Two groups of Victoria family physicians are opening virtual clinics to navigate patients — especially those without family doctors — through screenings to reduce the number of late-stage cancers they see coming through their doors.
Doctors J. Charles Lamb, Robin Norris and Mariia Shevchenko have launched CancerScreening.ca — a telehealth clinic to help patients determine their eligibility for breast, colorectal and lung cancer screening tests, book appointments, and process results.
“Early detection is crucial when it comes to cancer,” said Lamb, former chief of medical staff at Saanich Peninsula Hospital. “Over the last three years, the countless number of patients with either no consistent knowledge or access to cancer screening has led to a tragedy of late presentations.”
In 2019, breast cancer was responsible for 12.8 per cent of cancer deaths in B.C., colorectal cancer 11.9 per cent, and lung cancer 22.1 per cent. Together they accounted for almost 50 per cent of all cancer deaths in the province that year.
“I’ve had far too many shifts as an emergency or urgent care doc seeing patients who do not have a family doctor who have not been screened for cancer,” said Lamb. “If I’m suspicious I do a test and, boom, the CT scan is positive for metastatic cancer. That has happened more times than I can count.”
The physicians — with experience in family practice, hospital, emergency, and urgent care — say the clinic visits will be covered by the Medical Services Plan.
The clinics are focused on people who don’t have a family doctor, about a million people in B.C. and about 100,000 on the south Island. But they are open to anyone who isn’t in the cancer screening system or isn’t getting their recommended screenings done for one reason or another, the doctors say.
“Primary care is struggling to provide quality care for 100 different things and so we’re saying we’re going to take one area of primary care — cancer screening — and do it really well,” said Lamb.
Physicians blame the number of late-stage cancers discovered in recent years on a number of factors: the pandemic, the family-physician shortage, lack of a singular electronic medical record, and patients who are unaware of cancer screening recommendations, indifferent or apprehensive about receiving positive results.
Results of a study on the effect of the COVID-19 pandemic on cancer care and outcomes, published in the Canadian Medical Association Journal this past week, said “health-care disruptions during the COVID-19 pandemic in Alberta considerably affected cancer outcomes … the largest impact was observed among early-stage cancers and those with organized screening programs.”
Other studies from several countries reported decreased diagnoses of some cancers.
“Although cancer care, such as active chemotherapy and emergency surgery, was prioritized in the early stages of the pandemic, some cancer care services — including non-emergency surgeries and screening programs for breast, cervical and colorectal cancers — were delayed or paused,” according to the study.
“COVID has really precipitated late presentations in both attached and unattached patients,” said Lamb.
The physicians will initially meet with patients via video or phone to determine their eligibility for various screenings, create a plan to email and text reminders for follow-up screenings if results are negative, order tests and make referrals to specialists if the results are positive, and serve as a secondary repository of that cancer-related information.
“Our commitment to the public does not end with a referral to the B.C. Cancer Agency and should a patient have difficulty either understanding or accessing their cancer care information, our door will remain open,” said Lamb.
Norris, who is not clinically practising at the moment but has worked with the B.C. Cancer Agency as a general practitioner specializing in oncology since 2019, is a co-founder and co-director. He suffered a spinal cord injury in a mountain biking accident in 2021.
“We’re seeing people presenting with fairly untreatable diseases or disease that has progressed to the point that treatment is not going to be very successful, so I think the more people we can screen and catch early, the more successful treatment becomes,” said Norris.
The physicians say while telehealth appointments can lack intimacy, it’s a trade-off that allows physicians to see a greater number of patients and in turn provide a more timely and accessible service for all, including those with mobility issues or living in remote and rural areas.
“This is a gap that we feel is not being fulfilled in the current state of family medicine or the current state of medicine in general in B.C. so if we can expedite cancer screening and make it more accessible for the public, it will allow for earlier diagnosis,” said Norris.
Lamb said CancerScreening plans to grow into a national service, with a current network of about 30 physicians and an office already established in Calgary. It will remain public and even Canadian citizens without MSP coverage will be seen by the clinic: “Robin’s heart and soul mirrors mine, and we would die on our sword before allowing a private-for-profit enterprise to take over.”
‘Gallstones’ turned out to be colon cancer
Claire Atkinson is a major advocate for cancer screening programs after her colon cancer was caught by chance during an emergency-room visit.
Atkinson, 64, was patient zero for CanScreenBC.com, another provincial cancer screening clinic based in Victoria that recently launched.
It’s run by doctors Stuart Bax and Cal Shapiro, of Boundless Medical which ran an accredited Victoria-based private COVID‑19 testing clinic during the pandemic charging up to $200 for same-day PCR tests for travel. They also work in Greater Victoria in family medicine, urgent and hospital-based emergency care.
When Atkinson arrived at the emergency department in December 2021 with stomach issues, she was led to believe it was gallstones. Instead, it was a tumour estimated to be growing for seven years. It had yet to metastasize and was removed along with about 30 centimetres of colon.
