Progress Report on Cancer Control in Canada

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Executive Summary

Why a Progress Report?

The Progress Report on Cancer Control in Canada is the first national report of its kind, offering Canadians a comprehensive overview of how Canada is doing in the fight against cancer. Its purpose is to raise overall awareness of cancer issues among general readers and to focus public attention on key issues related to cancer control and care in Canada. The report also aims to help health policy makers understand past efforts in cancer control, enabling them to apply lessons learned to better allocate health resources and to better determine the most appropriate strategies for cancer control in Canada.

How was the report developed?

The report was developed by Health Canada in close collaboration with key cancer stakeholders from across the country and is based on the most recent data available from Health Canada’s Population and Public Health Branch, Statistics Canada and other federal and provincial agencies, non-government organizations and cancer researchers.

What are the goals of cancer control?

Cancer control aims to prevent cancer, cure cancer, reduce the suffering associated with cancer and increase survival and quality of life for those who develop cancer. It does this by converting knowledge gained through research, surveillance and outcome evaluation into strategies and actions.

Who is involved in cancer control in Canada?

There are many organizations involved in cancer control in Canada. They include federal, provincial and local governments as well as non-governmental organizations such as the Canadian Cancer Society, the National Cancer Institute of Canada, and community groups. The majority of frontline cancer control programs in Canada are developed and run by provincial cancer agencies.

Since 1999, Health Canada has been working in partnership with the Canadian Association of Provincial Cancer Agencies, the Canadian Cancer Society and the National Cancer Institute of Canada and other stakeholders to develop the Canadian Strategy for Cancer Control (CSCC).

The Strategy seeks to optimize the benefits of current knowledge and available resources for cancer control, while enhancing the sustainability of the health care system through more collaborative planning, priority setting, public policy development and implementation. Integration and coordination of activities under the CSCC is expected to help reduce cancer incidence, morbidity and mortality rates and enhance the quality of life for those living with cancer.

How is Canada doing in the battle against cancer?

In order to understand how Canada is doing in the battle against cancer, it is necessary to understand the nature of cancer itself. Cancer is not one but many related diseases characterized by uncontrolled cell growth. Some cancers are slow-growing, while others are highly aggressive. Some types of cancer are highly treatable, while others are almost uniformly fatal.

The divergent and complex nature of cancer makes progress in cancer control an ongoing challenge. As this report indicates, Canada’s response to this challenge has been generally positive, with significant progress being measured over the past 15 years. Small declines in mortality rates for cancer among both men and women have been observed since the late 1980s, primarily as a result of decreasing mortality rates from breast, prostate and colorectal cancer. Perhaps the most important progress has been the falling prevalence of cigarette smoking. This has led to declining lung cancer rates in males, and it is anticipated that similar declines for females will be observed within the next decade.

Progress in these areas may be attributed to broad social trends as well as to specific cancer prevention initiatives and advances in cancer screening and treatment. Thanks to these combined efforts, Canada’s record in cancer control is good. A comparison with other countries reveals that the rate of new cancer cases (incidence) and mortality rates for cancer in Canada are comparable to those of the United States, and that while incidence rates in Canada are higher than those in Western European countries, death rates are, in general, lower, meaning that Canada has better cancer survival rates.

However, despite these positive steps in cancer control, cancer is currently the leading cause of premature mortality in Canada, and is expected to be the leading cause of death within the next several years. In 2004, more than 145,000 new cases of cancer are expected to be diagnosed in Canada; these numbers are expected to double by the year 2020 as Canada’s population grows and ages. The number of people living with, or having been diagnosed with, cancer is increasing at roughly twice the rate of new cases of cancer.

The obstacles to future progress in the battle against cancer include a failure to fully apply the knowledge gained from past research and the lack of knowledge of how to effectively prevent and treat many cancers. In addition to more and better research, greater emphasis must be placed on cancer prevention, the development of effective early detection and screening programs and the expansion of quality palliative care.

