Transcript: Terry Sullivan - The Best Ways To Prevent Cancer - Pt & Ask | Dec 24, 2003

 (music plays)

A slate reads “The advice given in Mini-Med School is of a general nature only. Viewers should consult their own medical professional for medical advice specific to their circumstances.”

Against a blurry background of blue and pink pills, a video reel displays pictures of medical gear such as a needle, a scan of a human body and heart rate monitors.

The title of the show slides in: “Mini-Med School.”

Then, Terry Sullivan stands on a stage in a university auditorium giving a lecture. He’s in his mid-fifties, with brown hair and clean-shaven. He’s wearing a dark suit, a light gray shirt, a patterned tie and glasses.

Behind him, a computer screen is projected on a tall white wall.

Terry says IN THE CASE
OF PROSTATE SCREENING IN OUR,
OUR, MY, THE NEXT SPEAKER MAY
SPEAK TO THIS CLEARLY, WE DO
NOT RECOMMEND, THE CANADIAN
TASK FORCE DOES NOT RECOMMEND
ROUTINE SCREENING FOR PROSTATE
CANCER IN MEN, FOR A RANGE OF
VERY GOOD REASONS.

A caption appears on screen. It reads “Terry Sullivan. Cancer Care Ontario. The Best Ways to Prevent Cancer Part 2.”

He continues THE FIRST ONE IS THAT WE HAVE
NO EVIDENCE THAT THIS SCREENING
PROCEDURE ACTUALLY REDUCES
DEATH IN OLDER MEN BY DETECTING
CANCERS EARLIER.
WE KNOW IT DOES DETECT CANCERS
EARLIER.
WE ALSO KNOW THAT THERE ARE A
WHOLE SET OF DIFFICULTIES
ASSOCIATED WITH THE SCREENING
PROCEDURE, BECAUSE AGAIN A
FALSE, POSITIVE AND THE, THE
COMPLICATIONS ARISING FROM THE
DOWNSTREAM CASCADE OF
INVESTIGATIONS ARISING FROM
FALSE, POSITIVES.
THERE ARE TWO OR THREE VERY
LARGE, HIGH QUALITY TRIALS IN
MOTION INTERNATIONALLY.
AND WITHIN FIVE YEARS WE WILL
HAVE VERY PRECISE INFORMATION
ABOUT THE MORTALITY BENEFITS OF
SCREENING FOR PROSTATE CANCER
AND WHICH PARTICULAR KINDS OF
CANCER AND WHAT PARTICULAR
KINDS OF MEN, SO WE'LL BE IN A
BETTER POSITION TO BE MORE
PRECISE ABOUT A RECOMMENDATION
FOR PROSTATE CANCER.
AND I'M NOT GONNA WALK THROUGH
THIS IN DETAIL IN THE INTEREST
OF TIME.
UM, SO THERE ARE A COUPLE OF
CANCERS FOR WHICH GASTRO-
INTESTINAL CANCERS, I'M JUST
GONNA TOUCH ON.
COLORECTAL CANCER.

He runs a PowerPoint presentation.

He continues WHAT YOU SEE IN THIS SCREEN IS
AN ADENOMATOUS POLYP, WHICH IS
IN THE CANAL IN THE COLON, AND
THAT IS THE FIRST INDICATION
THAT SOMETHING IS GOING WRONG
WITH RESPECT TO COLON CANCER.
AND IF YOU HAPPEN TO HAVE A, A
COLONOSCOPY AND YOUR, YOUR
ENDOSCOPIST FINDS AN
ABNORMALITY THIS IS IN ALL
LIKELIHOOD WHAT HE OR SHE IS
LOOKING AT.
UM, IN, WHEN THEY'RE, WHEN
THEY'RE DOING THE COLONOSCOPY
AND THEY SIMPLY, SNARE THE, THE
LESION AND REMOVE IT AND THAT'S
ALL DONE IN ONE PROCEDURE IN
THE CASE OF COLONSCOPY.
SO JUST AGAIN TO RECAP, THE
NUMBERS OF MEN AND WOMEN
GETTING AND DYING FROM
COLORECTAL CANCER IN ONTARIO.
A VERY SMALL FRACTION OF
COLORECTAL CANCER IS ASSOCIATED
WITH SINGLE GENE IRRITABLE
DEFECTS THAT MAKE THEM MUCH
MORE LIKELY IN FAMILIES WHERE
FAMILIAL POLYPOSIS EXISTS OR
HEREDITY NON-POLYPOSIS
COLORECTAL CANCER.

A pie graph appears.

He continues THESE ARE A SMALL NUMBER OF,
OF, OF FAMILIES IN THE
POPULATION THAT HAVE THESE
IRRITABLE GENE DEFECTS.
THERE IS A LARGER GROUP OF
FAMILIES THAT HAVE FAMILIAL
PATTERNS FOR WHICH WE'RE NOT
CLEAR YET ON WHAT THE
HEREDITABILITY ISSUES ARE.
WE BELIEVE THEY MAY BE
ASSOCIATED WITH MULTIPLE
CLUSTERS OF MUTATION IN THOSE
FAMILIES AND THERE IS NOW SOME
INTERESTING, VERY EXPENSIVE,
HIGH THROUGH PUT STUDY GOING
ON.
AND WE HOPE IT WILL ACTUALLY GO
ON IN ONTARIO TO CHARACTERIZE
WHICH APOTYPES ARE ASSOCIATED
WITH THESE FAMILIAL PATTERNS.
BUT THE MAJORITY OF COLORECTAL
CANCER IS NOT FAMILAL.
IT'S SPORADIC AND ARISES IN THE
POPULATION AND IMMINENTLY
PREVENTABLE.
I'M JUST GONNA FOCUS ON SOME
AREAS OF PROMISE FOR PRIMARY
PREVENTION AND COME BACK TO THE
SCREENING IDEA.
UM, IN THE CASE OF, OF GASTRO-
INTESTINAL CANCERS THESE ARE
THE AREAS THAT HAVE BEEN MADE
REFERENCE TO AND ARE OFTEN
TALKED ABOUT.

