The Canadian Cancer Survivor Network held its second Saskatchewan All-Party Cancer Caucus (APCC) in Regina on March 12, 2024. The two topics discussed at this Caucus were colorectal cancer screening and cervical cancer screening. CCSN was represented by Nir Hagigi, CCSN’s Public Policy Analyst, who was joined by the Colorectal Cancer Resource and Action Network (CCRAN), represented by Ms. Cassandra Macaulay, Senior Manager of Programs and Education, who spoke about colorectal cancer screening in Saskatchewan. Mr. Trong-Minh Tran attended the APCC to speak about his experience as the caregiver of his late wife, Ms. Ph??ng Bach, who, at the age of 35, was diagnosed with Stage IV colorectal cancer. Dr. Karen Yeates, who is a professor at the Queen’s University Department of Medicine, joined virtually to speak on the benefits of HPV self-testing for the screening and prevention of cervical cancer in Canada. CCSN consultant David Klug of Konsul Strategies also attended.
CCSN President & CEO Jackie Manthorne began her opening remarks by acknowledging that the Caucus was gathering on the traditional lands of the Treaty 4 Territory, the traditional territories of the Cree, Saulteaux, Dakota, Nakota, and Lakota peoples, and the homeland of the Métis.
Manthorne reminded everyone about the importance of moving from reactive care, where we treat someone who is already sick, to preventative care, where we try to prevent disease before it can develop. Although this may often seem impossible, Saskatchewan has already started the move toward the prevention of cancer. Manthorne recalled the previous APCC in Saskatchewan, where CCSN spoke about the increased number of breast cancer diagnoses at later stages because of women being too young to be eligible for screening. The good news is that starting in January of 2025, people will be eligible for breast screening from age 40.
Manthorne also mentioned the opening of a new Breast Health Centre in Regina, and the implementation of new breast cancer tumour localization technology. All of these are wonderful, but there is still a problem: many individuals aged out of the breast screening program during the COVID-19 pandemic, and once you are over 74, you must have a doctor’s referral to access this screening. However, one in six Saskatchewanians do not have a family doctor, making access to screening much more difficult.
It is important to note that nearly 20 per cent of women are diagnosed over the age of 75, and this is not an insignificant number! CCSN believes that women and men of any age should be able to opt into screening at their own discretion. After all, no one is going to wake up one morning and decide to have a mammogram for fun, and without good reason!
Manthorne then spoke about the urgent need for Saskatchewan to develop a lung cancer screening program. We know that lung cancer screening is a proven and effective way to save lives. Those diagnosed at Stage I can often be cured with surgery, but those diagnosed at Stage IV are usually in treatment for the rest of their lives, which are frequently cut short.
Manthorne raised the issue of radon, which Health Canada estimates causes 16 per cent of lung cancer deaths in Canada. That is, every year, 3,300 people die from radon-caused lung cancer. Manthorne noted that nationally, 6.2 per cent of households have radon levels over the guidelines of 200bq/m3, and 0.7 per cent have levels exceed 600bq/m3, which requires urgent attention. However, in Saskatchewan, those numbers are much higher, with 14.4 per cent of households having radon levels above 200bq/m3 and 1.3 per cent of households exceeding 600bq/m3. For both thresholds, Saskatchewan rates are nearly DOUBLE the national average. The district that we are currently in (Regina Qu’Appelle Regional Health Authority) has one of the highest rates of household radon levels, not just in Saskatchewan, but in the entire country.
Manthorne ended her remarks by congratulating the Saskatchewan Housing Corporations (SHC) for partnering with Lung Saskatchewan in testing radon levels in SHC units across the province over the next 10 years. She also praised Lung Saskatchewan for providing funding for homeowners to remove radon, but unfortunately, that funding is limited, especially when because a third of Canadians cannot afford radon mitigation.
“Let’s do much better,” Manthorne urged, recommending that that the government prioritize saving lives by adding radon exposure to any future lung cancer screening program in Saskatchewan, and by making radon tests easily accessible and government funded.
Colorectal Cancer Resource and Action Network: Taking Aim at Colorectal Cancer
Nir Hagigi introduced Ms. Cassandra Macaulay, Senior Manager of Programs & Education at the Colorectal Cancer Resource and Action Network (CCRAN). Macaulay described CCRAN’s mandate of championing the health and wellbeing of all Canadians touched by colorectal cancer (CRC) and others at risk of developing the disease. Before beginning her presentation, Macaulay noted that the organization has recently expanded its patient-focused mandate to serve a population outside of the colorectal cancer space through health technology assessment (HTA) submissions, educational events, and advocacy initiatives to ultimately reduce the burden of cancer on Canadians.
