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.
Conservative
The Chair Conservative Ben Lobb
Good afternoon, ladies and gentlemen, and welcome to our committee. We're kicking off our two-meeting study of lung cancer in Canada. We have two groups here this afternoon from 3:30 to 4:30. First up we have Dr. Paul Wheatley-Price and Dr. Natasha Leighl.
You have 10 minutes, so go ahead.
The Clerk of the Committee Mr. Andrew Bartholomew Chaplin
They're presenting as individuals, so each gets 10 minutes, but they're coordinating their presentations.
Conservative
Dr. Paul Wheatley-Price Medical Oncologist, The Ottawa Hospital Cancer Centre, As an Individual
Thank you very much, Mr. Chair, for this opportunity.
As you're aware, nearly half of all Canadians will develop cancer at some point in their lifetime and of these, lung cancer is the most common cancer in Canada. It's by far the biggest cause of cancer deaths in Canada and worldwide. In 2012, the WHO reported that lung cancer is the fifth-leading cause of mortality worldwide after ischemic heart disease, stroke, chronic obstructive pulmonary disease, and pneumonia. In Canada this year we expect over 26,000 cases of lung cancer and nearly 21,000 deaths. To put that in context, the four most common cancers in Canada are lung cancer, colorectal cancer, breast cancer, and prostate cancer, but lung cancer will kill more Canadians than those other three combined.
We don't usually think of lung cancer as a woman's cancer, but lung cancer will kill more women in Canada than will breast cancer, ovarian cancer, cervical cancer, and uterine cancer combined. In other words, it's a major cause of morbidity and mortality in this country, and as has been widely reported, the Canadian Cancer Society is predicting that overall the number of cancer cases is going to increase by up to 40% over the next 15 years, not due to an increase in individual risk but rather given an increase in the Canadian population and the aging of the population.
Unfortunately with lung cancer, the vast majority of patients are diagnosed when their cancer is already at an advanced and incurable stage. As a result of that, we see that lung cancer has one of the lowest survival rates of all cancers. Currently about 18% of patients with lung cancer survive five years after their diagnosis. That being said, there are some real grounds for optimism in the treatment of lung cancer. The first one I would bring to your attention is that lung cancer screening strategies to identify lung cancer at an earlier stage in individuals who are yet to develop symptoms may reduce lung cancer mortality by up to 20%. That would represent around 1,250 lives a year saved in Canada.
We are seeing other advances. The molecular profiling of lung cancers means that we can now identify, if you like, a genetic fingerprint of a cancer. We recognize that lung cancer is not just one disease but a myriad of a number of different subtypes and for many of those, we now have a drug that can target the particular type. A little bit later you're going to hear from Colonel Jacques Ricard, who is a physician in the Canadian Forces as well as a lung cancer patient and a beneficiary of one of these new molecularly targeted agents.
Very recently we've been hearing in the news about immunotherapy as the most exciting advance in lung cancer treatment for some years. The immune system for all of us depends on multiple checkpoints or immunological breaks, and they work to prevent your immune system from over-activating and attacking your own healthy cells. Cancer cells have learned to take advantage of those checkpoints to avoid detection by your own immune system. These new-generation immunotherapy drugs affect these checkpoints, essentially unleashing the breaks to attack the lung cancer cells. We've had some very positive news just in the last couple of weeks about a new drug that's already had FDA accelerated approval in the States and we'd like to see it coming to Canada as soon as possible.
You may hear from Dr. Pantarotto, my colleague and also a radiation oncologist, about some of the new and exciting technologies for delivering radiotherapy for very focused and precise treatments. There is optimism, but that optimism is in the context of a disease that is extremely deadly.
Dr. Leighl and I both volunteer for an organization called Lung Cancer Canada in addition to performing our clinical and academic roles. Lung Cancer Canada is a national charitable organization that aims to increase awareness, patient support, advocacy for the families of patients with lung cancer. We're hoping, and have been engaging with members from the federal government over the last year or two, to try to develop some programs.