“I think if it had been caught a month later, I would have been in serious trouble because I think the tumour would have spread through the wall of the colon,” said Atkinson. Instead, she returned to work six weeks later.
Atkinson underwent surgery for colon cancer in January 2022 and now requires six-month check ups, including screenings and blood work.
After losing her family doctor in February, she signed onto the provincial registry for family doctors. In the meantime, her sister stumbled on the CanScreenBC clinic website.
“I want continuity of care,” said Atkinson. “The clinic is going to phone me in six months. I think that’s fabulous.”
Atkinson doesn’t remember ever being advised to have a stool screening test in her 50s, as recommended by the province, but believes a few years ago, at age 62, she was given a requisition for a fecal immunochemical test (called a FIT test) but neither she nor the physician followed up.
These are the kinds of cracks in the system Bax and Shapiro want to fill.
Bax is hoping to attract other doctors by offering a fully automated and streamlined work-flow system that would allow those physicians to “log on for a few hours” on a fee-for-service basis as an adjunct to their other work. “We want it to be really flexible and encourage that type of workflow,” he said.
The province offers bookings for breast screening, colon screening, lung screening and cervical screening, and says those who don’t have a primary care provider can access cancer screening through an urgent and primary care centre, walk-in clinic, nurse practitioner clinic, or virtual primary care provider.
But family doctors say it’s difficult to complete the self-referral cancer screening forms without listing a physician or nurse practitioner, a person to whom B.C. Cancer, which co-ordinates the cancer treatments, can send results.
“You hit this barrier when you haven’t got a doctor, you haven’t got the name, to put on the form,” said Bax. “You can’t order these things without a referring clinician on the reports.”
A family doctor or clinic can’t refuse to be listed on the form.
“Mammograms are a crazy one, the amount of patients coming into a walk-in clinic just to get a request for a mammogram,” said Bax. “They’ve tried to order it themselves but they are turned away because there is no one to receive the report.”
‘Why are those rates so low?’
One in two British Columbians will be diagnosed with cancer in their lifetime, with an estimated 25,000 new cases diagnosed each year, according to B.C. Cancer.
But fewer than half the eligible population, 47.2 per cent, is up to date with breast screening, just 61 per have had a Pap test in the past 42 months, and just 60 per cent of the eligible population is up to date with colon screening, according to the Health Ministry and B.C. Cancer.
“We were seeing people coming in through the walk-in clinic who hadn’t had cancer screenings in five years, or 10 years or 20 years, so that’s how we’re approaching this problem,” said Bax. “Why are those rates low, that’s what we need to pin down. Is it lack of access or is there misinformation as we’ve seen around COVID vaccine rates or is there other stuff going on we’re not appreciating.”
Both clinics will collect data to hopefully show the Health Ministry in six months time the number of people screened who wouldn’t have been otherwise and the number of cancers caught early as a result.
Bax said his clinic will also see patients through to the end of their cancer journey, if they need a physician to help co-ordinate their care through surgeons, oncologists, radiologists as orchestrated by the B.C. Cancer Agency.
“The plan is to follow them through their cancer pathway,” said Bax. “If there’s a cancer treatment, then yes, we will be your clinic for the entirety of your cancer course.”
For every 1,000 people screened, about five or six cancers will be detected.
“Cancer is a big scary thing for everyone,” said Bax. “I think it’s the disease that causes the most fear and anxiety. Certainly when you ask patients in a walk-in setting what’s wrong with them, it’s always what patients are scared about, so hopefully we can help them get their screenings and maybe prevent some of those late-stage diagnoses.”
CANCER SCREENING IN B.C.
•Breast screening, a low-dose X-ray of the breast tissue, can be accessed by women age 40 and older in B.C. Among those regularly screened for breast cancer, 5.6 to 5.8 cancers are detected per 1,000 women screened.
• Colon screening, which involves analyzing a stool sample for the presence of blood, is generally advised for those age 50 and older every two years. Colonoscopies, which examine the colon via a flexible colonoscope, are ordered for various reasons, including positive stool tests and family history. The Health Ministry says each day in B.C., colon cancer is diagnosed in one person through screening, and about seven people each day have high-risk pre-cancerous lesions identified and removed. Under the B.C. colon screening program, the incidence of colon cancer is starting to decrease.
• Pap tests are generally advised every three years for women and transgender people ages 25 to 69. In B.C., screening has reduced the incidence of cervical cancer by more than 70 per cent. (A vaccine can prevent almost 100 per cent of cases of cervical cancer caused by the HPV).
• Screening for lung cancer, the leading cause of cancer death in B.C., is done through a low-dose CT scan of the chest and is targeted to people ages 55 to 74 who are smoking or have a smoking history of 20 years or more. B.C.’s lung cancer screening program — the first in Canada — was announced last year and is available in 36 sites.
• Patients outside recommended age guidelines for cancer screening tests might still be eligible.
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