Macaulay then provided MLAs with background information on colorectal cancer, including the four stages of the disease and the commons sites of colorectal metastases. After noting that the disease is 90 per cent curable when diagnosed at an early stage, she delved into the worrying statistics about CRC:
- It is the second leading cause of cancer death.
- It is the third most diagnosed cancer.
- Twelve Saskatchewan residents are diagnosed with colorectal cancer every week.
- Five Saskatchewan residents die from colorectal cancer every week.
“The average person has a 6.3 per cent chance of developing colorectal cancer over their lifetime, and it is likely that one of us in this room will die from it,” Macaulay pointed out, urging a collective recognition of the gravity of the situation. She added that both colorectal cancer cases and deaths are expected to begin rising in 2030, largely driven by the under 40 population.
Macaulay then addressed Saskatchewan’s Screening Program for Colorectal Cancer. “The program invites and even provides a requisition for participants via mail, and also sends the results,” she said, commending the program for its thoughtful integration of crucial support services such as Nurse Navigators and Early Detection Coordinators.
Fecal Immunochemical Tests, or FITs, are the most common pathway for colorectal cancer screening. The program allows asymptomatic individuals between the ages of 50 and 74 with an average risk of colorectal cancer to screen for the disease every two years. Macaulay gave the audience a quick demonstration on completing a FIT. “Quite simply, it’s a poop smear test,” she said, before praising the province for having one of the more seamless colorectal cancer screening programs in Canada.
After examining the 15 per cent and 23 per cent decrease in colorectal cancer incidence in the 50-64 and 65+ age groups, respectively, Macaulay concluded: “screening works!” However, she noted that only 49 per cent of eligible Saskatchewan residents have completed a FIT within the past 2 years. We must do better.
In Saskatchewan, it is disheartening that individuals under 50 lack access to colorectal cancer testing, despite a concerning increase in cancer rates among this demographic. Healthcare providers often dismiss their symptoms solely based on age, leading to later-stage diagnoses with more aggressive characteristics.
“They are mothers and fathers, sons and daughters, and brothers and sisters, productive and engaged members of society, who had been living full lives and who expected to have their whole lives ahead of them – lives that are unequivocally changed and far too often cut short by a preventable, detectable, curable cancer. Lives that could have been saved if only they had been eligible for screening.”
“Every week, I speak to people in their 40s, their 30s, and even their 20s, who have been diagnosed with this terrible disease,” Macaulay said. Saskatchewan’s screening criteria, based on outdated guidelines from 2016, fails to align with both the current Canadian and American recommendations. Early screening is a logical step given the rising cancer rates among younger populations.
You might wonder about the cost but consider this: a recent Canadian study analyzed the national cost of colorectal cancer treatment and management. It found that lowering the screening age to 45 could result in $719 million in savings with less than $300 million in additional costs. Further reducing the age to 40 was projected to cost $649 million but would save the health system $1.1 billion.
“Reducing the screening age is a win-win-win: we can save lives, resources and money by lowering the screening age,” said Macaulay.
Mr. Minh Tran and Ms. Phu’o’ng Bach: Young & Overlooked
Mr. Minh Tran travelled to Regina from Saskatoon to speak to the Caucus about his late wife, Ms. Ph??ng Bach. At the age of 35, Ph??ng, a loving wife and astute accounting professional, was diagnosed with Stage IV colorectal cancer. Ph??ng lost valuable time during which the tumour could have been removed before the cancer spread. After pursuing treatment both in Canada and internationally, Ph??ng was told that she had an incurable cancer. She fought bravely for three years before leaving us in January 2024.
Ph??ng’s husband, Minh, believes that early detection and quicker response from the Canadian medical system could have saved her life.
CCSN has summarized his presentation here.
Good afternoon, everyone, my name is Minh Tran. I am currently working for the City of Saskatoon. I was hesitant at first to join this Caucus meeting when I received the invitation because the loss of my wife and painful memories are still fresh since my wife passed away in January. When I composed the eulogy for my wife, Ph??ng Bach, it was extremely hard for me to complete it; I had to stop many times to control the emotion and anger. It took me nearly a week to finally agree to participate in this meeting, for her and many others.
