Health Committee on Feb. 12th, 2024

[Andréanne Larouche, Bloc, Shefford, QC]

I'd like you to tell us a little more about what was proposed in the 2019 Budget. I'm talking about the $10 million over five years that was provided to Ovarian Cancer Canada starting in 2019‑20 to address existing gaps in knowledge and effective options for the prevention, screening and treatment of ovarian cancer. All of that is more difficult, as you explained so well in your remarks and in your answer to my question.

According to the brief submitted to the committee by Ovarian Cancer Canada, and according to the explanation you provided to my colleague who wanted more details on the $10 million, that investment helped fund research that led to new discoveries that would help people with ovarian cancer live better and longer.

Can you tell us a bit more about the research projects that have been funded as a result of this investment, as well as their outcomes?

[Dr. Gillian Hanley]

I would think that Tania would probably have much better information about the specific projects than I do.

[Tania Vrionis]

I'm happy to jump in.

As I mentioned, we were able to fund.... We currently have five clinical trials ongoing right now, all testing new and novel treatments. There is one that is launching very soon out of British Columbia that is going to challenge the way that a certain type of ovarian cancer is treated. It will be very interesting to see the results of that—giving PARP inhibitors first, prior to surgery or any other type of treatment, along with a treatment regime of three different types of drugs.

There's also been a really fantastic study in Montreal testing vaccines as treatment, and we're seeing real promise in that.

We have the five clinical trials, but we've also had those 13 preclinical studies, with the ultimate goal in those to lead to clinical trials and be able to bring more treatments to patients faster.

Then, of course, we have the core in the 25 projects based on model development, helping scientists understand how the disease is responding to different types of treatments and responses.

There is a lot of incredible work going on, but this has only been happening for five years. That's a really short time in the span of research. Just to put it in context, 25 years ago there were only three ovarian cancer scientists in all of Canada. Today there are 250-plus. We have some ground to make up, but we're making it up. However, it can only continue with the necessary funding in order to drive that forward.

[The Chair, Liberal, Sean Casey]

Thank you very much.

Next we have Ms. Barron, please, for six minutes.

[Lisa Marie Barron, NDP, Nanaimo—Ladysmith, BC]

Thank you, Chair.

I'm happy to be sitting in on this committee today, as this is a big opportunity to finally be talking about an issue that has not been prioritized for a long time. For us to gather today to talk about women's health, specifically gynecological health, makes it a great day for me to be here.

I have some questions that I'd like to go through.

First, Dr. Dinh, I believe it was you who had said that 6.5 million Canadians do not have access to a family doctor across Canada. I'm wondering if you can highlight the impacts on women to be able to access the care they need, and also the preventive care they need, when it relates to gynecological health.

[Valérie Dinh]

I'd like to clarify that I'm not a doctor; I'm the Quebec regional director for Ovarian Cancer Canada. In fact, if I may, I'll answer you in French, as a Quebec representative.

We talked about the context of the lack of access to family doctors and its impact on ovarian cancer. Women who don't have a family doctor and are diagnosed with ovarian cancer often find themselves in emergency situations. They are diagnosed later, which is associated with a poorer prognosis and a lower survival rate.

In addition to the issue of access to family doctors, it's also important to talk about raising their awareness of the symptoms of ovarian cancer so that they can properly recognize the symptoms, which are very vague and not specific. Once they've recognized the symptoms, they need to order the right tests so that patients are referred to a treatment centre and can be followed in oncology gynecology.

[Lisa Marie Barron, NDP, Nanaimo—Ladysmith, BC]

I can't ask my question in French because my French isn't good enough, but I understood your answer. Thank you very much.

My next question is to Dr. Hanley or perhaps Dr. McAlpine. It's to whoever is best suited to answer it.

We've been talking a lot today about the importance of national standards when it comes to women's access to health care services and also with regard to prevention and diagnosis, and I'm wondering what impacts you could foresee if there were stronger national standards in place, and specifically how would that trickle into the care available in British Columbia.

Are there any specific impacts or benefits that you can think of to having a national standard in place, rather than a patchwork approach in which the health care differs from province to province?

[Dr. Jessica McAlpine]

That's a wise question, and you've hit the nail on the head. I think it would go tremendously far.