That leads me to what we would like to see as a possible role for the federal government in lung cancer. We would respectfully ask the standing committee to seek ways federally to support lung cancer. For example, provide leadership in raising awareness about a deadly disease and in tackling stigma, which Dr. Leighl will talk about, while continuing to work towards a smoke-free Canada. Collaborate with organizations such as Lung Cancer Canada in developing lung cancer programs for the populations that the federal government is responsible for. You'll hear a little bit later from Dr. Stephen Lam from British Columbia about a potential screening program for veterans.
We would ask you to consider giving guidance to Health Canada, CIHR, and the Public Health Agency of Canada to provide proportionate research funding. You will hear a little bit from Dr. Leighl again about our concerns around the disproportional assistance that lung cancer receives. We would like to see Health Canada give regulatory approval to lung cancer drugs.
Anecdotally, we feel that lung cancer doesn't get the same attention as some other cancers and illnesses. We would ask you to consider using some examples from perhaps the U.S. In 2013 the high mortality cancer bill was passed. It focuses primarily on cancers with high mortality rates, primarily lung cancer and pancreatic cancer.
Those are my comments. Thank you for the time.
I'll now pass it over to Dr. Leighl.
Dr. Natasha Leighl Associate Professor, Lung Site Lead, Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, As an Individual
Great.
Thank you so much. Paul and I are honoured to be here to address the committee. We both are medical oncologists at separate institutions. We treat lung cancer. We have an interest in the treatment of lung cancer. We also volunteer with a charitable organization, Lung Cancer Canada, devoted to supporting people with lung cancer.
As you've heard from Paul, this is a major public health problem. I want to talk a bit more about the toll this has on people who are diagnosed with lung cancer here in Canada. I also want to talk about what holds us back from progress, the very low survivorship rate, and the stigma, which I'll touch on a bit more. This results in a disproportionate amount of public support for people diagnosed with this disease and their families, and a disproportionate amount of research funding. Like Paul, I want to highlight some of the opportunities where we think this group can really help us change outcomes for people with lung cancer in this country.
Lung cancer, as you've heard, is, sadly, the number one cause of cancer in the country. I am quite competitive, but to be number one in this is difficult. Lung cancer is, sadly, far and away the leading cause of cancer-related death.
Although 80% more women die from lung cancer than breast cancer, breast cancer is the women's cancer here in this country. Over 200% more men die from lung cancer than prostrate cancer, and yet prostrate cancer is the cancer people remember on Father's Day and associate with the men in their lives. We feel this really does need to change. It's estimated by Statistics Canada that cancer remains the leading cause of death for Canadians, but lung cancer by itself causes one in fifteen deaths: 8% of Canadians who die every single year die from lung cancer. That's really second only to cardiovascular disease.
Who gets lung cancer today in Canada? Of course, we do see people with smoking histories: 15% of the patients I see smoke currently. But the vast majority, over 60%, have quit smoking at some time, anywhere from the year before diagnosis to as many as 60 years before. A growing proportion of people—in my practice it's up to 25%, and in other people's practices it's as low as 10% to 15%—were never smokers, and never had that association with tobacco.
Most people, 75%, are diagnosed as already at an incurable stage, which I think really speaks to some of the lack of early detection here in this country and some of the lack of awareness of how we can find lung cancer early.
At least half of the people I meet with lung cancer in my clinic must quit working. Only about 15% are actually able to continue to support their families. Lung cancer is a major cause of financial distress for families in this country. More than a third of patients perceive that this has a devastating impact on their family and their finances. We know that people with lung cancer—this is from a study in the U.S.—have a higher rate of bankruptcy than do people without cancer. Of all the cancers surveyed, lung cancer actually has the highest bankruptcy rate. I'm hoping you get a sense of the devastation that lung cancer inflicts not only on an individual but also on a family.
We've also learned that many of the people we diagnose with lung cancer are diagnosed too late to receive treatment. Through some work we've done and recently published, we've found that only a quarter of people diagnosed with advanced cancer are actually well enough to have some of the incredible therapies that Paul has just talked about. Again, this really speaks to the need for early detection and a shift in our mindset to how and when we diagnose this disease.
