Innovations wanted: Medical breakthroughs can only get us so far if people can’t access them

Many people in Canada face barriers to accessing cancer screening and early detection. Simple innovations can have a huge impact.

Annemarie Edwards is a digital health and innovation leader in cancer at the Canadian Cancer Society. This opinion piece originally ran on the Toronto Star.

The numbers are sobering. The latest figures estimate that two out of every five people in Canada are expected to be diagnosed with cancer in their lifetime. And about one in four people is expected to die from it.

But these stats don’t tell the whole story.

Some people are more likely to be diagnosed with life-threatening late-stage cancer in a hospital’s ER department — especially in the wake of pandemic-fuelled screening delays and backlogs. While Canada’s healthcare system is available to all, not everyone has the same access to potentially life-saving cancer screening.

There’s plenty of data showing people with lower incomes, newcomers to Canada, those living in rural and remote areas, as well as racialized communities, members of the LGBTQ2+ community, and those living with mental illness and disabilities, all face barriers to accessing cancer screening and early detection.

There has been tremendous innovation in technology and treatment, with millions of dollars going to more life-saving research. But these advances can only get us so far if they aren’t reaching every person in Canada.

Take colorectal cancer, the fourth most diagnosed cancer and the second leading cause of cancer-related death in this country. Early detection can make an enormous difference. While 67 percent of people with colorectal cancer are still alive at five years after diagnosis, that number skyrockets to more than 90 percent for those whose cancer is caught early, before it spreads.

Screening, whether that’s through a colonoscopy or an at-home stool test, is so important because colorectal cancer is tricky. It stealthily develops over time, and symptoms can be subtle or non-existent in the initial stages.

Simple at-home tests — the primary screening tool for individuals at average risk of colorectal cancer without any symptoms — are incredibly powerful as a public health screening tool. Taking only minutes to complete, the test can detect small amounts of blood in stool that may be only noticeable under a microscope. In the case of a colonoscopy, if recommended by a healthcare provider for those at higher risk of colorectal cancer or as follow-up for a positive stool test, a gastroenterologist can practically eliminate the possibility of the disease developing by removing small polyps before any of these benign growths become cancerous.

With such a high success rate, why doesn’t everyone ask for an at-home stool test or book a colonoscopy if eligible before trouble starts? If the target is to screen at least 60 per cent of eligible individuals, why has no province yet met that goal? The issue is complicated, but the socioeconomic barriers preventing uptake can be immense.

Many colorectal screening programs rely heavily on healthcare provider referrals to encourage their patients to take part. Yet, according to Statistics Canada, some 4.6 million Canadians do not have regular access to a primary care provider, particularly those in rural or remote areas. Other barriers include access to tailored information about screening. Why would you sign up for screening if you had no idea how valuable it is? Language barriers can make it difficult to navigate our healthcare system. Meanwhile, mailing an at-home test to someone without a fixed address is a challenge.

I believe there has never been a better time to address these gaps to make sure every eligible person in Canada can access cancer screening. To ensure success, we must embrace inclusive engagement with the people we are trying to reach.

That’s why the Canadian Cancer Society has partnered with MaRS Discovery District to create an innovation competition: Innovating for Everyone: the Colorectal Cancer Early Detection Challenge. This is a different kind of challenge. We are not looking for ground-breaking technological advances and diagnostic techniques. Rather, we’re looking for simple, impactful initiatives and approaches that can be implemented quickly. We know innovation can come from anywhere — we want to hear from cancer care providers, academic institutions, cancer survivors and the general public.

That might mean creating multilingual communications posters and mail-in reminders. Or changing the words “cancer screening” on educational materials to “health screening.” So simple, and yet it meaningfully addresses fears some communities experience around wording.

And if millions of people in Canada don’t have a family doctor, doesn’t it make sense to allow them to simply order a home-test online? Or how about allowing pharmacists to distribute them?

When Canada’s modern healthcare system was designed in the 1950s and ’60s, its architects talked of universal access to care. But there are deep disparities and inequities entrenched in the system that prevent that vision of universality from being fully realized. It’s time that changed.

To achieve a more inclusive health system — one that meets the needs of everyone — we need to co-design solutions with input from people with diverse lived experiences. This kind of transformative change requires innovative models of partnership that centre around public participation and empowered citizens.

Applications for Innovating for Everyone: Colorectal Cancer Early Detection Challenge are now open. Find out more here.

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