A slide shows a bulleted list.

He continues DIETARY FIBRE, FRUITS AND
VEGETABLES, VITAMIN, VITAMIN
D/CALCIUM, NON-STEROID ANTI-
INFLAMMATORY DRUGS, ASPIRIN,
VITAMIN C AND E.
THE OVERALL RESULTS FROM CASE
CONTROLLED STUDIES ARE
GENERALLY SUPPORTIVE OF THE
PROTECTIVE EFFECT OF DIETARY
FIBRE.
UM, THERE ARE QUESTIONS ABOUT
HIGH INTAKE OF DIETARY FIBRE
AND, AND DECREASED RISK OF, OF,
OF COLON CANCER AND, AND
ADENOMATANS IN THE COLON.
THERE IS SOME CLEAR EVIDENCE
THAT INCREASED VEGETABLE
CONSUMPTION HAS A PROTECTIVE
EFFECT AGAINST COLORECTAL
CANCER.
MIXED FINDINGS WITH RESPECT TO,
FRUIT, TO FRUIT PERSE, BUT
BECAUSE OF THE COMBINED
BENEFITS OF FRUITS AND
VEGETABLES ON A RANGE OF
CHRONIC DISEASES WE STILL
ADVOCATE HIGH LEVELS OF FRUIT
AND VEGETABLE CONSUMPTION IN
THE POPULATION.
CALCIUM PRESIDES, IS CLEARLY
ASSOCIATED WITH REDUCED
LIKELIHOOD OF COLORECTAL
CANCER, BUT WE DON'T REALLY
RECOMMEND IT AT THIS STAGE ON
ITS OWN, UM, AH, SOLELY TO
PREVENT COLORECTAL CANCER.
BUT CERTAINLY ADEQUATE CALCIUM
IN, INTAKE IS IMPORTANT FOR A
RANGE OF, OF DISEASE
PREVENTION.
IT FACTORS IN PARTICULAR,
PARTICULARLY IN WOMEN.
AND WE DON'T HAVE CLEAR
EVIDENCE YET FOR VITAMIN C OR E
IN A REDUCTION OF COLORECTAL
CANCER.
AND IN THE CASE OF NON-STEROID
ANTI-INFLAMMATORY DRUGS AND
ASPIRIN, IT DOES LOOK LIKE LOW
DOSE AH, AH, NON-STEROID ANTI-
INFLAMMATORY DRUGS ARE
ASSOCIATED WITH REDUCED
LIKELIHOOD OF COLORECTAL
CANCER.
BUT ONCE AGAIN THERE HAS BEEN
NO WIDESPREAD, AH,
RECOMMENDATION TO CONSUME THEM
WITH REGULARITY SOLELY AND
EXPRESSLY FOR THE PURPOSE OF
PREVENTING COLORECTAL CANCER.
AND AS YOU MAY HAVE SEEN IN
THE, IN THE PRESS IN THE LAST
WEEK A LARGE STUDY NOW
SUGGESTING THAT LARGE, THAT
REGULAR CONSUMPTION OF, OF
AVERAGE DOSES OF ASPIRIN MAY,
UNDERLINED, BE ASSOCIATED WITH
ELEVATED RISK OF, OF ANOTHER
FORM OF CANCER IN, IN THE
DIGESTIVE TRACT, PANCREATIC
CANCER.
SO WHAT ARE WE SAYING ABOUT
COLORECTAL CANCER TO COME BACK
TO SCREENING?
WE'RE SUGGESTING THAT EVERYBODY
IN THE ELIGIBLE AGE RANGE, OVER
THE AGE OF 50, SHOULD BE
SCREENED EVERY YEAR FOR
COLORECTAL CANCER.
WE ARE RECOMMENDING THAT FECAL
OCCULT BLOOD BE THE SCREENING
METHODOLOGY THAT INVOLVES NOT
THE MOST UM, ENTERTAINING AH,
PROCEDURE.
SMEARING SOME STOOL ON SOME,
SOME, SOME GEL TO SEE HOW IT
REACTS WITH RESPECT TO WHETHER
THERE'S BLOOD IN HIS STOOL.
BUT AGAIN, LARGE TRIALS, FIVE
LARGE TRIALS INDICATE THAT ON
AVERAGE IF PEOPLE DO THIS WITH
REGULARITY OVER THE PERIOD OF,
OVER A TEN YEAR PERIOD, THERE'S
A DRAMATIC MORTALITY BENEFIT
FROM THE DETECTION OF EARLY
STAGE CANCER.
UM, SO WE ARE INTRODUCING A
PILOT IN ONTARIO THAT'S BUILT
ON FOBT.
PEOPLE, SOME PEOPLE WALK WITH
THEIR FEET.
MORE AND PEOPLE ARE HAVING
COLONSCOPY IN ONTARIO.
THERE IS NO RANDOMIZED
CONTROLLED TRIAL EVIDENCE ON
ITS OWN THAT RECOMMENDS
COLONOSCOPY.
COLONOSCOPY IS A MUCH MORE
INTRUSIVE PROCEDURE THAT HAS
VERY SMALL, BUT MEASURABLE
RISKS.
WHEREAS, FOBT HAS MUCH LOWER
RISKS OVERALL.
IF YOU HAVE A POSITIVE FOBT,
THAT IS YOU'RE SHOWING EVIDENCE
OF SOME BLOOD IN YOUR STOOL,
YOU MAY OR MAY NOT HAVE A
PROBLEM.
FOBT IS ONE OF THOSE PROCEDURES
THAT IS NOT AH, THE MOST
SENSITIVE AND SPECIFIC TEST AND
THERE ARE A NUMBER OF FALSE,
POSITIVES.
IF YOU HAVE A POSITIVE TEST, IN
ALL LIKELIHOOD YOU'LL HAVE A
COLONSCOPY.
SO THE COLONOSCOPY IS, IS THE
REALLY THE GOLD STANDARD FOR
THE DETECTION, EXTRACTION OF
ABNORMALITIES IN, IN, IN THE
EARLY STAGES OF COLORECTAL
CANCER.
AND, AND IN FACT MY COLLEAGUE
THAT I WAS WORKING WITH, WHO'S
A GENTLEMAN THE AGE OF 54, WENT
TWO WEEKS AGO AND DISCOVERED HE
HAD TWO POLYPS.
THEY WEREN'T ADENOMATOUS, BUT
THEY WERE POLYPS.
HE HAD THEM REMOVED.
SO THOSE POLYPS WHICH WERE NOT
ADENOMATOUS WERE NOT YET
CANCER.
IF THEY PROCEEDED TO CANCER AND
WE DON'T HAVE A CLEAR PICTURE
YET ABOUT HOW THEY ALL PROCEED
AND DON'T PROCEED TO CANCER,
THEN HE WOULD'VE HAD THE, THE
ENTIRE CANCER PREVENTED BY
HAVING THOSE POLYPS REMOVED.
LONG WAY BACK TO THE SIMPLE
RECOMMENDATION THAT ALL ADULTS
OVER 50, SHOULD BE SCREENED
REGULARLY FOR COLORECTAL
CANCER.
AND RIGHT NOW IN ONTARIO, ABOUT
TEN PERCENT OF THE POPULATION
IS I THINK ANY FORM, TWELVE
PERCENT OF THE POPULATION ANY
FORM OF INVESTIGATION
ASSOCIATED WITH THE BOWEL THAT
MIGHT HAVE MERIT FOR THE
SCREENING PROCEDURE.
ONTARIO HAS ONE OF THE HIGHEST
RATES OF COLORECTAL CANCER IN
THE WORLD BY THE WAY.