Born on April 6th, 1985 in the picturesque seaside city of Vung Tau in Southern Vietnam, Phuong spent her entire childhood there, earning a reputation as a high achieving student at Le Quy Don High School for the Gifted. In 2003, she entered college in Ho Chi Minh City where she received numerous scholarships at Banking University – Ho Chi Minh City. In her 4th year of college, she was one of the very few who were selected for an internship at Australian New Zealand Bank (ANZ Bank) after a nation-wide competition. Graduating in 2007, she earned a Bachelor of Economics with a major in Finance – Credit and worked for ANZ Bank for three years. Phuong’s journey took her to the United Kingdom in 2010, where she obtained a Master of Science in Management from the University of Southampton in 2011. We were married the same year. Returning to Vietnam in 2012, she worked for the largest oil-gas corporation of the country for one year then joined me in Saskatoon in 2013 and became a proud Canadian citizen in 2018.
Adapting to her new life in Canada, Phuong faced challenges with resilience, starting with entry-level jobs and working her way up in accounting. She pursued further education at night, receiving the Certificate from the Accounting Certificate Program with Great Distinction from Saskatchewan Polytechnic in 2018. She continued her studies with Chartered Professional Accountants of Canada (CPA Canada) while working full-time as an Accounting Analyst at Affinity Credit Union. Her career was very successful, and she was sought after by many recruiting agencies. Her dedication and strength were truly remarkable.
Covid hit while she was working on her last year of the program, and her cancer symptoms started to show and negatively affected her health. Various issues from the pandemic combined with a strained healthcare system caused a significant delay in early detection. Her family doctor was unable to refer her to a specialist in a timely fashion. An appointment was finally scheduled with a specialist, but it was six months away. Ph??ng couldn’t wait – she had to go to Emergency months before that appointment. From the information on the eHealth portal, we figured out the worst news ourselves before we talked to the doctor – she had metastatic cancer. She even received an information package from the Cancer Centre before meeting with an oncologist. When we asked the family doctor about that information, they denied that it was cancer.
The GI doctor who performed her colonoscopy mentioned they would do surgery to remove the tumour, but somehow it was cancelled, and after consultation with an oncologist, a stent was put in instead. She was officially diagnosed with Stage IV terminal illness early in 2021, as the cancer had metastasized to the bone, liver, and lymph nodes. It forced her to stop working and turned her life and mine upside down.
This started Ph??ng’s three-year battle with cancer. In the first year-and-a-half, she underwent chemotherapy since there was no other option in Saskatchewan. But she did not give up and started seeking treatment across Canada and beyond. This journey took us to Japan and Vietnam for half a year in 2022. In Vietnam, she was able to have her sigmoid tumour removed, and she recovered successfully. This surgery should have been done in the beginning, but she could not have it in Canada even though the medical system is much more advanced.
In 2023, we went to Vietnam for five months to seek the opinion of a top liver surgeon and to explore the slim chance of having liver surgery. Unfortunately, it was too late. Cancer had spread too close to the portal vein, so there was no chance for the surgeon to work on her liver.
Looking back, to me it feels like in Saskatchewan we are still using the old medical textbook to treat colorectal cancer, geared towards a “disease of old age.” But colorectal cancer is attacking younger people, as you have seen on the PowerPoint.
Ph??ng was finally at peace on January 12, 2024 at the Royal University Hospital in Saskatoon. Today is March 12, exactly two months from the day she left me. What a coincidence. She surpassed doctors’ expectations by six months, showing incredible foresight and planning throughout her battle.
I must mention that the care she received in Saskatchewan was exceptional, from the hospital staff, home care nurse, oncologist, Cancer Centre staff, and for that we are very grateful. But having said that, the reality is the Saskatchewan healthcare system failed to screen and detect the disease early, failed to react quickly, and did not have skilled surgical oncologists to treat advanced colorectal cancer.
Saskatchewan also does not have the option for those who want to have early screening. I was encouraged by my wife to have virtual colonoscopy screening, but it couldn’t be done in Saskatchewan; I had to drive to Calgary to have it done and paid from my own pocket. Luckily, the cost was later reimbursed from my wife’s account.
Just last week, our Saskatchewan government announced the expansion of age eligibility for breast screening to include ages 40-49. Don’t stop there, please do that for colorectal screening as well.
Think about the cost of Ph??ng’s care: chemotherapy twice a month, CT scans, bone scans, MRIs, supplements, and various medicines needed by a cancer patient. The total cost is substantial. My wife went from being a high tax paying person, to a person drawing from both private and public disability plans and tax credits. By the time you consider the total financial impact of her care, it would be enough to pay for doing many screenings.
We need to change the belief that colorectal cancer is a disease of old age. Give them the ability to send patients to screen quicker. My wife would have had a better chance of beating the disease if she had received care sooner.
