Breast-cancer patient Christine Van Deven sits in her backyard with her dog Charlie in London, Ont., on June 9, 2023. Ms. Van Deven wonders what might have happened if her cancer had been caught earlier.Nicole Osborne/The Globe and Mail
Significantly fewer cases of cancer were picked up in Alberta during the first wave of COVID-19 than in the past, according to new research that reinforces other Canadian findings that many patients were denied crucial early diagnoses in the beginning months of the pandemic.
The Canadian Medical Association Journal (CMAJ) study, published Monday, concluded that new diagnoses in Alberta of four types of cancer plunged in the spring of 2020, when much of the health system was shuttered to deal with the new virus.
Diagnoses of melanoma, an aggressive skin cancer, were 43 per cent lower than expected in the province during the first three months of the pandemic. New cases of prostate and colorectal cancer were down by 36 per cent, while breast cancer diagnoses were lower by a third. Some of the biggest drops were in early-stage cancers.
The common factor uniting all four types of cancer is that screening tests such as mammograms, colonoscopies and skin tests can catch them before patients begin feeling seriously ill. Usually, the earlier that cancer is found, the easier it is to treat. But during the first wave of the pandemic, pro-active cancer screening programs were all but shut down across the country.
“This really shows the importance of these cancer screening activities,” said Darren Brenner, a cancer epidemiologist at the University of Calgary and one of the authors of the CMAJ study. “It shows that they are working, because as soon as they go away, even for three months, we see a major drop in early-stage cancer diagnoses.”
The phenomenon of missed or delayed cancer diagnoses during the pandemic has been well-documented in Canada and around the world. Just last month, Statistics Canada reported that cancer incidence was 12.3 per cent lower in 2020 than the average annual rate over the previous five years, after adjustments for the growing and aging population.
The question now is what impact those missed diagnoses will have on cancer survival rates in the future. The new Alberta study found that patients with three types of cancer – colorectal, uterine and non-Hodgkin lymphoma – diagnosed in 2020 had slightly lower one-year survival rates than patients diagnosed with the same diseases in 2018.
However, Dr. Brenner said it was too early to say whether that was a true pandemic effect or a random year-to-year variation. Most other Canadian and international research has found no reduction in short-term cancer survival among those diagnosed in 2020.
In Ontario, researchers at ICES, formerly known as the Institute for Clinical Evaluative Sciences, mined multiple administrative databases to determine that an estimated 16,000 cases of cancer in adults were missed between the start of the pandemic and October, 2021.
But when they compared mortality among patients diagnosed in that period to patients diagnosed in 2018 and 2019, they found no difference in one-year survival rates. When they adjusted for age, sex, prediagnosis health, cancer type and other variables, they discovered that patients diagnosed during the pandemic were slightly more likely to survive, unless they had melanoma.
“This was a surprising result. We’re not seeing a negative pandemic impact,” said Rui Fu, a post-doctoral fellow at the Sunnybrook Research Institute in Toronto. “Just from the statistical analysis … there’s a protective effect of the pandemic on one-year overall survival.”
One possible explanation is that cancer patients who were fortunate enough to be diagnosed during the first 18 months of the pandemic went on to receive treatment and surgery faster because missed diagnoses meant there were fewer oncology patients in the pipeline, according to Dr. Fu.
But she and other cancer trackers agree it will take several more years – at least – to get a clear picture of how the pandemic affected cancer outcomes.
“I would personally expect to see more impact on the survival of the cancer cases that were diagnosed later in 2021 because I think that those are the cancers whose diagnoses were delayed, not the ones diagnosed in 2020,” said Talía Malagón, a cancer epidemiologist at McGill University.
Christine Van Deven, 53, of London, Ont., is one of those cancer patients diagnosed later in the pandemic. She turned 50 – the age at which Ontario recommends all women begin getting regular mammograms – in February, 2020, just as COVID-19 took off.
Ms. Van Deven, a mother of two and the general manager of a retirement home, didn’t get her first mammogram until the summer of 2021, after her doctor found a lump in her right breast. The mammogram found nothing of concern, but Ms. Van Deven’s doctor, still worried about the lump, sent her to a cancer surgeon for a second opinion.
That appointment took place in January, 2022, as the Omicron variant and staff shortages battered the health care system. Delays in MRIs and biopsies added up to Ms. Van Deven not being diagnosed until early May.
By that point, her invasive lobular carcinoma was at Stage 3. She had three tumours in her right breast, one of which was the size of a tennis ball. The cancer had spread to her lymph nodes. She had a double mastectomy, followed by chemotherapy and radiation.
Ms. Van Deven wonders what might have happened if her cancer had been caught earlier.
“I believe it could have been a smaller procedure. I really believe it wouldn’t have gone to my lymph nodes. But I can’t say for sure. I just don’t know,” she said.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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