As an Individual
Sorry.
5:05 p.m.
Liberal
Wayne Easter Liberal Malpeque, PE
Thank you, Chair.
Thank you to all the witnesses on this panel.
I'd like to start with you, Dr. Ricard. Thank you for the reality check. You make a potent point, I think, on the need for funding for research and early detection methods. I can't help but think that in your occupation you would likely be one who would be getting regular checks. That is so different from many in society, who don't get regular checks.
From your experience, or from having gone through what you've gone through, is there anything that you think governments can do, or the health system can do, that would make a difference in earlier detection?
5:10 p.m.
As an Individual
Thank you very much.
You know, I'm in Ottawa, and my health care is given to me by the federal government but we are referred to the civilian side for a lot of the testing. I was in exactly the right place at the right time to get second-to-none care. There was intervention immediately at the Ottawa General, with radiotherapy at 2 o'clock in the morning. You show up in the afternoon, and by 2 a.m. you're getting your first treatment.
Not everybody in Canada can get that, sadly. It is very important that everybody has access to the same quality of care I had—although, even then, the chances are not on my side.
It has to be a program that says, for instance, we will not just look at the fact that you want to have testing. We will have a program, a policy, that says if you're between 55 and 74 and you have been a smoker, we think you are a high-target population and will tell you that you need to have this test done. That way, everybody who can be detected early will be. People themselves won't have to come forward and say “I think I have a little thing here”, “I'm coughing blood”, or something like that.
If it has to come from the population, from the patient, to themselves identify that they have an issue, I don't think it will work that well. It's like self-examination for breast cancer; it's fantastic, but things are missed if you don't do it right. If you have a test that exists, the low-emission CT, and you apply it to people who you know are at risk, then these are, in army terms, high-value targets in effects-based operations.
5:10 p.m.
Liberal
Wayne Easter Liberal Malpeque, PE
Thank you for that answer.
Dr. Pantarotto, you mentioned that in Ottawa, going from an abnormal CT scan to really getting into the system for treatment takes 117 days, I think. I can tell you that's far, far, far better than it is in a lot of regions in this country. I can name my own, Prince Edward Island, as one. We finally just put a second shift on CAT scans, and we've been fighting for that for years.
First, what has to be done and what can be done by governments to reduce those wait times much more?
Second to that, I said in an earlier question that I see it as an investment. I think if you get early detection and early treatment, your expenditures within a public health care system will be a heck of a lot less.
Perhaps you could respond to that.
5:10 p.m.
Radiation Oncologist, Chief of Radiation Oncology, The Ottawa Hospital, As an Individual
Thank you very much for the question.
I completely agree with you. It's far better for the patient if we discover early-stage disease. Our cure rates are much higher; there are better outcomes with earlier-stage disease, and it's cheaper. It's cheaper to treat someone when they have early-stage disease and they're cured. All the costs that go with advanced disease or metastatic disease are avoided. Those costs are tremendous. Forget about the oncologist's cost. Forget about the chemotherapy or radiotherapy costs. It's the costs of visits to the family physician, the emergency departments, the drain on home care. These patients can be quite ill.
To come back to your main point, the role for governments, I think we have to mention prevention. That's key. There's prevention in terms of smoking cessation and there's a lot of literature and a lot of educated smart people around who know a lot about smoking cessation strategies that can work. There's also radon testing and reduction and the idea of having a mandatory test. Should I be able to buy a house without knowing what the radon levels are in that particular house? There should be some sort of registry perhaps, because unless people are forced to do it, I don't think people are going to do it.
Then there's screening, and we talked a lot about screening. The screening needs to be integrated. I think there are a lot of great ideas. For example, we could have a mobile CT scanner. We have to think through all the steps that go with screening. If you find something, it's no good unless we can get a needle into, and we can do a biopsy. Who's going to do that biopsy? If I live in Rankin Inlet and the mobile CT comes to town and they scan me, that's great. There's a higher likelihood that I'll actually participate. But if they find something and it needs to be biopsied, now I need to fly to Ottawa or Montreal, so we need to think that through. Things needs to be integrated, because one doesn't work without the other.
The need for integration is a key finding from our assessment over the last two years in terms of lung cancer wait times in the Ottawa region. In the health care system we don't do a great job of talking to each other from primary care to tertiary care to palliative care and survivor care.
5:15 p.m.
Conservative
The Chair Conservative Ben Lobb
Doctor, the bells are ringing here.
Mr. Young, go ahead and ask some brief questions.
June 16th, 2015 / 5:15 p.m.
Conservative
Terence Young Conservative Oakville, ON
Thank you, Chair.
Thank you, everyone, for your time today.
Dr. Ricard, I want to especially thank you for your courage in coming in and telling us your story today. It's extremely helpful. Thank you.
