Cover

The battlefront

In the war against cancer, the good news is that death rates for some types are declining

Mark Nichols October 25 1999
Cover

The battlefront

In the war against cancer, the good news is that death rates for some types are declining

Mark Nichols October 25 1999

The battlefront

Cover

Health Report

In the war against cancer, the good news is that death rates for some types are declining

In a demonstration of how not to treat breast cancer, a woman visits her family doctor, who spots warning signals and sends her to a surgeon. After diagnosing cancer, the surgeon removes one breast. She makes a good recovery and returns to her family physician—who recommends no further treatment. As a result, the patient probably never learns of the range of therapies that could prevent her cancer from recurring— and eventually killing her. What went wrong in the hypothetical case, says Dr. Leonard Reyno, head of medical oncology at Halifax’s Queen Elizabeth II Health Science Centre, was that the patient was never referred to a specialist to discuss followup treatment. Now, Reyno is deeply involved in efforts aimed at improving detection and treatment of cancer in the Halifax area. One goal, he says, is to “make sure every patient who has the disease is referred to a cancer expert because, for reasons we don’t understand, family physicians are not always doing this.” In the war against cancer, the good news for Canada is that for some types of the disease—including breast and colorectal cancer—mortality rates are gradually declining. But this year, an estimated 63,400 Canadians will die of the disease, more than a 20-per-cent increase in a decade. This year, the four deadliest cancers—lung, breast, prostate and colorectal— will take more than 33,000 lives. And some parts of the country have better track records than others in combating the disease. According to Statistics Canada data generated for the Macleans Health Report, the Halifax region had 40.8 breast cancer deaths per 100,000 population in 1996. That statistic helped boost the area’s cancer mortality rate among women to 215 per 100,000—the nation’s highest.

Thanks to British Columbia’s provincewide breast cancer screening program and cancer treatment guidelines, the Vancouver area has the lowest mortality rates in breast cancer and in cancer among women. Now, says Reyno, efforts are under way in Nova Scotia to emulate British Columbia’s success. “The provinces,” adds Reyno, “can learn from each other.” Even with a declining mortality rate, another frequently fatal disease—colorectal cancer—is expected to kill 6,300 Canadians this year. According to the 1996 data, the Quebec City and Montreal regions had the nation’s highest colorectal mortality rates—30.7 and 26.4, respectively—and Regina the lowest, at 11.5 per 100,000. A disease that can often be cured if detected in its early stages, colorectal cancer most frequently strikes older people and can be triggered by genetic factors. Many specialists believe eating habits can also play an important role, with some studies showing that the disease most frequently strikes those whose diets are high in fat content—and low in fruit and vegetables.

Prostate cancer—the frequently fatal disease of the walnutsized male organ that secretes a liquid in which sperm is carried—is another kind of cancer for which mortality rates have at least flattened out if not declined. According to the Health Report data, London, Ont., had the highest 1996 mortality rate for the disease—at 29.6 per 100,000—and St. John’s, Nfld., the lowest, at only 14.7.

In attempts to lower the prostate cancer death rate, controversy dogs the PSA blood test, which can detect early signs of the disease. Early detection, say critics like Stratford, Ont., family physician Kenneth Marshall, may persuade men to undergo surgery that can “cause incontinence and impotence without any guarantee that the cancer is gone.” Some experts maintain that extreme measures are often inappropriate for a cancer that can be so slow-growing many afflicted men will die of other causes before it becomes life-threatening. Other physicians vigorously defend PSA testing. “It has helped detect a lot of cancers at an early stage when they can be cured,” says Dr. Joseph Chin, a London surgeon who specializes in prostate cancer. When even the experts can’t agree, the road to reducing cancer deaths is far from clear.

Mark Nichols