Canadian Cancer Survivor Network holds fall 2023 Ontario All-party Cancer Caucus

Three days later, Deputy Premier and Health Minister Sylvia Jones lowers breast screening age from 50 to 40

CCSN President & CEO Jackie Manthorne opened the October 24, 2023, Caucus meeting by welcoming 19 MPPs, special guests, speakers, and patients.

She reminded attendees that many women and men are not old enough or are too old to be eligible for Ontario’s breast screening program, which was discussed during CCSN’s April 2023 Caucus meeting. The recent announcement by Deputy Premier and Minister of Health Sylvia Jones that Ontario is lowering the screening age from 50 to 40 is very welcome news and is a result of the continuous work of Dense Breasts Canada and other organizations, including CCSN, to raise awareness about the large number of young women who were diagnosed late because they were unable to access screening mammograms.

Now it is time to draw attention to those women and men who age out of the breast screening program at 74. What messages does this send? That people are not at risk of developing breast cancer after age 74, which is not true – 20 per cent of women and men are diagnosed with breast cancer after the age of 75. This is a significant number! Or is the message that women over the age of 75 don’t matter? Neither message is palatable. People should be able to opt into breast screening at any age; after all, no one requests a mammogram for fun!

Jackie Manthorne, President & CEO of the Canadian Cancer Survivor Network, opens Caucus meeting

Manthorne then raised similar issues related to lung cancer screening in Ontario, where there are only five screening sites, with one sole screening site in Northern Ontario, in Sudbury. Having to travel long distances is a real barrier to accessing lung cancer screening. This topic was discussed in detail at the October 2022 Caucus meeting. Again, those over 74 age out of lung cancer screening even though according to Lung Cancer Canada, from 2011 to 2015, 17 per cent of lung cancer cases were diagnosed in Canadians between 70 and 84, and 14 per cent in people over 85. This is 31 per cent who are not eligible to participate in Ontario’s lung cancer screening program! What message does this give? That those over 74 don’t matter? That anyone aged 75 and up suddenly becomes too frail to go through treatment, so why bother to screen them?

And then there is radon, which Health Canada estimates causes 16 per cent of lung cancer deaths in Canada; that is, 3,300 lung cancer deaths related to radon each year, with approximately 850 Ontarians dying from radon-caused lung cancer every year. We can save lives by adding exposure to radon to Ontario’s lung cancer screening program and by making radon tests easily available and free of charge to Ontarians with high radon exposure.

The Caucus meeting continued with presentations on the cancer risks of firefighting and colorectal cancer screening.

Firefighting and cancer

David Sheen, retired Fire Chief and President of the Canadian Fallen Firefighters Foundation

Manthorne introduced David Sheen, retired Fire Chief and President of the Canadian Fallen Firefighters Foundation. Chief Sheen began by stating that “firefighters have a nine per cent higher risk of being diagnosed with cancer and a 14 per cent higher risk of dying from cancer than the general population.” He added that cancer is the number one killer of firefighters.”

Cancer is a major threat to firefighters because they are exposed to so many carcinogens, including benzene and diesel exhaust, polycyclic aromatic hydrocarbons (PHAS), poly-chlorinated biphenyls (PCBs), and dioxins and furans. Cancer therefore becomes a major threat to firefighters because they lack personal protective equipment, education and awareness, and resources to deal with the risk of cancer.

Wildland firefighters

Chief Sheen explained that according to the Government of Ontario, presumptive legislation enables the government to establish, via regulatory measures, certain diseases or heart injuries among firefighters that would automatically be considered as job-related for workers’ compensation unless evidence to the contrary is presented.

There are 5,000 wildland firefighters in Canada. Although wildland firefighters can still apply for workers’ compensation, their exclusion from presumptive legislation means that they must prove that their cancer was caused by their job to get workers’ benefits. This process can be difficult and expensive, and many wildland firefighters are denied benefits.

Bill C-224, which received royal assent on June 22, 2023, created a National Framework on Cancers Linked to Firefighting.  Bill C-224 designates January as Firefighters Cancer Awareness Month. An important objective is to equalize the recognized firefighter cancers, which currently vary widely from province to province. Another goal is to establish comprehensive measures to tackle occupational hazards faced by firefighters, with a specific focus on cancer prevention and treatment. Bill C-224 calls for awareness, research, data collection, knowledge sharing, education of healthcare professionals, and early detection.

Chief Sheen then presented the following recommendations:

  • Pass a bipartisan, retroactive, presumptive law to include wildland firefighters under the Workplace Safety and Insurance Board (WSIB).
  • Personal protective equipment (PPE) procurement.
  • Advocate for a National Registry.
  • Support detection/screening for firefighters.
  • Encourage firefighters to have regular and frequent health checks.

Colorectal Cancer Screening in Ontario

Cassandra Macaulay, Senior Manager of Programs & Education of the Colorectal Cancer Resource & Action Network (CCRAN), told CCSN’s All-party Cancer Caucus members that colorectal cancer (CRC) is the third most diagnosed cancer and the second leading cause of cancer death. 24 Ontarians are diagnosed with CRC every day, and nine Ontarians die from CRC every day.

Canada has one of the highest incidences of colorectal cancer in the world. It affects men and women equally. CRC incidence and mortality are expected to increase after 2030, driven largely by the population currently under 40 years old.

