White Coat Black Art26:30The rapper battling Stage 4 colon cancer
A Hamilton, Ont., musician and actor who is fighting fourth-stage colon cancer is calling on his provincial government to lower the minimum age for colonoscopy screening from 50 to 30.
Bishop Brigante, a rapper with hits like his 2017 single Hard Times andan actor withturns on shows like Orphan Black, was diagnosed with colon cancer in October 2023.
But it was two years earlier when, in his early 40s, he first started seeking care for stomach pain, diarrhea and blood in his stool.
“My doctors would say, ‘That’s hemorrhoids.’ They told me that I had irritable bowel syndrome, which at that time I was told, ‘You just gotta kind of work on your diet, fix the food you eat’ and stuff like that,” he told Dr. Brian Goldman, host of CBC Radio’s White Coat, Black Art.
By the time Brigante pushed for and eventually received a colonoscopy, followed by MRI and CT scans, he had an eight-centimetre tumour that had penetrated the wall of his rectum and spread to other places like his liver and lungs.
Hearing that news “was a pretty heavy load to bear.”
Brigante is part of a puzzling rise of colon cancer in a younger group of adults than is typical. The Canadian Cancer Society says it’s now the second leading cause of cancer deaths in men, and the third leading cause in women.
The trend prompted the United States in 2021 to lower the age for routine colonoscopies in average-risk individuals from 50 to 45, and has led to calls like Brigante’s and others to change how health systems approach both screening for and awareness of the disease.
“I’ve been treating colorectal cancer for over 20 years, and no doubt we are seeing patients being diagnosed at an earlier age,” said Dr. Sharlene Gill, a professor of medicine at the University of British Columbia and B.C. Cancer oncologist whose work focuses mostly on gastrointestinal cancers.
Dr. Sharlene Gill is a professor of medicine at the University of British Columbia and a gastrointestinal medical oncologist with B.C. Cancer. (Submitted by Sharlene Gill)
She said it’s now estimated that about 10 to 15 per cent of new diagnoses of colorectal cancer are in people under age 50.
Looking back earlier in her career, Gill would estimate that only about one in 40 of her colon cancer patients were under 50, which is considered early onset of the disease.
She said cancer stats show that the risk of early onset colorectal cancer is now almost two and a half times higher for people born after 1980 versus previous generations.
“I do feel that we need to, in Canada, look very seriously at lowering our age of screening to age 45.”
Brigante is now nearing the end of a series of 12 chemotherapy sessions and says his main tumour appears to be shrinking. The goal is to get to a place where he can have colorectal and peritoneal surgeries.
But he said the experience has driven him to try and enact change to prevent other people from having colorectal cancer diagnosed at such a late stage.
Colorectal cancer screening
Most provinces and territories offer a fecal immunochemical test, or FIT test, which detects the presence of blood in a stool sample collected at home.
During the more invasive colonoscopy, a health-care provider examines the inside of the colon — also known as the large intestine — using a long flexible tube with a light and tiny camera on one end. They may remove abnormal growths called polyps for further testing. Left alone, some polyps cangrow into larger tumours, and some of those can become cancerous.
That’s why Brigante says it bothers him that the current screening guidelines are based on what he described as “very outdated” statistics.
Bishop Brigante, a rapper and actor, right, poses with Dr. Brian Goldman, host of CBC Radio’s White Coat, Black Art, at Brigante’s home in Hamilton, Ont. (Sameer Chhabra/CBC)
Both the FIT test and colonoscopy screening are made available to average-risk individuals starting at age 50.
His petition on change.org had nearly 30,000 signatures as this story reached publication time, and was presented in the Ontario legislature by NDP health critic France Gélinas on Feb. 20.
Ontario’s colorectal cancer screening program “continues to recommend screening for colorectal cancer starting at age 50,” the Ontario Ministry of Health said in a statement.
The ministry said it aligns with similar screening programs across Canada, and is the recommendation by the Canadian Task Force on Preventive Health Care and International Agency for Research on Cancer.
It also said individuals with a parent or siblingwho’ve had the illness may start screening earlier — 10 years younger than the age their relative was when they were diagnosed — and that people of any age with symptoms can seek testing through their primary care provider.
The Canadian Task Force on Preventive Health Care told CBC in a statement it will be updating its 2016 screening guidelines with a detailed review of recent studies.
“This will include studies on the rising incidence of colorectal cancer in younger age groups and the effectiveness of screening for colorectal cancer.”
No publication date has been set at this time.
Checks and balances
But expanding the age range for standard colonoscopy screening isn’t quite as straightforward as it may sound.
Barry Stein, president and CEO of Colorectal Cancer Canada — himself a survivor of Stage 4 colorectal cancer diagnosed at age 41 back in 1995 — said while there seems to be movement internationally toward re-examining age-based screening criteria, Canada is still gathering information.
“Because when we bring in a screening program, the idea is to do no harm,” said Stein. While the FIT test is non-invasive, it’s a different story with a colonoscopy.
Barry Stein, president of Colorectal Cancer Canada, says additional screening for colon cancer needs to be considered carefully to ensure it doesn’t cause unnecessary harm. (CBC)
There’s a small risk that the colon can be punctured, or perforated, during the procedure, he said. One study pegged the incidence of this at around three in every 10,000 tests, or 0.03 per cent.
While very rare, perforations are extremely serious, leading to fatality between 21 and 53 per cent of the time, depending on the nature of the tear and the age of the patient, and whether they had other risk factors.
Colorectal Cancer Canada estimated that 24,100 people were diagnosed in 2023, with about 2,500 of those under the age of 50, Stein said.
It pegged fatalities from the disease at around 9,300 in that same time frame, which represents 11 per cent of all Canadian cancer deaths.
Stein said the incidences of these cancers in younger people seem to be happening more often in the lowest part of the colon, the rectum, for unexplained reasons.
“We are looking into different things with some of the researchers that we’re engaged with, for example, in the microbiome. So far, we do believe it’s due to healthy lifestyles — diet and exercise, in other words.”
Gill from UBC said while research is still ongoing, the so-called Western diet — low in fibre and plants and high in processed foods — indeed negatively impacts the microbiome, which “is understood to have a role in controlling inflammation as well as immune surveillance, i.e. how our immune system works, which can affect cancer development.”
WATCH | No one knows why colorectal cancers are rising in younger people:
Colorectal cancer cases are rising in young people, but no one knows why
1 year ago
Duration 2:58
Getting the public on board
Another aspect to the colon cancer prevention effort in Canada is addressing the general population’s reluctance to undergo routine screening — or lack of awareness that it’s even an option.
“More than, probably, 40 per cent of people who are eligible for screening aren’t getting screened,” said Gill. “Even in their early 50s and 60s, people aren’t doing it, and we are in a public health system where it’s at no cost to you to do the test.”
Gill said there is also an effort underway to let family physicians and other primary care providers that the picture with colon cancer is changing.
“If someone young presents with symptoms, you know, typically we would say, ‘You’re too young for cancer to be on the top of my list of things I’m worried about.’ But that narrative probably needs to change now.”
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.
