Good morning.
I am the President of the Quebec Association of Gastro-Enterologists. I represent 273 members. As medical specialists, we investigate and treat digestive diseases. We are the only doctors fully trained in digestive endoscopies, specifically those needed in the prevention of colon cancer.
Endoscopy is a way of exploring the interior of cavities in the human body. Our practice includes colonoscopies to study the colon and gastroscopies to study the stomach. Thanks to recent technological advances in endoscopy, we are able to use the patients' natural passages to conduct procedures, to take samples, to remove lesions and thereby to avoid classic surgery. These are short procedures, often taking less than an hour, needing no general anaesthesia, no hospitalization and no recovery time. The estimated cost of a colonoscopy in Quebec is less than $1,000.
Colonoscopy plays a crucial role in preventing colon cancer. This cancer is the third most frequent and the second most deadly in Canada. According to the Canadian Cancer Society, each year, 27,000 Canadians are diagnosed with it and 9,700 die.
Colon cancer is unusual in that it can be prevented. This distinguishes it from the early detection approach used in the case of breast and prostate cancers. Colon cancer screening, using colonoscopy with some of the patients, allows lesions that are still precancerous to be removed. Patients therefore develop no cancer at all, preventing surgery, chemotherapy and mortality. The science proves that colon cancer prevention programs reduce the incidence, the severity and the lethality of this very frequent cancer that affects men and women almost equally, starting in the 50s, and sometimes earlier.
Quebec is the only province yet to have an official program of colorectal cancer screening. Patients therefore must take action themselves and ask for a referral for an iFOBT test, also known as a FIT Test. This test is recommended for all Canadians 50 and older. It requires a stool sample and looks for the presence of microscopic traces of blood, blood that is invisible to the naked eye. If blood is detected, the patient is then referred for a colonoscopy. Five per cent of all iFOBT tests are positive, meaning that the same number of colonoscopies are necessary. They are recommended within eight weeks at the most, in order to prevent the lesions progressing during the waiting period.
Of the patients with a positive iFOBT test, 35% will have polyps, or precancerous lesions that can be removed to prevent cancer, and from 6 to 8% will already have cancer, but with no symptoms.
Before the pandemic, about 22,000 colonoscopies per month were performed in Quebec. Since March 2020, access to colonoscopies has been significantly reduced, which has had a major, negative effect on the number of polyps and cancers detected. Because of the marked reduction in endoscopies during the first wave, followed by a recovery that is still incomplete today, only 73% of the number of colonoscopies performed in Quebec in 2019 were done in 2020. So more than 63,000 fewer colonoscopies were performed during the pandemic, meaning that we currently have a backlog of more than 110,000 colonoscopies in Quebec, 63% of which are late.
A lot of catching-up will be required to slow the increase in the number of cancers, and of deaths from colon cancer.
At the moment, gastroenterologists do not have the human resources or the access to the equipment they need to start catching up.
We propose three solutions. First, we believe that new, fully functional endoscopy rooms must be quickly established. Second, specific budgets should be provided exclusively for endoscopy units, as they already are for emergency rooms and operating theatres. This will prevent hospital budgets being cannibalized by other more sensitive areas. It will also allow the specialized nursing staff to become more stable, thereby increasing productivity. Third, we must have reasonable investments in patient follow-up and in quality control.
In conclusion, I hope I have shown you that thousands of silent and asymptomatic Canadians are our patients of tomorrow. We should not let urgency outweigh importance.
Thank you for your attention.