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Alberta cancer diagnoses dropped sharply early in pandemic, Calgary study shows

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New research from the University of Calgary shows the detection of some cancers plummeted and hundreds of diagnoses may have been missed during the early stages of the COVID-19 pandemic in Alberta. That’s when screening services were scaled back and health systems scrambled to deal with a deadly new pathogen.

The research, published in the Canadian Medical Association Journal, looked at 10 of the most common types of cancer and diagnosis trends between January 2018 and December 2020.

“The sweeping and unprecedented measures enacted … had an inevitable impact on cancer care,” the study’s authors wrote.

A total of 42,862 diagnoses were analyzed. Researchers found dramatic reductions in identification of four key cancers as the province began battling COVID-19.

University of Calgary epidemiologist Darren Brenner is the study’s lead author. (Cumming School of Medicine)

The study shows diagnoses for melanoma dropped 43 per cent during the three months after Alberta’s public health emergency went into effect, in mid-March of 2020.

Colorectal and prostate cancer identification fell by 36 per cent and breast cancer diagnoses sank by 33 per cent.

“We really saw the largest drops that were observed in early-stage cancers,” said Darren Brenner, the study’s lead author.

“Most of this likely relates to disruptions in organized screening programs, and the related diagnostic activities, potentially also difficulty accessing primary care services and fewer in-person appointments.”

According to the study, while active chemotherapy and emergency surgery were prioritized early during the pandemic, some cancer services, including non-emergency surgeries and screening programs for breast, cervical and colorectal cancers, were delayed or paused.

Some cancers, including bladder, kidney and lung cancer, were not impacted, according to Brenner, an associate professor in the department of oncology and community health sciences at the University of Calgary.

That’s likely because there are no asymptomatic screening programs for them and efforts were made to preserve care for later-stage cancers, he said.

Nearly 1,500 cases may have been missed

The team’s modelling suggests 1,455 diagnoses of the four impacted cancers may have been missed, including 350 breast cancers, 398 colorectal cancers, 484 prostate cancers and 223 melanomas, between March and December 2020.

These cancers can be detected before symptoms arise through screening programs.

“These data show concretely that cancer screening works to catch early-stage cancers,” said Brenner.

“When we catch cancers earlier, we have better outcomes across the board.”

The situation improved monthly, the study shows, and by the end of 2020, cancer diagnoses had returned to expected levels.

Similar trends have been documented in other jurisdictions, the researchers noted, including the United Kingdom and the United States, as well as provinces such as Ontario and Manitoba.

And national data from Statistics Canada shows the incidence rate of new cancer cases dropped by 12.3 per cent in 2020 compared with the previous five years.

Patient impact

Cancer care advocates are not surprised by the findings.

“We heard quite a bit from people affected by cancer throughout Canada,” said Angeline Webb, senior manager of advocacy with the Canadian Cancer Society.

Angeline Webb wears a red shirt and black blazer as she looks directly into the camera
Angeline Webb with the Canadian Cancer Society says they heard from people across the country as cancer programs were paused early in the pandemic. (Stephanie Cragg)

“They were feeling scared and frustrated and they were feeling forgotten.”

Webb, who is based in Edmonton, worries about the long-term implications of delayed or missed diagnoses.

“We know that delays, backlogs and lengthy wait times can seriously impact someone’s cancer care outcome,” she said.

“[It] can result in increased likelihood of death. So that can have long-term impacts, not just on the people affected by cancer but entire families, caregivers and communities.”

The study includes preliminary findings showing lower survival rates for patients diagnosed with colorectal cancer, non-Hodgkin’s lymphoma and uterine cancer in 2020 compared to those diagnosed earlier.

However, Brenner cautions more research is needed to confirm any trends.

“It’s too soon to state concretely whether that state of emergency is going to have long-term impacts. These are very short windows to look at.”

Meanwhile, Brenner believes there are lessons to be learned about cancer care for any future pandemics.

“Finding ways to keep people in those screening programs even through turmoil-stricken times will be really important going forward,” he said.

“And to try to understand these trends now so that when something like this may happen again, we’re ready to … adjust our programs to keep them going and not close them down.”

 

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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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.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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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.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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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.

The Canadian Press. All rights reserved.

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