Canada's National Laboratory for Particle and Nuclear Physics Laboratoire national canadien pour la recherche en physique nucléaire et en physique des particules

Canadian PET Survey by TRIUMF/AAPS

27 February 2012

Report finds substantial variation in---and opportunity for---uptake of new technology for clinical care of cancer

Cancer is a growing challenge to Canadians and an increasing burden on healthcare budgets. A ground-breaking report released today suggests that access to, and utilization of, leading-edge medical-imaging technology for the diagnosis, staging, and monitoring of cancer treatment varies widely from province to province, putting cancer patients in some areas at a distinct disadvantage.

The technology, called Positron Emission Tomography, is often coupled with Computerized Tomography (CT) and is known as PET/CT imaging. PET imaging is already widely used and integral to cancer care in most developed nations, and increased utilization of this technology could provide more clinically-effective and cost-effective treatment for cancer patients in Canada. A nationally coordinated strategy to take up this technology and standardize its use could bring Canada back to the forefront of global cancer care.

"The Use of Positron Emission Tomography (PET) for Cancer Care Across Canada: Time for a National Strategy" was prepared for TRIUMF and AAPS, Inc. by independent medical-research consultant and well-known writer, Susan D. Martinuk. According to Martinuk, "PET is revolutionizing clinical cancer care in the United States and Europe, yet many Canadian doctors and policy officials continue to see PET as experimental and unproven technology. Cancer patients can suffer because of this reluctance." She reports that she was surprised at the variability among provinces in the utilization of, and access to, this key diagnostic technology.

One exception to the Canadian story is Quebec---where there is a network of 12 clinical PET scanners and PET imaging serves as the gateway to cancer treatment since patients are referred for a PET scan as soon as cancer is suspected. Some provinces have no PET scanners (e.g., Saskatchewan), while others have adequate equipment but restrict access (e.g., Ontario). In British Columbia, PET scanners are overwhelmed by patient volume.

Studies show that PET imaging is clinically effective; it can change the planned treatment regime of a patient in 36.5% – 50% of cases. Based on this, there is an implication that Quebec cancer patients will experience a very different standard of cancer management than their counterparts in other provinces. Of course, other factors beyond PET imaging contribute to overall success in managing cancer.

The power of this non-invasive, nuclear imaging technology is that it can detect changes in the biological function of cells before they undergo the anatomical changes that are typically identified by other diagnostic modalities like CT. This feature makes PET uniquely capable of detecting cancer at an early stage, before a mass is formed, and thus has positive implications for detecting, staging and restaging of cancer patients. PET is also critical to early determination of the efficacy of cancer treatment regimes. Rather than waiting until the end of a trial to determine if chemotherapy is working, a scan early in the chemotherapy regime can show if the treatment is effective or if it should b