Thank you, Mr. Chairman. Good morning.
Good morning, members of the committee.
Thank you for giving me the opportunity to be here today.
I should mention that, when I received the invitation, I was only asked to speak about women and cancer and was not given any further details about what specific area was of interest. I have prepared my notes on my own experience in my own practice, but I'm more than happy to answer any questions.
I’m a medical oncologist, practising in Fredericton, New Brunswick. I have been in practice for more than 13 years. Patients with breast cancer represent most of my practice.
Fredericton is a city with a population of more than 60,000 people. However, the catchment area that we look after has a population of more than 170,000, so the majority of the population in my catchment area live in a rural setting. The annual population growth rate in my area is 6.2%, per Statistics Canada. However, our local data shows that the increase in cancer patients is 8.2%. New Brunswick has seen an unprecedented increase in population since the COVID pandemic.
I would like to share with you today the differences in the journey of women who get diagnosed with breast cancer, depending on where they live. As you are aware, breast cancer is common and can affect one in eight Canadian women. When a woman is diagnosed with breast cancer, she usually undergoes surgery, with or without radiation, with or without chemotherapy, and it may or may not be followed by endocrine therapy in the form of pills. The problem is not having access to surgery, chemotherapy or radiation. The problem is having access to extra supports, which are just as important. Luckily, the cure rate is high, but it comes with a price. That’s where your place or residence can make a difference. That’s when it matters whether you live in an urban or a rural setting.
After such a diagnosis, a woman may require physiotherapy following her surgery. If she doesn’t, she might end up with long-term limitations to arm and shoulder movements, which would obviously affect her quality of life. Some women might develop lymphedema, which can be a complication following surgery and radiation that may cause pain, swelling and even disfiguration of the chest and arm on the affected side. Having access to a physiotherapist with special training in the treatment of lymphedema is crucial to help mitigate that. A physiotherapist with such training can provide treatment, fit the affected woman with the proper compression sleeve or glove, or even make it to order. Women living in rural New Brunswick have limited access to such services.
A breast cancer diagnosis and all the treatments that come with it, including the endocrine treatments that a woman can be on for five to 10 years, can have a significant toll on mental health. Having access to mental health services can make a huge difference. Again, women living in rural New Brunswick have limited access to such services.
Unlike surgery, which is required once or twice, radiation, which is usually prescribed anywhere from three to six weeks, or even chemotherapy, which is prescribed for anywhere from three to six months, physiotherapy or mental health support is usually required for a much longer duration and has a maintenance component to it.
What makes this even more challenging is that not only are we seeing an increase in the numbers of women being diagnosed with cancer in general, but we are also noticing that they are being diagnosed younger. The average age for a woman to be diagnosed with breast cancer is 60 to 65, but we are seeing more women being diagnosed in their forties and even in their thirties, when they have jobs and young families to look after and have to live with the complications of the treatments longer.
I am seeing an increasing number of women who are unable to go back to their jobs and normal lives after the completion of their treatments, and even having to go on disability due to treatment long-term effects that are not managed properly due to the lack of resources in rural areas.
In summary, I believe that women living in rural New Brunswick have good access to treatment once diagnosed with breast cancer, equal to women living in urban centres. They should have equal access to supportive services during and after completion of treatment.
Thank you.