The head of the medical imaging department at the University Hospital of Northern B.C. has serious concerns the new Prince George cancer clinic now under construction will be missing a vital piece of equipment needed for cancer diagnosis and to assess patient response to treatment.
Dr. Larry Breckon says the BC Cancer Agency Centre for the North will not have a positron emission tomography-computed tomography (PET-CT) scanner now considered the industry standard in cancer clinics in the U.S.
The scanner uses a radioactive tracer that's attracted to glucose, the energy source of all tissues, including tumours. Tumours use more glucose for their metabolism than normal tissue, and that gets detected by the camera in the scanner.
"If you just do the PET scan itself, you pick up areas of activity and you have a rough idea of where they are, but if you combine it with CT you can actually identify lymph nodes and masses, exactly where they are anatomically," said Breckon. "That makes it very easy for surgeons to localize abnormal lymph nodes they might want to remove or give an exact anatomical location for radiotherapy.
"It's also extremely valuable to monitor the course of a disease, so if you were diagnosed with lymphoma and you go on chemotherapy, which is typically what happens, you can monitor the response of the tumour to chemotherapy. Halfway through, if we did a PET-CT scan, we would have a good idea of whether or not you're responding to the chemotherapy, and at that point they could change the therapy or carry on."
Chemotherapy introduces poisons to the body which also affect healthy tissue and Breckon says it's essential to invest in equipment that could limit the side effects of cancer treatments.
"There's no point in making you sick if it's not working," he said.
A course of chemotherapy treatment ranges in cost from $5,000 to $20,000 and can last three or six months. By identifying treatments that aren't working, Breckon says that could even save the clinic money.
The machine uses software that combines the images of both scans (PET and CT) to produce one image. Breckon said the cost of a PET-CT is about $1.5 million, about $500,000 more than the CT scanner that's been approved for the Prince George clinic.
Dr. Suresh Katakkar, a regional medical leader in hematology and oncology for the BC Cancer Agency, says PET-CT scans can detect the difference between benign growths and malignancies, and can eliminate the need for exploratory surgery.
"I have a list of patients who would have benefited from a PET scan but I just couldn't do it," Katakkar said. "So I have to send them to a chest surgeon to get a biopsy or something.
"If I have a patient with lung cancer and has lymph nodes in between the two lungs, we consider that inoperable. In that situation I need to know, is the cancer in the lymph nodes or is it just the lymph nodes between the lungs that are enlarged. You can tell with a PET scan if the cancer is there and that helps so we can avoid patients having chest surgery to biopsy the lymph nodes. That why we need that PET scanner."
The scanner has other medical applications. It can used as a test for dementia and can also differentiate dead heart tissue from heart muscle that hasn't been working right due to reduced blood flow, to help cardiologists in surgery to repair coronary artery disease.
Plans for the room that will house the CT unit in the $100-million Prince George cancer clinic did not allow for installation of a PET-CT scanner. Breckon spoke to someone who toured the building last week who was told the design of the wall protection to keep radiation localized in that room was insufficient. But Breckon said engineering worries about the walls buckling under the weight of the PET-CT scanner and a lead shield are unfounded because borosilicate glass shielding is available as a lighter alternative to lead shields.
"The medical community as a whole questioned the design of the building right up front, whether or not there would be PET-CT, given that it was only available in Vancouver," said Breckon. "Cancer Control [Agency of B.C.] and the government gave us the usual b.s., that we don't have big enough numbers to make it worthwhile. This is nothing to do with numbers or anything else, it's just good medical care. You can't tell me the patients up here don't deserve the same as they get in Vancouver. Unfortunately, that's not the case."
Through a source in Vancouver, Breckon learned in July the Cancer Control Agency of B.C. - that oversees the province's cancer treatment - put out four requests for proposals to vendors Phillips and Siemens to make purchases of their PET-CT scanners. He said those units were for existing cancer clinics in Surrey, Abbotsford, Victoria and Kelowna, but not Prince George.
In response, Breckon dropped off letters to the constituency offices of MLAs Shirley Bond and Pat Bell, and wrote to Cancer Control, asking why Prince George was left off that list, but failed to get a response.
"That [letter] went into the Ministry of Health for a review so normally what we do is request that they respond to it," said Bell. "We rely on Northern Health and have lots of confidence in what they do and if this is a piece of equipment they think is appropriate, it's the health authority and the Ministry of Health that would make those decisions.
"What I know is we have a great facility that's $100 million that will serve the needs of northern British Columbians very well, and if we need this piece of equipment I'm sure it will eventually end up on the order list."
Breckon has encouraged cancer patients, through a letter to the editor in the Citizen that appeared a few months ago, to put pressure on provincial politicians to find a way to bring a PET-CT scanner to Prince George.
"This cancer clinic, for $100 million, all it's doing is adding radiotherapy to what we're already doing, it changes nothing else," Breckon said. "PET-CT would certainly make it a truly stand-alone cancer clinic.
"I do have a vested interest in this because I smoke, so I'm probably going to get cancer down the road, and I'd rather get my treatment here than have to fly back and forth to Vancouver to get a test that could easily be done here," he said.
"We've got a history up here of being leaders in a lot of ways, not just sitting back on our hands and taking what the government hands out, and it's going to stay that way. There's no reason why we should take second-best."