Cassandra Macaulay, Senior Manager of Programs & Education of the Colorectal Cancer Resource & Action Network

The Good

Macaulay then explained ColonCancerCheck, Ontario’s population-based screening program. The Fecal Immunochemical Test, or FIT, is for those Ontarians aged 50 to 75 who are asymptomatic with no first-degree relatives (parent, sibling, child) with CRC. They should be screened every two years. Colonoscopy is for those at increased risk because they have a first-degree relative with CRC. They should be screened every five years if their relative was diagnosed before age 60, and every 10 years if their relative was diagnosed after age 60.

Since the introduction of colorectal cancer screening programs across the country, there has been a marked decline in colorectal cancer incidence rates, with a decrease of 15 per cent in the 50-64 age group, and 23 per cent in the 65+ age group.

The Bad

Only 43 per cent of Ontarians have completed a FIT test in the past two years, which falls well below the Canadian participation target rate of 60 per cent. In addition, individuals with the lowest income are 14 per cent less likely to have been screened. Equity gaps include:

  • Immigrants from the Middle East, Western Asia and North Africa have the lowest rates of screening.
  • People who speak primarily English and/or French at home have higher screening rates than those who speak Indigenous or other languages.
  • Individuals living in rural or remote areas are less likely to be screened and those communities experience a higher incidence of colorectal cancer.
  • Individuals with mental illness may be 20 to 30 per cent less likely to complete screening.

The Ugly

The incidence of colorectal cancer in adults under the age of 50 is rising at an alarming rate. But these Ontarians are ineligible for asymptomatic screening, and they are often dismissed by healthcare professionals based purely on their age when presenting with symptoms. Young Ontarians are being diagnosed at a later stage with more lethal disease characteristics. Early-age onset colorectal cancer is missed by Ontario’s screening program.

Steve Slack’s presentation

Steve Slack, diagnosed with Stage 4 colorectal cancer at age 48.

Steve Slack, a devoted husband, loving father of two teenage boys, and successful bank manager, was diagnosed with stage 4 colorectal cancer at the age of 48.

As he was ineligible for screening, he eventually developed symptoms related to the large tumour growing undetected in his colon. Steve told Caucus that after having his symptoms dismissed for several months by healthcare providers and hearing that he was “too young for cancer,” he eventually required an emergency surgery as the tumour was blocking his colon. After, he learned that the cancer had already spread to his lymph nodes and liver.

“I wonder if my cancer may have been caught earlier if I had been eligible for screening,” Steve remarked.

Opportunities for system improvement

Macaulay then spoke about opportunities for improvement of colorectal cancer screening:

  • Engagement with patient advocacy groups to increase uptake of screening.
  • Thoughtful evaluation of the age requirements associated with screening eligibility.
  • Engagement of local communities and collection of local-level data to create profiles of specific populations.
  • Conduct more research to better understand the barriers, facilitators, and optimal approaches to increasing screening uptake among population groups that experience inequities.
  • Collaborate with First Nations, Inuit, and Métis communities to develop effective, peoples-specific approaches, grounded in reconciliation, for increasing uptake of colorectal screening.
  • Look for and adopt innovative new solutions, including embracing technology and education.

Manthorne called the formal part of CCSN’s All-party Cancer Caucus to a conclusion, but not before reminding Caucus members that all screening programs must reconsider both lower and upper age limits that leave younger and older Ontarians out, often resulting in late-stage diagnoses that put their lives at risk.

From Left to Right: MPP Dawn Gallagher Murphy, Steve Slack, Cassandra Macaulay, MPP Natalia Kusendova, Jackie Manthorne, MPP Daisy Wai, Liberal Party Leader John Fraser, MPP Stephanie Bowman, MPP Lorne Cole and MPP Dr. Adil Shamj

CCSN and Ontario cancer community representatives
Jackie Manthorne, President & CEO, Canadian Cancer Survivor Network
Mona Forrest, Operations Manager, Canadian Cancer Survivor Network
Nancy Clifford, Board Member, Canadian Cancer Survivor Network
Lindsay Timm, Community Engagement Manager, Canadian Cancer Survivor Network
Trevor Smith-Millar, Communications Manager, Canadian Cancer Survivor Network
Nir Hagigi, Public Policy Analyst, Canadian Cancer Survivor Network
David Sheen, President, Canadian Fallen Firefighters Foundation
Cassandra Macaulay, Senior Manager of Programs & Education, Colorectal Cancer Resource & Action Network
Steve Slack, Colorectal cancer patient/advocate
Eileen Tobey, BeSpeak Communications

MPP Members of the All-Party Cancer Caucus  
PC: Hon. Peter Bethlenfalvy, Hon. Brian Saunderson, Hon. Graydon Smith, Rick Byers, Lorne Coe, Dawn Gallagher Murphy, Parm Gill, Logan Kanapathi, Natalia Kusendova, Robin Martin, Laura Smith, Effie Triantafilopoulos, Daisy Wai

NDP: Teresa Armstrong, France Gélinas, Peter Tabuns, Kristyn Wong-Tam

Liberals: John Fraser, Karen McCrimmon, Mary-Margaret McMahon, Dr. Adil Shamji, Stephanie Bowman

Green: Mike Schreiner

Independent: Bobbi Ann Brady