Summary of Key Findings of the Report
1.1 Cancer is a Growing Challenge in Canada
One out of every four Canadians will die from cancer. It is the leading cause of premature death
in Canadians, and the number of cancer cases will increase each year as the Canadian population
grows and ages.
1.2 PET Scans Can Play an Important Role in Cancer Detection and Diagnosis
Studies have shown that PET is a clinically-effective diagnostic modality for cancer and has a
significant influence on the management strategies of patients. Recent economic reviews show that PET is a cost effective diagnostic modality in the following situations:
- The staging of non-small cell lung cancer;
- The differential diagnosis of solitary pulmonary nodules;
- The restaging of colorectal carcinoma after recurrence; and
- The restaging of Hodgkin's and non-Hodgkin's lymphoma.
1.3 PET is Unevenly Deployed across Canada
- Canada is far behind the United States and Europe in its adoption of PET and other diagnostic technologies.
- The availability and utilization of PET infrastructure varies widely, province by province.
- Quebec leads Canada with a well-established and expanding PET infrastructure that offers broad access to PET imaging for cancer.
- In sharp contrast to Quebec, the province of Ontario has restricted patient access to PET over the past decade.
1.4 Growth of PET is Constrained by Costs, Infrastructure, and Education
- High operational and capital costs are challenges to Canada's publicly-funded healthcare system.
- Limited availability of the radiotracer FDG (18F-fluorodeoxyglucose) currently creates high cost
barriers for cancer-care programs integrating PET technology.
1.4.2 Infrastructure and Policy Framework
- Canada's geography and population density have constrained the widespread deployment of PET
- Health Canada's regulation of FDG is viewed as a hurdle to the efficient use of PET resources.
- Canada does not have a national approach or national policies for the use of PET as a clinical
tool for cancer care. Indications for the use of PET vary from province to province.
- The increasing use of other diagnostic modalities has led to concerns about the potential
overutilization of PET.
1.4.3 Education and Training
- Physician groups, cancer patients and the general public are uneducated about the utilization
and benefits of PET technology in cancer care.
- The medical-specialty groups associated with nuclear medicine appear to have different visions
as to how scarce healthcare dollars are spent.
- There is a critical shortage of HQP (highly qualified personnel) in all areas of nuclear medicine.
This demand will increase with growing numbers of PET facilities and cyclotron installations.
1.5 Canada is Ready to Seize the Opportunity
The expansion of PET is critical to Canada's world-wide leadership in nuclear medicine. In the face
of the opportunity for full deployment of PET technology to assist in dealing with cancer, Canada
has a choice to make. Each province need not deal with this situation on its own, in isolation.
Coordinated action, based on a clear business case that outlines action at federal and provincial
levels, is required.
1.6 Time for a National Strategy
- A national approach is required to overcome the initial high costs of an expanding PET infrastructure; this approach could include improved access to capital or coordinated/collective purchase agreements with key manufacturers in the supply chain.
1.6.2 Infrastructure and Policy Framework
- A key constraint is availability and access to the chief radiotracer FDG. Coordinated investments
would allow Canada to develop a network of cyclotrons for distributed and equi-geographic
production of FDG.
- A national PET Steering Committee would allow establishment of uniform PET policies and
indications for all provinces to follow.
1.6.3 Education and Training
- A PET-education campaign directed at physicians, medical students, cancer advocacy groups and the general public would facilitate informed, strategic choices by the different elements of the provincial healthcare systems.