A slide displays a line graph.

He continues SO THERE'S A LOT WE CAN DO
HERE, BY ADVANCING THE
SCREENING AND BY ALL OF US
BEING SCREENED WITH REGULARITY.
THIS IS ANOTHER SIMULATION
LOOKING FORWARD TO HOW MANY
CASES OF COLORECTAL CANCER
WOULD BE PREVENTING FECAL
OCCULT BLOOD TESTING IN
ONTARIO, AND YOU GET A PICTURE
THAT OVER THE NEXT 15 YEARS, 20
YEARS, WE WOULD, WE WOULD
PREVENT UP TO 6,000 CASES, WITH
EASE BY ACTIVE SCREENING.
I WON'T GO INTO THIS IN DETAIL,
BUT SIMPLY TO SAY THAT WE HAVE
A PILOT GOING ON BEGINNING NOW
IN EIGHT COMMUNITIES IN
ONTARIO, TO ACCELERATE
SCREENING IN A NUMBER OF
PRIMARY CARE PRACTICES AND
THROUGH THE PUBLIC HEALTH, IN
12 DIFFERENT COMMUNITIES IN
ONTARIO, AND MAYBE NEXT TIME,
THIS TIME NEXT YEAR I'LL BE
ABLE TO TELL YOU A LITTLE BIT
ABOUT HOW THAT'S PROCEEDING.
THERE IS ALSO SOME DEVELOPING
AND EMERGING EVIDENCE THAT
STOMACH CANCER MAY BE TIED UP
WITH A LITTLE BUG CALLED
HELECOBACTER PYLORI, H-PYLORI.
SOME OF US GREW UP WITH THE
BELIEF THAT IF YOU HAD A
STOMACH ULCER OR A DUODENAL
ULCER, IT SOMEHOW WAS RELATED
TO ANXIETY, WORRY.
IT TURNS OUT TO BE MUCH MORE
RELATED TO WHETHER OR NOT THIS
UNUSUAL LITTLE BUG IS IN YOUR
STOMACH, WHICH IS A FORM OF
MICROBIAL INFECTION.
SO IT'S AN IMPORTANT CAUSE OF
CANCER THAT INFECTS A
SUBSTANTIAL PORTION OF THE
CANADIAN POPULATION.
AND WE HAVE A PIECE IN MOTION
LOOKING AT THE MERITS OF
SCREENING FOR H-PYLORI IN, IN,
IN THE POPULATION.
OVERALL IN A PILOT STUDY TO
TAKE A LOOK AT ZERO PREVALENCE
OF THIS PARTICULAR PROBLEM IN
ONTARIO.
WE DON'T HAVE AN EXACT PICTURE
OF HOW MANY PEOPLE IN ONTARIO
HAVE THE BACTERIA IN THEIR
STOMACH.
WE THINK IT'S SOMEWHERE BETWEEN
25 AND 35 percent OF THE POPULATION.
AND HAVING THE BACTERIA SIMPLY
RAISES YOUR RISK.
IT'S NOT YOU KNOW, IT'S ALL
ABOUT WHETHER, WHAT YOUR RISK
IS.
UM, WE KNOW IN, IN SOME
PARTICULAR COMMUNITIES IN
ONTARIO WE'VE GOT ESTIMATES FOR
EXAMPLE, IN, IN, ON RESERVE,
ABORIGINAL COMMUNITIES WE KNOW
THE RATES MAY BE AS HIGH AS 60
OR 70 percent OF THE POPULATION.
WE DON'T HAVE A CLEAR PICTURE
IN THE GENERAL POPULATION.
WE'RE GONNA FIND OUT AND WE'RE
GONNA TRY AND DO SOMETHING
ABOUT THIS IN A MORE SYSTEMATIC
WAY IN ONTARIO.
AND WE KNOW THAT ERADICATING
THE BUG CAN BE DONE, 90 percent OF
INDIVIDUALS CAN HAVE IT
ELIMINATED.
MANY OF YOU MAY HAVE HAD THE
PROCEDURE.
I'VE HAD THE PROCEDURE.
YOU TAKE TRIPLE THERAPY, WHICH
IS A MIXTURE OF ANTIBIOTIC AND,
AND PROTON PUMP INHIBITORS TO
PAIN OF REDUCE, TO, TO, TO KILL
THE BUG.
AND WHEN YOU'VE KILLED THE BUG
YOU REDUCE YOUR LIKELIHOOD OF
EVER GETTING CANCER.
AND FOR THOSE THAT HAVE HAD
CANCER, KILLING THE BUG REDUCES
THE LIKELIHOOD OF GETTING IT
AGAIN.
AH, SO IT'S AN IMPORTANT CANCER
TO BE LOOKING AT.
LASTLY, I'M JUST GONNA MOVE ON
QUICKLY THEN TO THE LAST TWO
AREAS.

