A new report from the Canadian Breast Cancer Network (CBCN) reveals disparities in access to available testing and treatment technologies.

The report, published Tuesday, was based on insights gathered from two separate round-table discussion groups. One of the groups consisted of six patients experiencing different forms and stages of breast cancer, the other consisting of four medical oncologists. Both groups identified a need for improvement in the way medical information is communicated, the individualized treatment of breast cancer patients, and the standardization of processes used to approve new medical technologies.

The CBCN report highlights “a need for equitable testing.” It indicated that options for treatment vary depending on a patient’s geographic location, the doctors treating them, and the funding options available to them.

Dr. Sandeep Sehdev is a medical oncologist and lead of the Breast Cancer Medical Oncology group at the Ottawa Hospital Cancer Centre, as well as a board member at CBCN. He is also a scientific advisor for the Canadian Cancer Survivor Network and cofounder of the Physician Alliance for Cancer Care and Treatment (PACCT). He was one of the oncologists who participated in the round-table discussions which informed the report.

According to Sehdev, precision oncology, the molecular profiling of a tumor to identify cancer-causing abnormalities, has been used in cancer diagnosis for years. He says it’s most helpful in tailoring treatment plans to suit individual patients’ unique needs.

“We've known for some time now that we can use pretty fancy molecular tools to genetically analyze…the genes that go wrong in cancer cells,” says Sehdev. “And, sometimes, we can find genetic alterations in cancer cells that tell us what the ‘Achilles heel' would be for that particular patient's tumor. That might help us better choose what treatment to give them.”

According to the Canadian Cancer Society, over 27,000 people in Canada are diagnosed with breast cancer every year, which represents around 25 per cent of all new cancer diagnoses in Canada. It is estimated that, on average, 15 Canadian women die from breast cancer every day.

Precision oncology has gradually become a mainstream technology in the past few decades due to increased affordability, but Sehdev says it’s not standardized for use in the diagnosis and treatment of breast cancers in Canada. Precision oncology is used in the treatment of other cancers, but hasn’t been approved for the treatment of breast cancer, although it is being used in regions where private funding is available. According to Sehdev, this has led to some breast cancer patients being offered fewer treatment options than others.

“We've had a parallel development of many new drugs, often oral drugs, that can target those genetic abnormalities and kind of turn off those genetic signals or block them to really help the cancer resolve or improve without the need for more traditional and more difficult treatments like chemotherapy,” says Sehdev. “So the problem has been that we have these technologies, but our processes across Canada to approve them, to get them into our hands and available to patients, unfortunately, have been somewhat slow.”

The report recommends that regardless of the availability of funding, every breast cancer patient should be informed of the uses of precision oncology and other medical technologies available to them.

Although Sehdev says that he is “proud” of Canada’s “methodical process to evaluate new science,” he points out that international developments in medical technology are occurring too rapidly for Canada’s evaluation process to keep up. This could put Canadian breast cancer patients at a disadvantage compared to those in other developed nations.

“The cost of drugs is so expensive that the right testing to get the right drug for the right patient is usually a worthwhile investment,” says Sehdev. “But our processes in Canada are also very complicated. We like to wait until all the evidence is in—not just that a test is accurate, but that by acting on the test and giving the special treatment, that the long term outcomes really are better than what we're already doing. The problem is these advancements are coming through so quickly that patients have fallen through the cracks, and we're at risk of falling behind the times internationally with rapidly evolving treatments that we would want for our family if they had cancer.”

Before being made available to doctors and patients, new medical technologies in Canada must receive approval from Health Canada, and then from the Canadian Agency for Drugs and Technology in Health (CADTH). The CBCN report calls for amendments to this process so patients can have access to new technologies sooner.

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