Good morning, Mr. Chair. I thank you and the members of the committee for your invitation.
I am going to discuss the impact of COVID-19 on cancer, a chronic disease with acute episodes of care over a long period of time. It is very different from single episodes of care such as orthopedic surgery for hip or knee replacement, or cataract surgery.
The postponement of medical activities has caused diagnostic delays that have major consequences. Indeed, a longer diagnostic delay allows cancer to progress, leading to an increased risk of relapse and a decreased chance of cure. For patients, the consequences are important since it will result in increased morbidity. As patients are sicker and are sick longer, the intensity of treatment required will have to be increased because the disease will be more advanced. The more advanced stage of the disease will also result in higher mortality. Because cancers are diagnosed too late, the impact of the pandemic will be felt for many years, both on patients and on the human and financial resources required by health care systems.
Three things need to be tracked: waiting lists, patients on those lists whose care has been delayed, and diagnostic delays, which are very telling of the real impact.
Let's talk about screening programs first. Patients with symptomatic illnesses come to the emergency room, are seen, and for the most part, are managed. That hasn't changed much. Screening programs, on the other hand, diagnose patients at early stages who do not have symptoms. It is estimated that screening programs can reduce mortality from detected asymptomatic cancers by 20% to 40%. This is because diseases discovered at early stages require much less intensive, easier care. They can be limited sometimes to simple surgery rather than requiring a combination of surgery and chemotherapy.
In Quebec, colon and breast cancer screening programs were shut down in the first wave of the epidemic in March 2020. It has not been possible to catch up diagnostically for these patient cohorts. I will provide data in a few moments.
During the previous sessions, Dr. Bélanger explained the strategy for screening for blood in the stool, occult blood, for colon cancer. Patients who test positive for blood in the stool will undergo colonoscopy, which sometimes reveals polyps, a lesion considered precancerous, or even colon cancer.
Presumably, we are seeing a significant reduction of about 28% in tests performed compared with the previous year. The cumulative backlog, despite the lull in the COVID-19 pandemic over the summer and early fall, has not been cleared. What is known is that the less screening that is done, the fewer diagnoses are made. There are not fewer cancers, it's just that they haven't been screened.
In care-delayed patients, there is less occult blood screening and the number of patients who are found to have blood and to whom we want to offer colonoscopy has increased. So the care-delayed patients represent significant numbers, on the order of about 152% if you look at the entire cohort.
In Quebec, about 800 fewer colon cancer surgeries were performed this year than at the same time last year. Dr. Bélanger noted that this cancer is the third leading cause of cancer death in Canada. So this is something that has important consequences. Indeed, as the cancer progresses, surgery may become pointless and one must then turn to chemotherapy or radiation therapy.
These observations are essentially the same for breast cancer, where screening is down 30%, so at 70% of the previous year's level. There are far fewer patients diagnosed with the disease at an early stage. For Quebec as a whole, there is currently a reduction of about 22% in the number of biopsies confirming the diagnosis of cancer, the biopsy being the first step in the confirmation of a cancer. This means that for approximately 60,000 new cancer diagnoses annually in Quebec, there is a cancer diagnosis deficit of approximately 10,000 people.
As a result, there are significant delays and timelines for many oncology surgeries are not being met.
In conclusion, we really need to be concerned about these delays, because patients and society will pay the price. For 13 of the 17 cancers that were studied, a four-week delay in diagnosis increased the risk of mortality by 6% to 8%.
For colon cancer, each four-week delay in diagnosis increases the risk of mortality by about 6%. For breast cancer, the increase is 8%.
British epidemiologists estimate that the mortality rate for cancer patients could be as high as 20% in the next year, but that the price to be paid could extend over 10 years. Indeed, there could be 10% excess mortality per year for the next 10 years.
To solve this problem, we must preserve human resources. As Dr. Belanger mentioned to you, we need significant additional investment to ensure that we have the human and material resources to provide the therapies that patients need.
I have appended several charts that come from the Quebec Ministry of Health and Social Services that give examples of delays in diagnosis and delays related to the various tests that I mentioned.