A slide under the title “So, what can a family physician do in preventive oncology” appears on screen. A column reads “Treatment: 6 pts diagnosed/year all cancer. 1 lung cancer/year. 1 breast cancer/year. 1 ovarian cancer/5 years” And another column reads “Prevention: 300 smokers, 855 physically inactive, 435 overweight/obese, 200 eligible for cervical screening/year, 75 eligible for breast screening/year, 350 eligible for colorectal screening/year.”

He continues WHAT CAN A FAMILY DOC DO?
YOU THINK ABOUT THE TRAFFIC
PATTERNS.
A GUY LIKE -- MIGHT DEPENDING
ON -- THE AGE OF HIS POPULATION
MIGHT SEE HALF A DOZEN
PATIENTS, MAYBE YOU SEE A LOT
MORE MIKE, UH, AGAIN DEPENDING
ON THE AGE OF YOUR POPULATION.
HALF A DOZEN PATIENTS WITH
CANCER, YOU KNOW, MAYBE ONE
LUNG CANCER, ONE BREAST CANCER,
MAYBE ONE COLORECTAL CANCER
EVERY TWO YEARS.
ON THE OTHER HAND, PRIMARY CARE
DOCS CAN DO A LOT WITH RESPECT
TO INTERACTING WITH SMOKERS,
PHYSICAL ACTIVITY, WEIGHT, UH
AND SCREENING PROCEDURES WITH
THEIR PATIENTS.
SO, IF YOU'RE THINKING ABOUT
THE BALANCE OF EFFORTS, THERE'S
A BIG PART OF FAMILY PRACTICE
WHICH WE NEED TO KEEP SHINING A
LIGHT ON IN RELATION TO
PREVENTATIVE HEALTH SERVICES,
BECAUSE MOST OF US ARE
INTERACTING WITH OUR PRIMARY
CARE DOC, THEY ARE REALLY
IMPORTANT ROUTES TO PREVENTION
SCREENING OVERALL.
I'M GOING TO GO VERY RAPIDLY
THROUGH THIS BECAUSE YOU'VE GOT
ALL THE BACKGROUND MATERIAL IN
HERE, SO WE CAN GET ALL THE
QUESTIONS.
CANCER 2020 IS A WAY OF SETTING
UP A PLAN FOR CANCER PREVENTION
IN ONTARIO.
UM, AND, UH, WE SET TARGETS FOR
REDUCTION IN TOBACCO, DIET AND
NUTRITION, BODY WEIGHT,
ALCOHOL,
OCCUPATION ENVIRONMENTAL
EXPOSURE, UV AND VIRAL
INFECTIONS, AS WELL AS
SCREENING.
AND, WE ARE PUTTING IN PLACE A
MECHANISM TO TRACK HOW WE'RE
DOING YEAR, BY YEAR AND REPORT
TO THE PUBLIC, ACROSS ONTARIO,
ABOUT HOW WE'RE DOING IN
ACHIEVING THESE TARGETS.
BUT, TO GIVE YOU AN EXAMPLE,
WE, WE KNOW THAT TEEN SMOKING
IS
AN ISSUE, WE'D LIKE TO BRING
DOWN TEEN SMOKING IN THE NEXT
15
YEARS FROM 19 percent DOWN TO 2 percent IN
THE
POPULATION.
THAT'S A TARGET, WE TRACK THIS
EVERY YEAR, WE HAVE A SURVEY,
WE'LL BE REPORTING BACK TO YOU
ON
HOW WE'RE DOING IN THIS AREA.
AND, IF MISTER McGUINTY MAKES GOOD
ON HIS PROMISES AROUND TOBACCO,
THESE NUMBERS WILL START TO
FALL
FAIRLY QUICKLY.
SO, WE'VE SET OUT A NUMBER OF
TARGETS HERE IN RELATION TO
YOUNG PEOPLE, ADULTS, QUITTING,
EXPOSURE TO SECOND-HAND SMOKE
AND SMOKE-FREE SPACE.
LIKEWISE, WE'VE SET OUT TARGETS
FOR FRUIT AND VEGETABLE
CONSUMPTION, PHYSICAL ACTIVITY,
OBESITY AND ALCOHOL
CONSUMPTION.
AND, WE WILL BE TRACKING AND
REPORTING TO PEOPLE IN ONTARIO
HOW WE'RE DOING IN THESE
TARGETS.
HOW MUCH OF A DIFFERENCE COULD
WE MAKE, IF WE LOOK AT WHAT THE
RISK REDUCTIONS WOULD BE ASSOCIA
WITH ACHIEVING THESE TARGETS.
IN THE AREA OF SMOKING WE'D
REDUCE THE NUMBER OF DEATHS BY
6,000, IN THIS PERIOD OF TIME,
INCREASED FRUIT AND VEGETABLE
CONSUMPTION WOULD DECREASE THEM
BY MORE THAN 3,000 AND PHYSICAL
ACTIVITY WOULD BRING DOWN
CANCERS DRAMATICALLY.

