Health Committee on Feb. 12th, 2024

[Tania Vrionis]

That is something we are focused on as an organization—improving that awareness, getting the message out and working with partners in doing that. I think it's really important to elevate this particularly with family physicians when they're recognizing these symptoms.

We do recognize that when a patient is coming in with symptoms, it is likely already late stage just because of the nature of this disease, but it's really important we keep this as a focus and make sure that we are highlighting this for all Canadians. It's an important part of women's health. It's important how it all fits in with our annual conversation with our doctors. Access to care is critical.

[Sonia Sidhu, Liberal, Brampton South, ON]

As a follow-up, research published in cancer research says that the incidence and burden of breast and ovarian cancer vary among racial groups. There's a higher incidence among white women, yet worse survival among Black women compared with other racialized or ethnic groups.

Could you share your insights on treatment based on the demographic factor?

[Tania Vrionis]

Yes. I wish we had more insights, to be honest. I think we're still learning. Again, this is a relatively new area of research that we're trying to understand.

When we as an organization reached out to our community in what we called our Every Woman Study, we actually that found our results came back very homogeneous. We had primarily white, well-educated women responding to our survey. We're working hard as an organization to reach into communities.

We do know, through a number of studies, that there are certainly challenges with culturally safe care. For instance, if ovarian cancer is suspected, what will happen in order to start the process of diagnosis is a pelvic exam, a transvaginal ultrasound and a CA125 blood test. They're quite invasive procedures in order to move this forward, so culturally safe care particularly is a real challenge that women stay away from. We know that a number of women are diagnosed in the ER, which is not ideal as well.

There is a lot that we still need to learn and understand. We're working hard to do that, but there are still lots of unknowns as well.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Vrionis.

[Dr. Jessica McAlpine]

May I—

[The Chair, Liberal, Sean Casey]

I'm sorry, Dr. McAlpine. We're well past time for this round. Hopefully, someone else will allocate some of their time to complete that topic.

Ms. Larouche, you have two and a half minutes.

[Andréanne Larouche, Bloc, Shefford, QC]

Thank you, Mr. Chair.

Some of the witnesses touched on what's being done abroad. I'd like to come back to that with you, Ms. Dinh.

Canadian cancer statistics from 2023 suggest that increased efforts in primary prevention are needed to reduce the risk of developing cancer.

How do primary prevention measures that exist in Canada compare to those in other similar countries?

[Valérie Dinh]

Unfortunately, I'm not the best person to answer that question.

[Andréanne Larouche, Bloc, Shefford, QC]

Would any of the other witnesses have a more international perspective and could answer that question?

[Dr. Jessica McAlpine]

Is that in terms of prevention or in terms of treatment?

[Andréanne Larouche, Bloc, Shefford, QC]

Actually, I'll move on to my next question.

What evidence‑based interventions used in other countries could be replicated in Canada to improve primary cancer prevention for women?

[Dr. Jessica McAlpine]

I guess in some things, I would say, for opportunistic salpingectomy, we're actually the global leaders. The statistics and uptakes on that are fantastic.

Prevention or screening is difficult anywhere in ovarian cancer. I would say that we all globally struggle. There are different models of population-based testing in other countries that I think are good examples and that I hope we move toward, and there's the risk-based assessment that Dr. Hanley touched on. I think some countries have better vaccination rates than we do that could be learned from. Some are worse.

I'll let others comment, but I don't think there's one country that's an example. I would say the defeating thing is that this lack of funding in gynecologic cancers is international, unfortunately.

[Dr. Shannon Salvador]

I would definitely agree with Dr. McAlpine.

[Dr. Gillian Hanley]

I agree with Jessica. As I mentioned in my speaking notes, Canada has really led the world in a lot of gynecologic cancer research and a lot of effective prevention and diagnostics. Endometrial cancer molecular classification started here. Opportunistic salpingectomy started here. With HPV-based screening, we're out ahead again. I think in that sense, we're not missing anything that's been done in other countries, but sometimes other countries have been more effective in ensuring equitable uptake and access.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Hanley.

We're past time, but Dr. Salvador, I don't think your mike activated when you started to speak. Please complete your thought as concisely as possible.

[Dr. Shannon Salvador]

Thank you.