What are the report’s key highlights and observations?

Prevention

• About one-half of cancers in Canada are preventable, based on our current understanding. Most of the important factors identified to date relate to lifestyle; unfortunately, lifestyles are difficult to change on a population basis.
• Perhaps the greatest success in cancer control has occurred in reducing the use of tobacco. Tobacco is the leading preventable cause of cancer in Canada. Smoking among Canadians has declined by more than one-half over the last one-third of a century. In 1965, 50% of Canadians aged 15 years and older were smokers, compared with 21% in 2002. The reduction in smoking has resulted in important reductions in lung cancer in men, but insufficient time has elapsed for lung cancer rates to begin to decline in women.
• Some successes have also been noted for diet. Canadians are eating more fruits and vegetables, and rates of cancers of the gastrointestinal tract are declining. Unfortunately, Canadians are getting fatter; this is contributing to increases in other cancers.

Screening

• There are no proven population screening techniques for most forms of cancer.
• Screening for cervical cancer is highly effective at detecting and allowing for the treatment of lesions before they become cancerous. In Canada, the large reduction in death rates from cervical cancer over the last 30 years is believed to be primarily the result of cervical cancer screening. The proportion of Canadian women who report having had a Pap smear test within the previous three years has remained stable over the last seven years at about 73%.
• Regular screening mammograms reduce the chance of dying from breast cancer among women aged 50 to 69 years by about 30%. Approximately 50% of Canadian women in this age group reported having received screening mammography in the previous two years in both the 1994–1995 National Population Health Survey and the 2000–2001 Canadian Community Health Survey.
• Although screening trials have demonstrated that fecal occult blood tests can reduce colon cancer mortality by 20%, there has been limited adoption by the public, and no province has initiated a population-based screening program.
• There is widespread use of the Prostate- Specific Antigen (PSA) test for prostate cancer screening, but researchers are still waiting for the results of several ongoing screening trials to indicate whether PSA screening is effective.

Treatment

• Over the last several decades, many billions of dollars have been spent internationally to investigate the cellular and molecular basis for cancer, with the ultimate intention of improving cancer treatments. Unfortunately, with some notable exceptions for some rare cancers, progress in cancer treatment has been modest. Improvements in survival have been limited far more by the lack of new, effective therapies than by an inability to deliver current therapies in a timely, comprehensive fashion.
• In addition to more research into better treatments, there is an urgent need for coordinated planning for future human resources and for increased numbers of training positions, along with improved retention and recruitment strategies. Several provinces have moved or are moving toward cancer agency-based comprehensive cancer control programs.
• The large volume of new and sometimes conflicting information on best practices in cancer control has placed greater emphasis on systematic reviews of research evidence and the development of clinical practice guidelines. Several provinces are actively collaborating on clinical practice guidelines as well as protocols for chemotherapy.

Palliative care

• Most palliative care in Canada is provided to patients diagnosed with cancer. Strategies for supporting and sustaining effective palliative care services will become increasingly important as Canada’s population grows and ages.
• Some institutions and home care services incorporate palliative care services into cancer care, but overall, this area remains underdeveloped. Where these programs exist, they are increasingly integrated across a variety of institutional and community-based health care settings and offer a comprehensive range of services, including relief from pain and other symptoms, psychological and spiritual care, a support system to help patients live fully until death, and support for families.

Future challenges

While the report highlights obstacles to progress in cancer control, it underscores the fact that Canada has, in several areas, responded well to the cancer challenge. Nonetheless, as identified by the Canadian Strategy for Cancer Control, Canada’s approach to cancer control needs to encompass increased recognition of the value of health promotion and disease prevention, a greater commitment to broader integration of cancer control activities through better national and provincial planning, the promotion of greater participation in effective screening programs, use of evidence-based guidelines to inform clinical care and service delivery and an awareness of the value of palliative care and the need to increase palliative care capacity as our country’s population grows and ages.

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