A bar graph shows what he mentions.

He continues VERY STRONG RELATIONSHIP,
EVOLVING
NOW, BEING CLEAR, BETWEEN A
PHYSICAL ACTIVITY AND BREAST
CANCER AND COLORECTAL CANCER IN
PARTICULAR.
AND, A VERY GOOD POSSIBLE
RELATIONSHIP WITH UH, PROSTATE
CANCER IN MEN AS WELL.
UV EXPOSURE, WE'VE SET TARGETS
HERE AS WELL, IN RELATION TO
SUN EXPOSURE, OCCUPATIONAL,
ENVIRONMENTAL AND SCREENING,
WE'VE SET TARGETS THERE AS
WELL.
AND, THE CAPACITY TO MONITOR
AND ADOPT ANY EMERGING ISSUES
WITH RESPECT TO ANTI-CANCER
AGENT IN THE PREVENTION OF
CANCER.
A PANEL HAS BEEN INSTRUCT TO
DIGEST AND RESPOND TO NEW
DEVELOPMENTS IN SCREENING FOR
CANCER BECAUSE THEY'RE COMING
FAST AND FURIOUS, ARISING FROM
PROTEIN MARKERS BECAUSE OF THE
EXPLOSION OF... MIX, UH THERE
ARE MANY PROMISING EARLY
MARKERS FOR CANCER THAT NEED TO
BE ASSESSED CONTINUOUSLY.
SO, WE SET OUT FOUR PRIORITIES
FOR THIS.
COMPREHENSIVE TOBACCO CONTROL,
WHICH, IF I SOUND LIKE A BROKE
RECORD ON TOBACCO, IT'S BECAUSE
THAT'S WHERE WE CAN MAKE A
DIFFERENCE.
COLORECTAL SCREENING AND AS I
MENTIONED ONCE WE'D ANNOUNCED
THIS PROGRAM, WITHIN IN TWO
MONTHS WE GOT AN AGREEMENT TO
PROCEED WITH THE PILOT.
SO, THOSE AREAS ARE NOW
ACTUALLY MOVING IN A GOOD
DIRECTION AND WE'RE LOOKING TO
STRENGTHEN THE EXISTING
SCREENING PROGRAMS.
AND, IMPLEMENT A SPECIAL FOCUS
ON ABORIGINAL POPULATIONS
BECAUSE OF UNIQUE PATTERNS OF
CANCER, INCIDENTS AND FRANKLY
LARGE PROBLEMS WITH SMOKING IN
MANY ON RESERVE POPULATIONS IN
ONTARIO THAT NEED ATTENTION.
WE DON'T WANT TO TAKE ON MORE
THAN WE CAN CHEW, SO WE'VE KIND
OF UH, UNLIKE THE, UH, THE
DRIVE OF THIS PARTICULAR CART,
WE'RE TRYING TO TAKE ON A SMALL
NUMBER OF IMMEDIATE PRIORITIES
TO TRY AND PUSH THINGS ALONG.
WE'VE SET UP A COUNCIL, THAT
HAS MET ONCE, OF PROMINENT
LEADERS ACROSS THE UH, WORLD OF
NGOs, PUBLIC HEALTH AND UH, THE
GOVERNMENT OF ONTARIO TO TRY
AND PUSH THESE THINGS ALONG.
INCLUDING A FORMER MINISTER OF
HEALTH, RUTH GRUYERES, GOING TO
BE AN ACTIVE MEMBER OF THIS
COUNCIL OVERALL.
AND, TO REPORT ANNUALLY ON HOW
WE'RE DOING, SO YOU WILL HAVE A
PICTURE.
ALL, ALL PEOPLE IN ONTARIO WILL
HAVE A PICTURE ABOUT HOW WE'RE
DOING, BECAUSE SOMEHOW, WE
DON'T GET THE MESSAGE ACROSS
VERY WELL AND WE NEED TO
CONTINUE TO PLAY BACK TO PEOPLE
IN ONTARIO THAT PROBLEMS WITH
CANCER CAN ONLY BE UH, STEMMED
WHEN WE HAVE A VERY AGGRESSIVE
FOCUS ON PREVENTION AND
SCREENING.
THIS MEANS THAT PRIMARY CARE
PRACTICE HAS TO ALIGN WHAT
HAPPENS IN A FAMILY
PRACTITIONER'S OFFICE ON --
EVERY ENCOUNTER WITH A FAMILY
PRACTITIONER HAS TO BE ALIGNED
WITH THESE PREVENTION EFFORTS.
AND, I TRIED TO SHOW THIS IN
RELATION TO THE KIND OF
CLINICAL PICTURE THAT WALKS
THROUGH AS AGAINST THE
PREVENTION ACTIVITIES THAT
PRIMARY CARE DOCS MIGHT BE
INVOLVED IN.
AND, WE NEED SIGNIFICANT PUBLIC
INVESTMENTS IN ORGANIZED
EFFORTS.
SOME PEOPLE MAY THINK THIS MAY
BE THE NANNY STATE IN MOTION,
YOU KNOW TO TRY TO ORGANIZE A
PROGRAM TO SCREEN PATIENTS, TO
SCREEN PEOPLE IN THE
POPULATION.
BUT, ORGANIZED SCREENING
PROGRAMS ARE FAR MORE EFFECTIVE
IN PREVENTING CANCERS, THAN
PEOPLE JUST WALKING THROUGH
DOCTOR'S DOORS.
THEY CAN WORK VERY MUCH IN
COMPLEMENT TO THOSE PROCEDURES.
THE ONLY WAY TO MAKE THESE
PREVENTION AND SCREENING
METHODS WORK, IS TO HAVE STRONG
COALITIONS OF ACTIVE PEOPLE,
WHO ARE INTERESTED IN CHRONIC
DISEASE, PUSHING FORWARD,
RAISING THESE MATTERS IN THE
PUBLIC EYE AND PUBLIC ADVOCACY
IS NECESSARY TO CONVINCE
PEOPLE.
MISTER SMITHERMAN MADE A VERY
INTERESTING UTTERANCE IN HIS
FIRST DAYS IN OFFICE FOR THOSE
WHO WERE WATCHING.
HE SAID TWO THINGS, HE SAID HE
WAS REALLY GOING TO FOCUS ON
PREVENTION AND THEN HE SAID HE
WAS IMMEDIATELY GOING INTO
NEGOTIATIONS FOR WAGES WITH
PHYSICIANS AND DOCTORS, MOST OF
THEM WHOM WORK IN THE TREATMENT
END OF THE DELIVERY SYSTEM.
THAT'S THE DIFFICULT BALANCE
WE'RE FACING WITH, WE'RE FACED
WITH ALL THE TIME.
THIS IS A PICTURE OF WAITING
TIMES FOR RADIATION THERAPY FOR
CANCER IN ONTARIO.
THEY'VE BEEN GROWING FOR A
DECADE AND I'M HERE TO TELL YOU
THE SAME IS TRUE FOR SURGERY
AND FOR SYSTEMIC THERAPY.