What you've heard about today from all of us—and again, it's lovely to be on this panel with so many people we respect and who are all working toward the same goals—is that yes, there are things that just make sense to everyone, I'm sure, who is in the room there. There are things that are actually scientifically validated, that resonate with patients but are not universally implemented and are needing that guidance of what we call a knowledge translation and making sure people understand the value of it. Whether you lead them with a carrot or a stick or you set out guidelines that have to be followed, those are what help enable things to happen.

I'm incredibly distressed that a patient who is a 10-hour drive from me may have a conversation with their physician that is different from the one I have with the patient around the corner. I think we do a very good job of centralized care in cancer centres, but there are still challenges. There are differences in communities' awareness of disease and how to treat it, and I think national guidelines would go tremendously far in helping to say that this is the gold standard and let's all try to rise up to it.

[Dr. Gillian Hanley]

Yes, and I think the research that we've done nationally looking at differences and variation in uptake of opportunistic salpingectomy is really clear.

If there were national standards and opportunistic salpingectomy was being done at the same rate in other provinces in Canada that it's being done in B.C.... There are thousands of women who are going to get an ovarian cancer diagnosis that they do not need to get. They had an opportunity to have that cancer prevented and it was not taken, and that's just not acceptable. Women, wives, mothers, sisters, friends are going to die of this disease, and it's just not necessary.

[Lisa Marie Barron, NDP, Nanaimo—Ladysmith, BC]

Thank you. It looks like this will be my last question, so perhaps I'll keep it quick.

To follow on that, Dr. Hanley or Dr. McAlpine, there was some mention today of the HPV self-screening happening in British Columbia. Can you provide some insights, since you are in British Columbia, on how that's going and how this might help to support increased screening for those who may not have access to health care for various reasons? Are there any other examples we might see that are similar to this?

[Dr. Jessica McAlpine]

We're really excited and proud in British Columbia with the self-screening. As you can imagine, it helps to reduce the barriers of tremendous geographic distance, history of trauma, those who have traditionally not been within the screening system, and the disproportionate number of minorities not getting screened. All of these opportunities are there, and it has been embraced incredibly well—even by people who have not yet entered the screening age group—with regard to how approachable and surmountable it seems now.

I think we're getting there in some other disease states as well. I'm proud to say that we have free testing for molecular classification in Canada and, again, some of the other initiatives we talked about, so we are feeling that there's empowerment in a community eight hours from Vancouver to try to do these things. We have molecular stratification in other cancers that are underfunded, like vulvar cancer 2, where we're getting to tools with more precision.

I think we can get there. I think we just have to make sure that it's across the whole country and that there is enthusiasm as well as and education for the value added.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. McAlpine and Ms. Barron.

Next is Ms. Goodridge, please, for five minutes.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

Thank you.

I want to sincerely thank everyone for being part of this study and helping to make life better for women and girls and for Canadians in general.

At the back of our room here, I see a group of young women, and I was wanting to perhaps open this up.

Dr. Salvador, if you could give some advice to the young women at the back of the room and young women across Canada, what advice would you give them?

[Dr. Shannon Salvador]

I think the most important thing you can do is ensure that you're educated about your own health and what's available for you, and also what should be available for you, because sometimes what you don't know is what you should know. What can you do to improve your health? What is up and coming in the world?

It's about ensuring that you have done everything you can to maximize your health, that your vaccinations are up to date and that when you're going to see a health care professional, you have an opportunity to do some reading beforehand so that you can use the time to ask pertinent questions that are important for you and your family.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

That's wonderful. Thank you. I appreciate that. I think it's very good advice, and I hope all women take you up on that piece of information.

In these conversations, we've had the conversation around the BRCA gene. There are screening tools in place that detect breast cancer. They're not perfect and they're not all great and they're not super-comfortable, but they exist.

What exists, as it currently stands, to take women who are diagnosed with breast cancer to make sure they have some tests done to ensure the cancer doesn't metastasize to gynecological cancers? Is anything happening in Canada that's similar to that?

[Dr. Shannon Salvador]

I can field that question.

I actually sat in with a breast cancer group just at the beginning of the year as they were starting to really ramp up their BRCA testing programs. It's becoming much more permissible to get BRCA testing in breast cancer. It actually used to be fairly strict, and now they realize they should really be augmenting who can get tested. Most programs in each province are opening up about really maximizing the testing.