I think the issue is that other countries might have more equal access across their entire country, whereas Canada has disparities, depending on where you are. We're quite ahead in some locations and maybe not so much in others, based on where you might be.

[The Chair, Liberal, Sean Casey]

Thank you.

Go ahead, Ms. Barron, please, for two and a half minutes.

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

Thank you, Chair.

Dr. Hanley, can you tell us a little bit more about the communication strategies that you were referencing in your opening statement?

[Dr. Gillian Hanley]

I'm not an expert on how the federal government could communicate, but I think we have seen examples in the past of the federal government helping to get messages about health and wellness effectively out to all Canadians.

I think that it would be incredibly powerful to use that as a way to get messages out about gynecologic cancer to ensure that Canadians are aware of prevention opportunities like opportunistic salpingectomy and that all Canadians are aware that HPV-based self-screening is available to them. It's not available everywhere yet, but it soon will be.

When that is the case, it will ensure that all Canadians will know that they can order a test kit to their house, do this in the comfort of their own home when they want to, and know that this is more effective than Pap testing in terms of screening for cervical cancer. I think there's a tremendous opportunity to communicate these really important messages to Canadians.

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

Thank you.

Dr. Vrionis, can you tell us a little bit more about the importance of appropriate training and professional development so that we continue to have practitioners with the most up-to-date information who are able to work together and ensure that the information is transferred to new practitioners coming into the field, and so on? How does that all relate to our moving forward in a more effective manner?

[Tania Vrionis]

I will certainly share a brief comment. I'm also not a doctor, so I might ask Dr. Salvador to comment on this.

I would say that we do know, particularly with family physicians, that many of them will not see a case of ovarian cancer in their lives. We've worked as an organization to create some connections between upcoming medical students and patients who are living with the disease. Because they don't see it that often, it's not something that is necessarily easy to detect.

I want to allow the expert to comment on that, if I may.

[Dr. Shannon Salvador]

When it comes to training gynecologic oncologists, quite frankly, we are an incredibly tight community. There are not many of us in Canada. I don't think people quite understand. We're talking about 250 gynecologic oncologists serving the entire population of Canada. We're training probably about anywhere from five to 10 per year. I know all of them personally. They trained me, and I've gone on to train the next generations of groups.

The field is becoming more and more complex. This is where we need the help, which traditionally hasn't happened before, to bring more medical oncologists, nursing staff and family physicians into our field of practice. We have some very dedicated medical oncologists who have been with us for the last 40 years. We're trying to get the next generation of medical oncologists to become interested in gyn-onc, which has sometimes been deemed not quite as exciting, because maybe they're not doing the most exciting treatments that they might see while they're treating their lung and colon cancers, melanomas and things like that. We are now breaking into that, and we really need our colleagues' assistance to come and join us here.

When it comes to training, the gyn-onc group people are very tight within themselves, but we need to start bringing in medical oncologists, family physicians and nurses to join our team.

[The Chair, Liberal, Sean Casey]

Thank you, Dr. Salvador.

Next is Dr. Ellis, please, for five minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you very much, Chair.

Thanks, everybody, for being here.

I had a couple of questions around potential years of life lost. For me as a family physician, that always had significant meaning. Often we talk about cancers happening in older folks, but aside from endometrial cancer, of course, gynecological cancers specifically have a significant impact on mainly young and middle-aged women.

Dr. Salvador, do you have some comments around that?

[Dr. Shannon Salvador]

Cervix cancer has some of the potentially largest impacts on that. Most women who are diagnosed with a cervix cancer are usually between the ages of 45 to 55. These women are in the prime of their lives. They're also launching their children, highlighting their careers and trying to take care of older family members, and then they are struck down by what can be quite a devastating cancer.

Cervix cancer can be really quite traumatic. Genetic-related cancers are typically also in young women and women in their mid-forties to early fifties, and this is for both ovarian and endometrial cancers. However, as our woman population is living longer and longer, we have to acknowledge that the average woman in Canada can live well into her late eighties, and it will soon probably be into her nineties. They're living well and living healthily into their seventies and eighties.

When you ask about lives lost, these are healthy women with no other medical issues who are then struck down by an ovarian cancer. Before, when their lifespan was maybe into their late seventies and early eighties and they were getting their cancers at that time, all right, but now we're talking about women who had the potential to live for another 10, 15 or even 20 years.