A line graph appears.

He continues WE STILL HAVE GROWING PRESSURES
IN THE CANCER SYSTEM, BECAUSE
WE HAVE NOT BEEN BRINGING ON
CAPACITY FAST ENOUGH TO TREAT
THIS SLOW EPIDEMIC I'VE SHOWN
YOU OF CANCER IN THE POPULATION
AS A CONSEQUENCE OF AGING.
SO, WHENEVER WE'RE TRYING TO
PRESS FORWARD IN THE PREVENTION
AND SCREENING AGENDA, THIS
PICTURE OF CANCER PROBLEMS IS
SITTING IN FRONT OF US.
BUT, THOSE OF US IN THE AREA --
IN THE PUBLIC HEALTH END OF IT,
INTERESTED IN PREVENTION AND
SCREENING, WE'RE DETERMINED TO
WIN THIS BATTLE AND KEEP
PRESSING FORWARD TO BUILD A
STRONGER FOCUS ON PREVENTION
AND SCREENING.
THANK YOU VERY MUCH.

[Applause]

(music plays)

The caption changes to “Ask Doctor Mike.”

Mike Evans stands on the stage. He is in his mid-thirties, clean-shaven with receding blond hair. He’s wearing glasses and a light open-necked shirt.

Mike says UH, WITH RESPECT
TO ARTHRITIS ARE ANY OF THE
CARDIO-EXERCISE MACHINES BETTER
THAN OTHERS, TREADMILL,
RUNNING, WALKING, ROWING,
ELLIPTICAL OR STAIRMASTER?

The caption changes to “Mike Evans. University of Toronto.”

Mike continues UM, FIRST OF ALL, UH, THERE
HAVE BEEN SOME NICE TRIALS WITH
KNEE ARTHRITIS, SHOWING
EXERCISE REDUCED PAIN, UH, IN
PATIENTS WITH ARTHRITIS.
SO, THAT'S COUNTER-INTUITIVE,
YOU KNOW, I THINK A LOT OF
PEOPLE THINK, I'VE GOT
ARTHRITIS I GOTTA STOP MOVING.
UH, MOTION IS LOTION I TELL MY
PATIENTS, UH, AS FAR AS UH,
WHAT'S BEST, UH, IT DEPENDS A
BIT ON YOUR ARTHRITIS.
IF YOU HAVE SEVERE ARTHRITIS,
PROBABLY SOME OF THE POOL
EXERCISES AND SO ON AND SO
FORTH, PROBABLY WORK BEST FOR
YOU.
UH, THE UH, COMPANIES ARE
PUSHING THE ELLIPTICAL, THAT IT
MATCHES OUR WALKING MORE, I
GUESS THAT'S THE CASE, I DON'T
KNOW THE SCIENTIFIC EVIDENCE
ABOUT WHETHER ONE'S BETTER THAN
ANOTHER.
BUT, UH, WHAT I CAN SAY IS
EXERCISE HELPS THE PAIN AND
SYMPTOMS OF ARTHRITIS.
UH, THE OTHER KEY MESSAGE IS
THAT A LOT OF PEOPLE WAIT UNTIL
THEY'RE IN PAIN, YOU KNOW WAIT
UNTIL THEY'RE ON THE 16TH HOLE
OF THE GOLF COURSE BEFORE THEY
UH, TAKE THEIR PAIN MEDICATION.
THE KEY MESSAGE IS TO TAKE IT
EARLY, SO TAKE IT BEFORE.
IT'S A LOT EASIER TO DEAL WITH
PAIN DOWN HERE, THAN IT IS UP
HERE.
SO, TAKE YOUR MEDICATIONS
BEFORE YOU HAVE THE PAIN.