This is really a high-mortality cancer. Although the five-year survival in lung cancer has risen to 18% with a lot of effort, it's 88% for breast cancer, 95% for prostate cancer, and 65% for colon cancer. You can see the huge disparity here in survivorship alone. With low survivorship, we have a very low voice for advocacy. There's also stigma, the very common public perception that if you have a diagnosis of lung cancer, you smoked, and so you deserve it.
Some of the low survivorship is because of the late detection. I think you'll hear later from Dr. Stephen Lam about the availability of organized screening that, for those at high risk, can significantly reduce mortality potentially to a greater extent than currently existing screening programs for such things as breast cancer and cervical cancer.
This is a virulent disease. While we are making progress, it has a very high case-fatality rate. Currently, most people diagnosed do die. There's a real lack of research funding. The Charity Intelligence Canada report from 2011 suggests that only 7% of the national research funding goes to lung cancer, despite causing 27% of the cancer deaths in this country, and less than 1% of the public donations. I think that speaks volumes about the stigma.
Some of the other work we have looked at suggests that even though lung cancer funding is increasing—between 2005 and 2010 it doubled from $10 million to almost $22 million—it's still only a fraction of the $536 million that was spent on cancer research that year. Again, you can see that's only 4% for a cancer that takes the lives of more than one-quarter of Canadians who die from cancer.
I also looked at just this past year, and CIHR, the Canadian Institutes for Health Research, awarded five grants for lung cancer research, for a total investment of $230,000 per year. That's an organization with $1 billion budget to fund research on all diseases in this country. When we compare this to the situation for breast cancer, over the past five years we've seen over 500 grants for breast cancer research worth over $140 million; by contrast, for lung cancer research there were 159 grants worth $39.6 million. Again, that's a disproportionate amount of funding and support.
At Lung Cancer Canada we conducted a survey. We asked 1,600 Canadians online what they knew about lung cancer, and half of the people did know someone who had had lung cancer. Only one-third knew that it was the leading cause of cancer-related death. Again, most women thought breast cancer was the leading cause for women and prostate cancer the leading cause for men. Most people, including smokers, had not spoken to their doctor about their risk for lung cancer, and only 2% knew that there was a lung cancer awareness month, November.
The association with smoking was very well known, but as you'll hear about later, there are other important risk factors such as radon, and only 1% of the people we surveyed correctly identified that as an important cause of lung cancer, and only 7% of homeowners had had their homes surveyed for radon exposure.
Two-thirds of the people we surveyed felt that people were very responsible for what they'd done to themselves because of their smoking habit, but instead of identifying things like heart disease or even other cancers as a consequence of smoking, which we know they are, they felt that people with lung cancer were the least deserving of their support, and certainly, smokers were the least deserving of sympathy, followed by those who drink too much and overeat. Again, there seems to be this disproportionate stigma against people with behaviourally related cancers and those who have smoked, and for all of those tobacco-related diseases, including heart disease and others, the burden of the stigma really seems to be aimed at people with lung cancer.
So what about screening? About one-quarter of Canadians know that there is a screening test for lung cancer, and 90% said they would support a national screening program for those at high risk. Currently we know that screening is approved and funded south of the border, in the United States. It's been estimated by the Canadian Partnership Against Cancer that 1,250 Canadian lives could be saved every year through the introduction of screening programs. I think this really has a dramatic potential to change survivorship rates.
With that, I want to again highlight some of the priority areas in which I think this group could really help us. We need national leadership to raise awareness and to really raise sympathy, tackling stigma while still working towards a smoke-free Canada. We need a national mandate to reduce lung cancer mortality. The United States has a bill to decrease the incidence of lung cancer mortality. I think we have a similar challenge here in Canada and a similar need. Through the establishment of screening we can really change the face of this disease, change the survivorship rates, and make a major change to the progress we can make in lung cancer. We also need to have a mandate to increase national research funding to an amount proportional to the impact of this disease on our citizens, and also to increase the chance of curing more people with lung cancer here in this country.
We need our own national campaign to combat high-mortality cancers, and the highest of these is lung cancer. Thank you.
Conservative
The Chair Conservative Ben Lobb
Very good. Thank you very much.
Next up, from the Canadian Cancer Society are Rob Cunningham and Robert Nuttall.