Dr. Lam, 28% of our young people in grades 7 to 12 smoke marijuana. Some of them will become regular users. At least 5% will become addicted.
We've heard on this committee that marijuana can cause psychosis and schizophrenia in young people and damage the prefrontal cortex of their brains. We know that marijuana has more known carcinogens than tobacco does, but it's very difficult to tie evidence of marijuana use to lung cancer because marijuana users also smoke tobacco. They either roll it together and smoke it at the same time or they smoke it alternately.
What role do you think the regular use of marijuana would play in causing lung cancer?
5:15 p.m.
Chair, Lung Tumour Group, BC Cancer Agency, As an Individual
There is a suspicion that marijuana smoking can also increase the risk of lung cancer, but as you pointed out, it's very difficult to provide evidence for that because people smoke different types of marijuana and the number of joints they smoke also varies from day to day. It's very hard to quantify the amount they smoke in comparison with something like the number of cigarettes.
I have bronchoscoped a number of people who smoke marijuana. They have tremendous inflammation in their bronchial tubes and it leads me to think that they must have caused damage to promote lung cancer.
This is something we need to do more research on to decipher the exact problem with long-term smoking of marijuana.
5:15 p.m.
Conservative
Terence Young Conservative Oakville, ON
Thank you.
Do you think it's likely that marijuana can cause lung cancer?
5:15 p.m.
Chair, Lung Tumour Group, BC Cancer Agency, As an Individual
Yes. Some studies have suggested that marijuana can cause lung cancer. People have now smoked marijuana long enough that we'll start to see an impact of that smoking.
When I went to university in Toronto in the 1960s, people were starting to smoke marijuana at that time. Now it is 40 or 50 years later and I think more people smoke it and we will see a gradual increase in the problem in terms of lung cancer risk.
5:15 p.m.
Conservative
Terence Young Conservative Oakville, ON
Thank you very much.
Dr. Pantarotto, I read about this device called a “CyberKnife”, which is a non-invasive machine with a robotic arm for high doses of radiation targeted at tumours. It looks to me like they're only available in Ottawa, Montreal, and Hamilton.
I represent Oakville. I would like to know if you know why this device is not available at Princess Margaret hospital or in the part of the country I live in.
5:15 p.m.
Radiation Oncologist, Chief of Radiation Oncology, The Ottawa Hospital, As an Individual
We have a CyberKnife here in Ottawa. As you said, it's a robotic unit that gives focused beams of radiation to small targets in the body. In fact, that technique has been a major step forward in the treatment of stage one lung cancer in those patients who, for whatever reason, cannot have an operation.
The answer to your question is that this form of radiation or that technique can be delivered with other machines. In fact, even though we have a CyberKnife in Ottawa, of the 170 patients we treated in the last calendar year with that technique, we actually did not treat them on a CyberKnife. We treated them on another technology that does a very nice job for lung cancer.
5:15 p.m.
Radiation Oncologist, Chief of Radiation Oncology, The Ottawa Hospital, As an Individual
5:20 p.m.
Conservative
5:20 p.m.
Conservative
Terence Young Conservative Oakville, ON
Thank you.
Dr. Ionescu, I was fascinated to hear about the identifying biomarkers and drugs that target cancers. What is the promise of these kinds of treatments for lung cancer patients in the long term?
5:20 p.m.
Oncological Pathologist, Department of Pathology, BC Cancer Agency, As an Individual
As a pathologist, I do not see patients directly, as you know, but just based on the number of phone calls I get from the medical oncologists and their increasing interest in these biomarkers, I think this is their bread and butter. I really think this is the standard of care. I think that as we learn more about lung cancers, we are only going to see more and more drugs in targeted therapy and biomarkers as companion diagnostic tests.
I mentioned previously—and I submitted this in my brief—that if you think of one of those pie charts, we know the type of oncogenic drivers for about 54% or 55% of lung adenocarcinomas. We have the other 46% or 45% to research, and hopefully we can identify biomarkers and drugs that will really work for the patients—and not only in improving their overall survival, but also their quality of life. Indeed, without actually seeing the patients every day, what's important to me is their quality of life. I have learned from my medical oncologist colleagues that they no longer send their patients home by saying, “I'm sorry, but there is nothing I can offer you.” They can actually say to their patients that they can go home with an oral pill, they can swallow that particular pill for several months, and their prognosis and quality of life will be better. They can say, “We know you're going to live longer with your disease.”
5:20 p.m.
Conservative
The Chair Conservative Ben Lobb
Thank you very much. The bells are ringing, and I don't want to get in trouble with the whip's office, so we're going to have to conclude our meeting.
Thank you to the doctors.
We'll see you later. The meeting is adjourned.