For breast cancers, they are often doing it with blood testing, but what's interesting is that for our ovarian cancers that are at risk, we actually do tumour testing. We test the tumour itself when we're doing their surgeries. Then, once we know that a particular individual is testing positive for BRCA, whether it's in breast or ovarian cancer, we've been working very hard to try to maximize reaching out to family members and making sure that they know to contact pertinent blood family members so that they can come in and also get testing as well. The best thing we can do for anyone is prevention, by far.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I couldn't agree more.

I've been reflecting this week. It's a tough week. Fifteen years ago this week, I found out that my mom had breast cancer. About 11 months later, she passed away, unfortunately, and she passed away at 49. It was tough for our entire family. Because we lived in a rural and remote community, it prevented her from being able to have good screening early on.

Things have improved substantially in that time frame, but in this area, an ounce of prevention is worth a pound of cure. I'm wondering if anyone can share a bit more about best practices happening across the country that we can look to when it comes to prevention, because that's ultimately going to be where we're going to find help and save lives.

[Dr. Gillian Hanley]

I think there is a lot of really important research happening with respect to BRCA and detecting those mutations earlier. I know there are people who are part of the Gynecologic Cancer Initiative in B.C. who are looking at population-based testing.

We absolutely need to identify BRCA mutations as early as we possibly can in order to offer those people the prevention that we know works in both preventing breast cancers and preventing ovarian cancers.

There is a lot of interesting research happening on how to get people the testing they need as early as we possibly can in order to prevent the 20% to 25% of ovarian cancers in BRCA-mutated people. It should be preventable if we detect those mutations earlier. Unfortunately, often these mutations are being detected at the time of cancer diagnosis. We're really working very hard on ways that we can offer this testing to get those mutation results detected before any cancer has been diagnosed.

[Laila Goodridge, Conservative, Fort McMurray—Cold Lake, AB]

I want to thank you. That's great information.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Goodridge.

Next is Ms. Sidhu, please, for five minutes.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Mr. Chair.

I extend a heartfelt thank you to the panel from all Canadians. Thank you for the work you are doing.

We heard that eight women a day are diagnosed with ovarian cancer and 75% of them are in fourth stage. Definitely, women deserve better. Hearing that BRCA mutation is the only cause, and if the Pap test is not underlying, we can test for that, do you think the guidelines need to be changed?

My question is for Dr. McAlpine.

Can you say something about that? How can we protect women with ovarian cancer who are in the fourth stage and help them survive?

[Dr. Jessica McAlpine]

You're right. We don't have screening like we do for cervical cancer. We don't even have a heralding symptom like endometrial cancer, where you might spot or bleed. Usually when you have symptoms with ovarian cancer, it's already at an advanced stage.

There are very good international studies done in the U.S., the U.K. and Japan, none of which showed screening had a large enough impact on identifying people. That's really why we shifted our energies into prevention.

We talked a lot about BRCA. That's 20% of high-grade, serious ovarian cancers. That leaves 80% of patients who don't have a family history who are out in the community. They are what we call general risk. That's where we think we need to actually put our energies and motivation. When those individuals are having a surgery in their abdomen, we've moved from focusing initially on gynecologic surgeries: If you're getting a hysterectomy but they're going to leave the tubes, why don't you remove the tubes so that the cancer never develops?

We're also now moving into the general surgery forum. If you're getting gallbladder surgery or a colorectal procedure, your tubes are there and they are accessible. You have a skilled surgeon in the room. Can we remove those tubes so that the individual, 15 years later, doesn't develop ovarian cancer?

Otherwise, we're very challenged. We don't have a magic screening tool in our pocket.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

[Dr. Gillian Hanley]

Can I add one thing to that?

Jessica did a wonderful job, but one thing I also wanted to mention is that we are now moving the research as well to try to target people who are at higher-than-average lifetime risk for ovarian cancer who might want to come in for a Fallopian tube removal surgery in order to prevent it. That's not because they have a BRCA or another genetic mutation, but just because we're able to predict risk for ovarian cancer reasonably well and identify a subset of people who could benefit from Fallopian tube removal to prevent their cancer.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Ms. Vrionis, your data suggest that only 35% of patients had prior knowledge of ovarian cancer. The majority either had limited awareness or had never heard of it.

What recommendation do you have to promote patient engagement and increased awareness about this disease to improve the chance of early detection?