Go ahead.
Dr. Robert Nuttall Assistant Director, Cancer Control Policy, Canadian Cancer Society
Thanks.
I'm Robert Nuttall. I'm the assistant director of cancer control policy. I'll be doing the presentation, but my colleague, Rob Cunningham, a senior policy analyst with the society, will also be here for the question period.
Chair and committee members, I want to thank you for the opportunity to talk to you today about lung cancer. We're here on behalf of the Canadian Cancer Society, a national community-based organization of volunteers whose mission is to eradicate cancer and enhance the quality of life of people living with cancer.
As you've already heard, lung cancer is a significant contributor to the overall burden of cancer in Canada. It's a major concern for our organization. Lung cancer is the most common cancer diagnosed in Canada. It is expected that 26,600 new cases will be diagnosed this year. As well, as we've heard, the five-year relative survival rate for lung cancer is among the lowest of all cancers at 17%, whereas the overall survival rate for all cancers combined is 63%. This year, we expect 20,900 Canadians to die from lung cancer. As we've heard, that's more than the number who will die from breast, prostate, and colorectal cancers combined.
While these numbers are substantial, we have been seeing progress in the fight against this disease. Incidence rates for lung cancer among males have been declining since the 1980s, and the incidence rates for females have finally stopped increasing. This is a reflection of the past trends we have seen in tobacco use. However, even though smoking rates are dropping, 19% of Canadians continue to smoke.
Smoking is the leading cause of lung cancer. It's responsible for more than 85% of all cases, but a number of other factors also cause lung cancer, and these factors can also increase the risk of cancer in people who are smokers.
One of the most significant is radon. It's a colourless, odourless, radioactive gas found naturally in our environment. It's estimated that about 16% of lung cancer deaths in Canada are due to radon. That's more than 3,000 deaths a year. The health concerns from radon are primarily around radon in indoor spaces, where radon can accumulate to high levels. Health Canada has recommended an indoor radon limit of 200 becquerels per cubic metre, although it should be noted that there is no known safe level for radon.
Awareness of radon among Canadians is low. Last fall we did a survey of Canadians and found that only 32% of Canadians were somewhat or very familiar with radon. Sixteen per cent of Canadian had not even heard of it. Testing one's home is the only way to know if a home has high levels of radon. Our survey found that 96% of Canadians have not tested their homes. When asked why, the main reason, most said, was that they had never thought about it. This shows the importance of raising awareness about radon.
The society appreciates the work that Health Canada is doing to raise awareness through their support of the national “Take Action on Radon” campaign, but there are a number of additional initiatives that can take place at the federal level to minimize people's exposure to radon. These can include financial incentives, such as support to homeowners to lower radon through mechanisms such as tax credits; reviewing the radon guidelines set by Health Canada to consider whether 100 becquerels per cubic metre would be appropriate; reviewing national building codes to consider new measures for new home builds; and ensuring that public buildings get tested for radon and mitigation is undertaken when levels are above the Health Canada guideline.
Another major cause of lung cancer is asbestos. Although we no longer have operating asbestos mines in Canada, many workers continue to be exposed to asbestos currently used in products and buildings or through imported raw asbestos and asbestos-containing products. There's still more work that can be done to further reduce exposure to asbestos. This could include developing and maintaining registries related to asbestos, such as building registries that provide a public record of buildings that contain asbestos, and disease registries, so that we know how many Canadians are exposed to asbestos through their workplaces. As well, we'd like to see a phase-out of new asbestos products to ensure that for Canadians future exposures to asbestos do not occur.
In addition, there are a number of other workplace chemicals that cause lung cancer. The sectors that tend to be most affected by these chemicals include the construction and manufacturing industries. The strategies needed to protect workers will vary depending on the specific substance. However, we need workplace policies in place that strive to reduce exposures or that completely eliminate exposures whenever possible.
Another risk factor that we're paying attention to is air pollution. In 2013 the International Agency for Research on Cancer classified outdoor air pollution and particulate matter within air pollution as known carcinogens. Air pollution is a difficult term to define precisely, as it comprises many different components and a wealth of independent factors like weather fluctuations and nearby industries. There are several components within air pollution that are known to cause cancer, such as diesel engine exhaust, benzine, some volatile organic compounds, and other compounds
Protecting Canadians from air pollution can be done through initiatives that monitor releases, reduce emissions, and track diseases in affected communities.
