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Natasha Leighl
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Natasha Leighl
2015-06-16 15:37
Great.
Thank you so much. Paul and I are honoured to be here to address the committee. We both are medical oncologists at separate institutions. We treat lung cancer. We have an interest in the treatment of lung cancer. We also volunteer with a charitable organization, Lung Cancer Canada, devoted to supporting people with lung cancer.
As you've heard from Paul, this is a major public health problem. I want to talk a bit more about the toll this has on people who are diagnosed with lung cancer here in Canada. I also want to talk about what holds us back from progress, the very low survivorship rate, and the stigma, which I'll touch on a bit more. This results in a disproportionate amount of public support for people diagnosed with this disease and their families, and a disproportionate amount of research funding. Like Paul, I want to highlight some of the opportunities where we think this group can really help us change outcomes for people with lung cancer in this country.
Lung cancer, as you've heard, is, sadly, the number one cause of cancer in the country. I am quite competitive, but to be number one in this is difficult. Lung cancer is, sadly, far and away the leading cause of cancer-related death.
Although 80% more women die from lung cancer than breast cancer, breast cancer is the women's cancer here in this country. Over 200% more men die from lung cancer than prostrate cancer, and yet prostrate cancer is the cancer people remember on Father's Day and associate with the men in their lives. We feel this really does need to change. It's estimated by Statistics Canada that cancer remains the leading cause of death for Canadians, but lung cancer by itself causes one in fifteen deaths: 8% of Canadians who die every single year die from lung cancer. That's really second only to cardiovascular disease.
Who gets lung cancer today in Canada? Of course, we do see people with smoking histories: 15% of the patients I see smoke currently. But the vast majority, over 60%, have quit smoking at some time, anywhere from the year before diagnosis to as many as 60 years before. A growing proportion of people—in my practice it's up to 25%, and in other people's practices it's as low as 10% to 15%—were never smokers, and never had that association with tobacco.
Most people, 75%, are diagnosed as already at an incurable stage, which I think really speaks to some of the lack of early detection here in this country and some of the lack of awareness of how we can find lung cancer early.
At least half of the people I meet with lung cancer in my clinic must quit working. Only about 15% are actually able to continue to support their families. Lung cancer is a major cause of financial distress for families in this country. More than a third of patients perceive that this has a devastating impact on their family and their finances. We know that people with lung cancer—this is from a study in the U.S.—have a higher rate of bankruptcy than do people without cancer. Of all the cancers surveyed, lung cancer actually has the highest bankruptcy rate. I'm hoping you get a sense of the devastation that lung cancer inflicts not only on an individual but also on a family.
We've also learned that many of the people we diagnose with lung cancer are diagnosed too late to receive treatment. Through some work we've done and recently published, we've found that only a quarter of people diagnosed with advanced cancer are actually well enough to have some of the incredible therapies that Paul has just talked about. Again, this really speaks to the need for early detection and a shift in our mindset to how and when we diagnose this disease.
This is really a high-mortality cancer. Although the five-year survival in lung cancer has risen to 18% with a lot of effort, it's 88% for breast cancer, 95% for prostate cancer, and 65% for colon cancer. You can see the huge disparity here in survivorship alone. With low survivorship, we have a very low voice for advocacy. There's also stigma, the very common public perception that if you have a diagnosis of lung cancer, you smoked, and so you deserve it.
Some of the low survivorship is because of the late detection. I think you'll hear later from Dr. Stephen Lam about the availability of organized screening that, for those at high risk, can significantly reduce mortality potentially to a greater extent than currently existing screening programs for such things as breast cancer and cervical cancer.
This is a virulent disease. While we are making progress, it has a very high case-fatality rate. Currently, most people diagnosed do die. There's a real lack of research funding. The Charity Intelligence Canada report from 2011 suggests that only 7% of the national research funding goes to lung cancer, despite causing 27% of the cancer deaths in this country, and less than 1% of the public donations. I think that speaks volumes about the stigma.
Some of the other work we have looked at suggests that even though lung cancer funding is increasing—between 2005 and 2010 it doubled from $10 million to almost $22 million—it's still only a fraction of the $536 million that was spent on cancer research that year. Again, you can see that's only 4% for a cancer that takes the lives of more than one-quarter of Canadians who die from cancer.
I also looked at just this past year, and CIHR, the Canadian Institutes for Health Research, awarded five grants for lung cancer research, for a total investment of $230,000 per year. That's an organization with $1 billion budget to fund research on all diseases in this country. When we compare this to the situation for breast cancer, over the past five years we've seen over 500 grants for breast cancer research worth over $140 million; by contrast, for lung cancer research there were 159 grants worth $39.6 million. Again, that's a disproportionate amount of funding and support.
At Lung Cancer Canada we conducted a survey. We asked 1,600 Canadians online what they knew about lung cancer, and half of the people did know someone who had had lung cancer. Only one-third knew that it was the leading cause of cancer-related death. Again, most women thought breast cancer was the leading cause for women and prostate cancer the leading cause for men. Most people, including smokers, had not spoken to their doctor about their risk for lung cancer, and only 2% knew that there was a lung cancer awareness month, November.
The association with smoking was very well known, but as you'll hear about later, there are other important risk factors such as radon, and only 1% of the people we surveyed correctly identified that as an important cause of lung cancer, and only 7% of homeowners had had their homes surveyed for radon exposure.
Two-thirds of the people we surveyed felt that people were very responsible for what they'd done to themselves because of their smoking habit, but instead of identifying things like heart disease or even other cancers as a consequence of smoking, which we know they are, they felt that people with lung cancer were the least deserving of their support, and certainly, smokers were the least deserving of sympathy, followed by those who drink too much and overeat. Again, there seems to be this disproportionate stigma against people with behaviourally related cancers and those who have smoked, and for all of those tobacco-related diseases, including heart disease and others, the burden of the stigma really seems to be aimed at people with lung cancer.
So what about screening? About one-quarter of Canadians know that there is a screening test for lung cancer, and 90% said they would support a national screening program for those at high risk. Currently we know that screening is approved and funded south of the border, in the United States. It's been estimated by the Canadian Partnership Against Cancer that 1,250 Canadian lives could be saved every year through the introduction of screening programs. I think this really has a dramatic potential to change survivorship rates.
With that, I want to again highlight some of the priority areas in which I think this group could really help us. We need national leadership to raise awareness and to really raise sympathy, tackling stigma while still working towards a smoke-free Canada. We need a national mandate to reduce lung cancer mortality. The United States has a bill to decrease the incidence of lung cancer mortality. I think we have a similar challenge here in Canada and a similar need. Through the establishment of screening we can really change the face of this disease, change the survivorship rates, and make a major change to the progress we can make in lung cancer. We also need to have a mandate to increase national research funding to an amount proportional to the impact of this disease on our citizens, and also to increase the chance of curing more people with lung cancer here in this country.
We need our own national campaign to combat high-mortality cancers, and the highest of these is lung cancer. Thank you.
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