Mike reads WHAT CAUSES
STOMACH CANCERS AND CAN THEY BE
TREATED WITH ANTIBIOTICS?
He continues THERE'S TWO TYPES OF STOMACH
ULCERS.
WELL, UH, THERE'S ON TYPE OF
STOMACH ULCER REALLY, UH, SO
UM, WHAT HAPPENS IS THERE'S AN
ULCER AND AN ULCER IS EXACTLY
LIKE YOU HAVE IN YOUR MOUTH OR
UH, A CUT ON YOUR SKIN.
IT'S AN ACTUAL CUT IN THE
STOMACH, UM AND UH A HUGE
ADVANCE IN MEDICAL SCIENCE HAS
BEEN THAT WHEN WE FIND OUT THAT
WHEN WE TREAT PEOPLE WITH
ANTIBIOTICS THAT HAVE AN ULCER
AND TEST POSITIVE FOR SOMETHING
CALLED HELICOBACTER PYLORI, UM,
THAT THOSE PEOPLE HAVE A SEVEN-
FOLD DECREASE IN ULCER
RECURRING, OKAY?
UM, WE ALSO -- SO WHAT WE DO,
WE GIVE THEM TRIPLE THERAPY SO
TWO ANTIBIOTICS AND WE ALSO
GIVE GIVE THEM AN ACID REDUCER,
WHICH IS CALLED A PROTON PUMP
INHIBITOR.
HAVING SAID THAT THE VAST
MAJORITY HAS NEVER TALKED ABOUT
OF ULCERS OR WHAT WE CALL
DYSPEPSIA, WHICH IS REALLY
DEFINED AS UPPER ABDOMINAL
PAIN, THAT WE SEE IS SOMETHING
CALLED NON-ULCER DYSPEPSIA.
SO WHAT HAPPENS IS IF SOMEBODY
COMES IN AND SEES ME AND IF
THEY HAVE MILD DYSPEPSIA, MILD,
UPPER ABDOMINAL PAIN, UM, WE
USUALLY JUST TREAT IT WITH
LIFESTYLE MODIFICATIONS.
IT'S, ABOUT 40 percent OF THE TIME IT
HAS GASTRIC -- REFLUX COMMONLY
KNOWN AS HEARTBURN WITH IT.
WE ALL HAVE THAT.
SO I TELL PEOPLE THE THINGS
THAT CAN STOP, START IT ARE THE
ANTI-INFLAMMATORIES THAT WE
TALKED ABOUT FOR DR.
TANNENBAUM'S TALK.
NUMBER TWO, IS PROVOCATIVE
FOODS.
NOW WE USED TO TELL PEOPLE THAT
HOT FOODS STARTED IT, AND AS
YOU KNOW, HALF THE WORLD,
THAT'S MOSTLY WHAT THEY EAT IS
HOT FOODS.
IT'S REALLY PROVOCATIVE FOODS,
SO IT'S AN INDIVIDUAL THING.
UM, IT'S, IT'S SOMETIMES
COUNTER, COUNTER-INTUITIVE.
SO, SOMETIMES THINGS LIKE
PEPPERMINT CAN ACTUALLY CAUSE
ULCERS.
UM, ANYWAYS, MOST OF WHAT WE
SEE AND THEN IF IT'S SEVERE AND
DOESN'T GET BETTER OR SOMEBODY
HAS OTHER WARNING SIGNS OR IF
THEY'RE OVER 50, WE TEND TO DO
A SCOPE DOWN PEOPLE'S, AH, TO
SEE IF THERE'S AN ULCER THERE.
AND WE'LL TAKE A BIOPSY TO SEE
IF THERE'S H-PYLORI.
WE CAN ALSO TAKE THE H-PYLORI
THROUGH THE BLOOD.
UM, AND BUT OFTEN THERE'S
NOTHING THERE.
JUST A LITTLE INFLAMATION AND
WITH THOSE PEOPLE UM, IN FACT
PSYCOTHERAPY HAS WORKED JUST AS
EFFECTIVELY AS DRUGS.
SO IT IS A SORT OF MIND, BODY
THING THAT WAY.
IF YOU HAVE AN ULCER THOUGH
THAT NEEDS TO BE TREATED, AND
OFTEN YOU KNOW, AFTER A WEEK
OF, OF TREATMENT AND THEN MAYBE
A COUPLE OF WEEKS OF ACID
REDUCTION IT GOES AWAY AND IT
NEVER COMES BACK AGAIN, SO.
UM, A QUESTION I OFTEN GET IS,
WHAT ABOUT STRESS AND ULCERS?
NOT AS UM, YOU KNOW, AS WE WILL
PROBABLY
TALK ABOUT MORE AND MORE YOU
KNOW, THERE'S AN ALWAYS A MIND,
BODY CONNECTION.
TO THINK THAT THERE ISN'T IS
PROBABLY CRAZY.
SOME, SOME DISEASE IS A LITTLE
HARDER TO TEASE OUT, BUT, BUT
UM, IT'S NOT AS STRONG AS YOU
THINK AROUND ULCERS.
BUT HAVING SAID THAT, YOU KNOW,
IF YOU CAN CONTROL OR, OR, OR
HAVE BETTER STRESS REDUCTION,
THERE'S GONNA BE BETTER
OUTCOMES IN ALL YOUR
ILLNESSES.