Our organization is also a major organization in research funding. Last year we provided $5.1 million to fund a broad range of lung cancer and smoking-related projects across the country. Some highlights of what we're funding include research to identify genes that might make people more susceptible to lung cancer, particularly among non-smokers; a model that will provide new insights into how lung cancer starts; research on cancers due to working in the mining industry; and a new type of immunotherapy that can target a tumour's microenvironment.
There are two other projects I want to highlight. One project we're funding on occupational cancer in Canada will identify the number of cancer cases due to workplace exposures as well as the economic costs associated with these workplace exposures. The second is more of a population-based approach, looking at the number of cancers in Canada due to lifestyle and environmental factors. Both studies will give us a much better understanding of how many lung cancers in Canada can be prevented.
Your group is also interested in emerging best practices around screening and early detection. As you'll probably hear over the next couple of days, a pivotal study from the U.S. shows a 20% reduction in lung cancer mortality among people who are screened using a low-dose chest CT. The study involved more than 53,000 people between the ages of 55 and 74 who had a history of smoking. Lung cancer screening has the potential to reduce the number of cancer deaths in Canada. It also has the potential to have an impact on the costs associated with treating cancer. This will need to be weighed against the costs of implementing and running programs. Unlike other screening programs that target an entire population within a certain age range, lung cancer screening is most effective when done in a high-risk population. That will make recruitment and participation difficult.
Lastly, we know that smoking cessation is very effective at reducing lung cancer deaths. Lung cancer screening programs should aim to integrate with smoking cessation programs.
A number of initiatives are currently taking place across the country to help planners and decision-makers understand lung cancer screening. The Canadian task force on preventive health care is currently developing recommendations for lung cancer screening. A pilot study on lung cancer screening is currently under way in Alberta. A network convened by the Canadian Partnership Against Cancer brings together experts, including representatives from the society, to share information on the issue. This group was involved in developing a lung cancer screening framework for Canada, which is a tool used to support jurisdictions in their deliberations and/or planning for lung cancer screening. We want screening programs to exercise due diligence in assessing the impact of lung cancer screening to ensure that programs are developed in a responsible and evidence-based way.
Finally, as we've already heard, there is the stigma of lung cancer. The prevailing stigma is that lung cancer is a self-inflicted disease caused by smoking. This stigma is a common experience with lung cancer, and can result in psychological distress and lower quality of life for patients. A study of health care professionals, administrators, and not-for-profit organizations that was done in Ontario just last year found that lung cancer patients feel guilt and shame due to the stigma associated with their disease. Some participants reported that they felt lung cancer stigma resulted in reduced patient care and reduced funding for lung cancer compared with other cancers.
I want to end on something that somebody posted on our website. We have a website called CancerConnection.ca, an online peer support community for people with cancer. One woman wrote the following:
I am a 58 year old woman who started smoking at 13 when everybody smoked and was only finally able to quit just before the lung biopsy that confirmed I had lung cancer in January 2014....I told only essential people at work because I was embarrassed and I am still grateful that I have not had to go back yet...to face the questions. In a relatively small company of less than 200 employees, in a 5-6 year period I had 5 former co-workers, all women, die from lung cancer—smokers, non-smokers, former smokers. It doesn't matter. Lung cancer is a very deadly disease....The stigma is HUGE! No one deserves cancer.
In conclusion, lung cancer is the leading cause of cancer in Canada, responsible for more deaths than breast, prostate, and colorectal cancers combined. Smoking is the greatest risk factor for cancer, but other risk factors that have a significant impact include radon, asbestos, air pollution, and a number of occupational carcinogens. Awareness of radon is low, with only 30% of Canadians somewhat or very familiar with it.
People facing lung cancer often face serious stigma. Regardless of what caused someone's lung cancer, Canadians and their families facing this horrific disease should receive as much support as possible.
Thank you very much.
Conservative
The Chair Conservative Ben Lobb
Thank you very much.
