(April 29, 1999)

From: BC Cancer Agency
Sent: Friday, April 30, 1999 5:10 PM
To: sunletters@pacpress.southam.ca
Subject: Letter to the editor

David Schneider and his colleagues from the Centre for Health Services and Policy Research at the University of British Columbia performed a valuable service by bringing attention to the importance of prevention in improving the health of the citizens of B.C. However, the overall tone of "An Ounce of Prevention" (April 29) left readers with the unfortunate impression that not only are recent efforts against cancer disappointing but that B.C. fails to enjoy better cancer outcomes from this disease than the rest of Canada.

While Schneider acknowledges that death rates from cancer are lower in B.C. than the rest of the country he contends that case fatality rates (the proportion of people contracting a disease who eventually die from that disease) are a more appropriate measure for comparing B.C. with the rest of Canada.

So, what happens if we consider case fatality rates? (Source: "Canadian Cancer Statistics, 1999"). For all cancers combined the case fatality rate for males is 45.6% in B.C. and for Canada it is 51.4%, a difference of 5% in B.C.'s favour. For females it is 43.8% in B.C. and 44.3% for Canada.

Case fatality rates for the most common types of cancer in women are as follows: breast cancer 23% for B.C. versus 27% for Canada; colorectal cancer 28.6% for B.C. versus 35.8% for Canada. Of the major cancers, only lung cancer shows B.C. women to have a slight disadvantage - 80.4% versus 80% for all of Canada.

For men the case fatality rate shows a similar pattern: colorectal cancer, 33.3% in B.C. versus 38.3% in Canada; prostate cancer, 16.6% in B.C. versus 26.3% in Canada. B.C. males with lung cancer do worse with a rate of 93.4% versus 87.5% for Canada. The high fatality rate for all men with lung cancer points to the lethal nature of this disease. Clearly lung cancer is a problem for which new research efforts are important, both in the area of smoking prevention and in new techniques for screening high-risk heavy smokers.

However, it should be born in mind that all of Canada enjoys a comprehensive modern medical system with a high standard of cancer care so differences between provinces in cancer outcomes are unlikely to be large. Progress against cancer has been disappointing, but the effect of new treatment has been significant and we will be pleased to address that issue in a future article for Vancouver Sun readers. During the last 25 years the overall case fatality range from cancer has fallen by 15%.

Societal changes occurring during the last two centuries have had a profound impact on many diseases but have not had the same effect on cancer. It seems prudent, therefore, to continue to pursue research into both the treatment of cancer and the social determinants of the 200 diseases we call cancer.

BC Cancer Agency: Donald R. Carlow, MD President and Chief Executive Officer
Andrew Coldman, Ph.D. Head, Provincial Cancer Control Strategy
Richard Gallagher, M.A. Leader, Cancer Control Research
Suite 400, East Tower 555 West 12th Avenue
Vancouver, B.C. V5Z 3X7 Phone: 604 877-6115