Mike reads FUNCTION OF THE
GALLBLADDER, WHAT CAUSES
GALLSTONES, LONG TERM EFFECT OF
HAVING GALLBLADDER REMOVED.
He continues AH, HAVING YOUR GALLBLADDER
REMOVED IS THE MOST COMMON
OPERATION OUT THERE.
UM, AH, GALLBLADDER BASICALLY
PROCESSES SOME OF THE FAT, UM,
AND WHAT HAPPENS IS THAT YOUR
GALLBLADDER GETS STONES BUILT
AFTER A WHILE, AND SOMETIMES
THAT CLOGS THAT PROCESS OF, OF
DEALING WITH THE FACT.
SO PEOPLE WITH GALLSTONES TEND
TO EAT, THEY GO OUT HAVE SOME
SCOTTISH FOOD AT MCDONALD'S,
UM, AND THEY SUDDENLY GET RIGHT
UPPER QUADRANT PAIN.
SO PAIN IN HERE, AND IT GOES
AWAY AFTER A WHILE, UM, AND
THEY ONLY NOTICE IT WHEN THEY
HAVE THE FATTY FOODS.
SOMETIMES PEOPLE HAVE IT OTHER
TIMES.
SOMETIMES IT ACTUALLY GETS
INFECTED AND THAT'S A MEDICAL
EMERGENCY.
THE DATA AT THIS POINT TELLS
US, AND, AND NOW WE USED TO
HAVE IT, YOU KNOW, WHEN I DID
MY TRAINING YOU KNOW, WE OPENED
THE PERSON RIGHT UP.
NOW WE DO IT WITH UM, AH, WITH
THREE LITTLE SCOPES AND IT'S
ALL DONE AH, AH, NOT
NECESSARILY A DAY SURGERY.
BUT IT'S, IT'S AH, VERY LOW
IMPACT AND WE BLOW UP, WE, WE
SORT OF INFLATE THE STOMACH A
LITTLE BIT AND SUCK IT OUT OF A
LITTLE TUBE.
AND IT'S VERY SUCCESSFUL AND
THERE'S NO LONG TERM SEQUELLA
OF THAT OF NOT HAVING THE AH,
THE GALLBLADDER THERE FOR THAT.
SO AH, SO IT'S RECOMMENDED.
SOME PEOPLE DON'T GO FOR IT.
SOME PEOPLE JUST LEAVE IT OVER
TIME AND THAT'S FINE.
BUT AT THIS POINT THE ADVICE,
IT'S STILL ACTUALLY BEING
WORKED OUT THAT YOU HAVE IT
REMOVED.

Mike reads IF THE SYSTOLICAL PRESSURE'S
ALWAYS HIGH, 160 PLUS, BUT YOUR
DYE STOCK, WHICH IS THE LOWER
ONE, WHICH DOCTOR O TALKED ABOUT,
IS WITHIN NORMAL RANGE, AROUND
85, SHOULD THIS BE A CONCERN?
He continues SO WE USED TO UM, AH, DRAW THE
LINE AT 140 OVER 90.
AND THEN WITH PEOPLE OVER 60 OR
65, WE SAID 160 OVER 90.
TWO BIG TRIALS RECENTLY HAVE
SHOWN THAT 140 OVER 90 IS THE
GOAL FOR EVERYBODY.
EXCEPT FOR PEOPLE WITH DIABETES
OR PEOPLE WITH KIDNEY PROBLEMS,
AND FOR THEM IT'S 130 OVER 80
OR 85.
SO THE ANSWER FOR THIS PERSON
IS THAT AH, AH, FIVE YEARS AGO
I USED TO SAY ASSUMING YOU WERE
A LITTLE BIT OLDER, I'D SAY
OKAY, WE'LL WATCH THAT.
NOW WE'RE MORE AGGRESSIVE, UM,
AND UM, IT'S REALLY, REALLY,
TOUGH.
AND THE OTHER INTERESTING POINT
ABOUT HIGH BLOOD PRESSURE IS
YOU THINK YOU CAN JUST LET IT
FADE OFF AS PEOPLE GET OLDER.
WELL, THE BIGGEST BANG FOR THE
BUCK ISN'T WITH THE 50 YEAR
OLD, IT'S WITH THE 80 YEAR OLD.
SO THOSE ARE THE PEOPLE THAT
YOU HAVE A REAL PREVENTION
AROUND STROKE, ETCETERA,
ETCETERA.
SO THE REAL TWO SEQUELLA OF
HIGH BLOOD PRESSURE ARE STROKE,
CAUSE IT'S A HIGH PRESSURE
SYSTEM PUSHING AROUND IN YOUR
BLOODSTREAM AND, AND IT PULLS
OFF STUFF ON THE INSIDE OF YOUR
BLOOD VESSEL WALLS AND CAUSES
CLOT FURTHER DOWNSTREAM.
AND THE OTHER THING IS IT MAKES
YOUR HEART WORK MUCH HARDER.
SO YOU'RE PUSHING AGAINST A
HIGHER PRESSURE SYSTEM.
SO YOU GET AN ARNOLD
SCHWARZENEGGER, A WEIGHTLIFTER
FOR A HEART AND YOU DON'T WANT
THAT.
YOU WANT A LONG DISTANCE
RUNNER.
OKAY?
SO, THE ANSWER FOR THIS PERSON
IS, IS THEY NEED TO BE LOWERING
THEIR BLOOD PRESSURE.
AH, AH, LOWERING WEIGHT,
REDUCING SALT, UM, HAS A BIG
IMPACT.
BUT IN THE TRIALS A THIRD OF
PEOPLE NEED TO BE ON THREE OR
MORE MEDICATIONS, SO IT'S, IT'S
A REAL PROBLEM.

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Watch: Terry Sullivan - The Best Ways To Prevent Cancer - Pt & Ask