Up first is Ms. Moore, and I believe her questions will be in French. If you need interpretation, you can put in an earpiece to receive it.
Conservative
The Chair Conservative Ben Lobb
I would give you some French, but I'm not going to use it until July.
NDP
Christine Moore NDP Abitibi—Témiscamingue, QC
Thank you, Mr. Chair.
My first questions are about cancer screening. As Mr. Wheatley-Price said, when cancer is diagnosed, it is often no longer treatable. It is actually already difficult to treat or untreatable. So only the symptoms are treated.
I have a question about screening programs. At what age and in what situations are screening tests recommended? Of course, those tests are recommended to smokers, but would it be a good idea to recommend them to welders and people who work in a more at-risk environment? Who should be the focus of the screening program? In an ideal world, of course, at what age would it be preferable to begin with those tests to make sure we identify as many people with lung cancer as possible?
Associate Professor, Lung Site Lead, Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, As an Individual
Thank you. That's an excellent question.
I think Dr. Stephen Lam will outline more of an answer to your question. The best evidence we have for decreasing mortality in people at risk of lung cancer is in people aged 55 to 74 with a significant smoking history, with something that we call “pack-years”, such as 30 pack-years. If you smoked for 30 years at a pack per day, and if you had not quit within 15 years prior to being screened, that's the population where we know most about it. When you look at the ability to detect cancer and what's cost-effective, you might start older; you might start with a higher smoking exposure; you might also add in certain risk factors. I think Stephen will take you through some of the recommendations, but I think the age currently, at the youngest, would be 55.
There are a lot of questions, such as, ““What if I didn't smoke?”, or “What about people with a family history and other occupational exposures?” Currently, the best evidence for that comes from some work done by Martin Tammemägi, a Canadian. He has published a risk calculator, which we can certainly forward to people so they can calculate their risk, but currently the best evidence is in that age group of 55 to 74 with a significant smoking history.
Paul, do you want to add anything to that?
Medical Oncologist, The Ottawa Hospital Cancer Centre, As an Individual
I think that probably covers the main elements.
You'll be aware of the elements that are required for a successful screening program. Those include a population at risk that you can intervene with rather than just diagnosing someone earlier but not being able to change the course of their disease; we have that. There's having a test that is safe and accessible. We have that in the low-dose CT scan. You need to have an effective treatment; we have that. That's surgery, or in some cases radiotherapy for cancers caught at an early stage. The other element is that it needs to be affordable, which is—thankfully for me—your problem, not mine.
CT scans to screen the whole population would be probably unrealistic. The evidence to date is to go for the low-hanging fruit. We know that 85% of lung cancers are related to cigarette smoking, so we screen people who smoked heavily. That's where the benefits have been seen. If we can prove over the coming years that this is effective, affordable, and acceptable to the population and the public purse, then for sure, if there's good evidence, why couldn't we look to expand that to other groups?
Assistant Director, Cancer Control Policy, Canadian Cancer Society
I think the other consideration is that when you're looking at what the right age is, the evidence from the NLST study is that with regard to the 55-to-74 age group and the 30 pack-year criteria, this is where the benefit occurs. So if you were to start, you would start there.
The other issue with over-screening, and we see this for other types of screening, is that we know there are populations where screening doesn't work. A lot of times it has to do with the fact that there are harms associated with it. If you look for something, sometimes you find something that's not cancer, but in order to rule out cancer, sometimes you have to put a person through a lot of what would be considered follow-up tests or biopsies and so on, which potentially put a person at risk for something.
So you want to minimize the harms of screening. You want to make sure you're not finding false positives, which would put somebody through unnecessary surgery or things like that, while still maximizing the benefits. It's always this balance of where you'll get the most benefit in the trade-off with the harms. I think as you look at other age groups or other risk factors, you have the potential, if you don't know there's a benefit, for maybe additional harms. I think those need to be considered in some of the studies.
NDP
Christine Moore NDP Abitibi—Témiscamingue, QC
If a patient who underwent a CT scan for a specific problem had a reasonable risk of lung cancer, would they be advised to check their lungs at the same time?