I know you receive lots of requests asking for government support. However, losing a young person
from colorectal cancer who could have contributed to society is hard. It could suddenly happen to any one of us, someone we know of or even someone in our family. Reducing the colorectal cancer screening age will yield multiple benefits for the people of Saskatchewan, including:
- Cost saving in health care from treating advanced colorectal cancer.
- Cost saving to employers and the Saskatchewan economy through reduced losses in productivity.
- Less lost tax revenue.
- Healthier communities.
- And last but not least, it will save lives!
In closing, I hope that when you leave this room, you will ask yourself what you can do to save the lives of others like my wife.
The Benefits of HPV Self-Testing for Screening and Prevention of Cervical Cancer in Canada
Dr. Karen Yeates, professor at the Queen’s University Department of Medicine in Kingston, joined the Caucus virtually to speak to MLAs about reducing the burden of cervical cancer (CC).
Dr Yeates began by stating that the solution lies in increasing HPV vaccinations as a form of primary prevention and increasing screening as a form of secondary prevention. In 2021 in Saskatchewan, 50 new cases of cervical cancer were diagnosed, with 15 deaths attributable to the disease.
What is the relationship between the human papillomavirus (HPV) and cervical cancer?
Persistent infection with carcinogenic types of HPV can cause squamous and glandular malignancies in the cervix. HPV is a common sexually transmitted infection that is cleared by the immune system in healthy people, but persistent infection of the cervix can occur in women during their lifespan.
Primary prevention involves HPV vaccination of young girls and women between the ages of 9 to 45 and of young boys and men between the ages of 9 and 26. Canada has a set target of having 90 per cent of 17-year-olds fully vaccinated with the HPV vaccine by 2025.
In Saskatchewan, cervical cancer screening applies to all persons with a cervix 25 to 69 who are or have ever been sexually active. Approximately 90,000 people are having Pap tests in Saskatchewan. However, Pap tests have an increased likelihood of false positives, and the process is uncomfortable. Many provinces are implementing HPV self-testing. In fact, HPV self-testing or self-sampling is the recommended primary screening method.
HPV self-testing provides the following benefits:
- Allows for less frequent testing.
- Has higher sensitivity and higher negative predictive value.
- Collects an adequate sample.
- Increases population coverage and screens more women at risk who have been under-screened with Pap.
- Eliminates the requirement for Pap in almost 80 per cent of women.
- Provides easier access to the test.
- Can be done in a private location (home or clinic).
Quebec, Ontario, British Columbia, and Prince Edward Island have switched to using HPV testing. At home screening tests are available in British Columbia, with results available in four to six weeks through a healthcare provider or clinic.
Saskatchewan is using HPV reflex testing, the purpose of which is to detect the HPV in a Pap test sample. This helps to decide what follow up is needed for people in specific age groups with a low-grade Pap test result. People with a low-grade Pap result and a positive HPV reflex result will be referred to a colposcopist.
Steps to eradicate cervical cancer
We must work together to:
- Improve HPV vaccination rates.
- Implement HPV testing as the primary screening method to rapidly increase screening uptake and coverage (and to save lives).
- Enhance efforts for the follow-up of abnormal results.
- Increase political will and advocacy efforts; HPV testing is highly evidence-based with a decade of success in Australia and years of success across the European Community.
Canadian provinces need to invest in providing the highest quality (and easiest) screening test to women if we are going to move towards cervical cancer elimination.
CCSN had the privilege to meet with Minister of Health Everett Hindley and NDP Health Critic Vicki Mowat during our visit to Regina, where topics discussed were lung cancer screening, breast cancer screening, firefighters’; cancers, and CCSN’s Cancer Can’t Wait COVID-19 disruption of cancer care. Follow-up is continuing.
Attendees:
Canadian Cancer Survivor Network: Nir Hagigi; David Klug.
Saskatchewan Party: the Hon. Everett Hindley, Minister of Health; the Hon. Laura Ross, Minister of Parks and Culture, Minister Responsible for the Status of Women; the Hon. Lori Carr, Minister of Highways; MLA Alana Ross; MLA Hugh Nerlien; MLA Marv Friesen; MLA Dana Skoropad; MLA Daryl Harrison; MLA Travis Keisig; MLA Todd Goudy; MLA Doug Steele; MLA Fred Bradshaw; MLA Ken Cheveldayoff; MLA Terry Jensen; MLA Donna Harpauer; MLA Warren Kaeding; MLA Delbert Kirsch; MLA Blaine McLeod; MLA Greg Ottenbright; MLA Colleen Young.
NDP: MLA Carla Beck; MLA Jared Clark; MLA Trent Witherspoon.