PE: Can you
make specific recommendations regarding environmental contaminants? Dr. Mai: The effect
of chronic, low-level exposure to environmental contaminants is
a really difficult thing to study, and it's an area of research
that's evolving quickly. For instance, Health Canada is currently
measuring people's exposures to certain chemicals in the environment.
The Environmental Health Committee of the Ontario College of Family
Physicians is also working hard to keep on top of the science on
things like pesticides, endocrine disruptors and other pollutants,
and to make recommendations to GPs. I'd suggest regularly visiting
their website (www.ocfp.on.ca)
for information that can be passed on to patients.
In addition, a new national resource will
soon be available to provide better information support to physicians
dealing with possible exposures and patient questions. The federally
funded Canadian Partnership Against Cancer (www.partnershipagainstcancer.ca)
is currently developing an e-learning course for primary care providers
on the topic of occupational and environmental history-taking. It
should go online this month.
PE: What
role can GPs play in cancer prevention? Dr. Knight: One of
the points I want to make to primary care physicians is that a healthy
lifestyle is not just about cancer -- it's about total health. We
shouldn t just look at prevention strategies that apply to individual
diseases but rather, to the complete health package. Obviously,
measures that are going to affect a broad range of diseases should
have a higher priority.
Dr. Eisen: General practitioners are the primary
providers of cancer prevention information to patients, and they
re particularly involved in screening. The data show that -- even
though women can refer themselves to, for example, the breast screening
program in Ontario -- being referred by a GP has quite a strong
effect. Conversely, the way our health system is set up, specialists
haven t generally played a big role in cancer prevention. But maybe
this is an area we can re-examine. Most cancer patients come to
their specialist appointments with family members, so making some
basic recommendations about cancer prevention to them may have an
impact. This is not something we've traditionally done, but it may
be worthwhile to consider it.
PE: Where
do we need to make progress? Dr. Eisen: If you
look at the funding in a place like Ontario, only about 1% of the
whole cancer budget is spent on prevention. Of course, you can't
not treat people who have cancer -- and the treatments are expensive
-- but somehow we need a bigger vision and a stronger focus on funding
for prevention research.
Dr.
Mai: One of our main priorities in the Screening Action Group
for the Canadian Strategy for Cancer Control is to maximize what
we already know about screening and get that into better practice.
Even though we do have Pap testing and mammograms and the fecal
occult blood test for colorectal cancer, these tests aren t being
used to their full potential by the adult population for whom they
re recommended. I think that working with screening programs and
family doctors would be the best way to make sure we get the most
impact from the screening tools that are available. We can do better.