People undergo CT scans for various reasons. Since they are already at the hospital, could it be a good idea to scan their lungs if they have a reasonable risk of cancer?
Medical Oncologist, The Ottawa Hospital Cancer Centre, As an Individual
Well, it makes sense when you put it like that. A lot of the patients in my practice have been diagnosed with cancer at an early stage for exactly that reason.
I like to tell a story of a lady who went shopping for a turkey for Thanksgiving, and she went to one of those big commercial freezers at the back of the store. She wanted the turkey at the bottom and she fell in and she bruised her ribs. So she went to the hospital because her ribs hurt, and she had a scan and there was a lung cancer. She's been cured because it was caught at an early stage.
It's another step to say she's fallen over and she's banged her knee but she's a smoker, so if she goes to the emergency department as well as X-raying her knee they're going to scan her lungs. I'm not sure if you'd get a lot of buy-in from emergency department physicians, for example. So while when you put it the way you did, it makes sense, I'm not sure that's really the way that clinical medicine is practised. It may fall to a GP—
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
I would like to thank all the witnesses for coming here and being at the committee this afternoon.
The first question I have is for both Dr. Wheatley-Price and Dr. Leighl. I want to go back to statistics. I understand you already mentioned that the majority, or 85%, are smokers, and from what I know, in that group the numbers are more or less equal for men and women. However, in the non-smokers group, I understand that the numbers of women who get lung cancer are higher than those for men. I don't know whether my figure is correct, but I heard about 50% more women than men get lung cancer among non-smokers. I might be incorrect there.
Is there any indication as to why that is so? Have there been any breakthroughs on this issue?
Associate Professor, Lung Site Lead, Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, As an Individual
I think that's an excellent observation. Some published studies suggest, exactly as you've highlighted, that the risk of getting lung cancer in never-smoking women is twice that in never-smoking men. To date there is no conclusive evidence as to why that is. There have been some questions about estrogen and the potential of estrogen and second-hand smoke but nothing conclusive.
We do know that in patients who were never smokers, we are more likely to detect abnormalities within the cancer itself, driver genes, genes that have become abnormal and that drive cancer and then are more susceptible to therapy that targets that particular genetic abnormality. We have seen that, and there are particular kinds of abnormalities that are more common in women, such as a special mutation called the epidermal growth factor receptor.
So we don't know why, but we do see this in clinical practice.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Again with regard to statistics, in the groups that the federal government is responsible for providing health care to, which would be military, RCMP, and aboriginals, are statistics among those groups similar to those for the general public, or is there anything that we should be looking at? Is there anything alarming there?
Rob Cunningham Senior Policy Analyst, Canadian Cancer Society
Well, I can say that for first nations at the moment, lung cancer rates have not yet reached the rates for the general Canadian population; they're actually lower. That's because historically smoking rates among first nations were lower. They're now at 57% as compared to 19% of the general population, but historically they were lower. So I can assist on that part.
Conservative
Wladyslaw Lizon Conservative Mississauga East—Cooksville, ON
Okay.
My next question is about prevention. What should the public know about how to prevent lung cancer? We've heard about smoking and radon gas. Is there anything else in our diet? When you assess patients, are you looking at family history? Is it relevant? Is it not relevant?
Also, I know that time is limited, so therefore I'm going to ask the following question on early detection. I understand that the technology is available. Working with the national framework, there is a pilot project in Alberta that was mentioned and is being done. Once the patient is detected with a very early stage of cancer, what do you do? Do you intervene or not intervene? I've heard that sometimes early detection does not necessarily mean early intervention. How do you deal with it?
Medical Oncologist, The Ottawa Hospital Cancer Centre, As an Individual
On the first question about what should we do with respect to the general public, because smoking is still the dominant risk factor, any strategy that does not include efforts to reduce cigarette smoking will have only marginal impacts. We can educate about radon and some of the measures about asbestos, but ultimately, to make a big impact, I think we still have to focus on cigarette-smoking cessation programs, maybe taxation, and advertising smoke-free zones. My understanding is that a smoke-free Canada is not quite where we want it to be, and there are some provincial differences.
Ultimately, I think smoking is probably still the place where I would target.
