In the face of criticism over the way the BC Cancer Agency is being run, those responsible for its management have responded by saying British Columbians have the best cancer outcomes in the country.
Health Minister Terry Lake and others point to British Columbia's cancer mortality rates, which remain the lowest in the country – evidence, it is suggested, that the agency is fine and producing positive results. And they add that they're the result of a cancer-control strategy crafted under the guidance of the Provincial Health Services Authority, the provincial body which has been roundly condemned for the dismal state of affairs at the agency.
While pointing to cancer mortality rates helps deflect the criticism that has been aimed at the health authority – staff oncologists and researchers at the agency have complained about low morale, growing waiting times and surging levels of stress and burnout because of understaffing – experts in the field understand they have little correlation with the care being provided in the province.
"I'm afraid that everybody in B.C. has drunk the Kool-Aid the government has poured for them on this idea of the health service making people healthier," says Terrence Sullivan, the former decade-long head of the Ontario Cancer Agency and now an esteemed professor at the University of Toronto's school of public health. "It's true that B.C. has, by a small margin, a better life expectancy and lower mortality rates, but it's not specific to cancer. You have a healthier population, a more active population, that has lower risk factors for all chronic diseases, not just cancer."
Mr. Sullivan says there is little question there are extremely talented people working at the cancer agency in B.C., but adds: "Selling people the idea that the cancer system is generating higher life expectancy in B.C. for cancer patients when [higher life expectancy] actually occurs across virtually every condition is a bit of a fairy tale."
So let's look at some of the statistics underlying this issue. These are from the 2014 Canadian Cancer Society annual report.
It is true that B.C. has the lowest mortality rate from cancer in the country: 137.7 per 100,000 population. (In 2013 that amounted to 9,900 deaths). That compares, for example, to a rate of 240.9 per 100,000 in the Yukon to 143.2/100,000 in Ontario and 163.5/100,000 in Quebec.
Now let's look at the incidence rate for cancer in B.C. – that is the number of people getting the disease each year. Last year it was 360.9 per 100,000 people, which amounted to 24,300 new cases. That is the lowest incidence level in the country and compares to a ratio of 402.2/100,000 in Ontario, 414.2/100,000 in Quebec and 367.3/100,000 in Alberta.
This raises the question: Are B.C.'s low mortality rates related to the lower incidence of cancer in the province or the quality of care? The answer might be found in another chart contained in the cancer society's report related to survival rates.
If B.C.'s mortality ratio is low because of the work of the cancer agency, then you would expect survival rates from cancer in the province would lead the country. Except that isn't the case.
The report looks at the five-year survival rates for four different types of cancer: prostate, female breast, colorectal and lung cancer. In the case of prostate cancer in B.C., for instance, the average five-year survival rate is 93 per cent. In other words, of those diagnosed with prostate cancer, an average of 93 per cent are still alive after five years. In Ontario, as a comparison, the average is 97 per cent. In Nova Scotia, 95.
The survival rate for female breast cancer in B.C. is 88 per cent, which is similar to Ontario, and is a point below New Brunswick. Other provinces are in the same ballpark as B.C., or a point or two lower. For colorectal, the Canadian average is 64 per cent. In B.C., it's 61. For lung cancer, the national mean is 17 per cent, which compares to 16 per cent in B.C., 20 in Manitoba and 19 in Ontario.
While Mr. Sullivan finds survival rates interesting, he says they do tend to fluctuate yearly, from province to province. He says the low cancer mortality rates in B.C. are fundamentally a product of the population itself. The two major risk factors for cancer are diet, exercise and smoking on the one hand, and nationality on the other. For instance, people of Asian background have lower rates of prostate cancer. Consequently, a province with a high concentration of people of Asian origin (see British Columbia) will notice that fact reflected in its prostate cancer incidence rates.
The fact B.C. is a destination for healthy older people also affects cancer mortality rates. As does the fact it has low rates of people who smoke and high rates of people who are physically active and who eat healthier than those in many other jurisdictions in the country.
"Mortality is really a function of incidence," Mr. Sullivan says. "The more cases of the disease you get the more people who will die. B.C. has healthier people in general. Take any indicator you like of death: heart disease, arthritis, new degenerative disorders, B.C. will be low on all of them. You have a more active population that have lower risk factors for all chronic diseases, not just cancer."
It's certainly accurate to say that a good cancer agency produces good methods of cancer control for its entire population. However, to say that is what's keeping people living longer is a myth being propagated by people who have a vested interest in spinning such tales.
"Everyone loves the fairy tale that this is what's keeping people living longer," Mr. Sullivan says. "But it's simply not the case."
Gary Mason