March 10, 2001

The Globe and Mail

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Health
Is yours the right address?

Depending on which province you live in, latest lifesaving medical technology costs nothing or thousands

LISA PRIEST, HEALTH CARE REPORTER

One of medicine's hottest new diagnostic tools is available to patients in Vancouver for $2,500, while people in Quebec -- and soon Alberta -- can get the scan free of charge.

In other provinces, the test, known as a positron emission tomography scan, is sometimes covered by medicare, but only in exceptional circumstances. Some involve travel out of province or out of the country, prompting some to wonder whether the latest medical technology is simply for the wealthy or those with the right postal code.

"I feel my life was saved by having the scan," said 63-year-old Diana Brynlee, whose second case of breast cancer, which numerous mammograms failed to pick up, was detected on one of two PET scanners at Vancouver's University of British Columbia. One of the university's machines is used for research; the other, which is used for diagnosing patients, is funded privately and not under the provincial health plan.

"I had $2,500, but how many women have that amount of money lying around?" said Ms. Brynlee of Brentwood Bay, B.C., who has since had surgery on her left breast to remove the tumour.

Normand Laberge, chief executive officer of the Canadian Association of Radiologists, said it's an example of how private business is picking up where medicare leaves off.

"Because the government is not covering the services, the private system is taking over," said Mr. Laberge, who estimated that 30,000 Canadian cancer patients would benefit from a PET scan.

The PET scanner uses radioactive isotope tracers, such as glucose, to highlight cancer, but it can also detect dying heart muscle, heart disease and Alzheimer's disease. Unlike the MRI or CT scan, the PET scanner sees molecular changes in cells.

"It can make the diagnosis much earlier and we can tailor the treatment for the cancer," said Dr. Sandy McEwan, president of the Canadian Association of Nuclear Medicine. "It's a routine clinical tool in the rest of the world and it should be here."

More commonly used in Europe and the United States, the PET scanner is particularly important for cancers of the lung, colon, testes and breast, and for lymphoma and melanoma. It can detect cancer earlier, and it shows the extent of the disease, giving doctors a better idea of how to treat a patient. That reduces the odds of too much or too little radiation therapy, chemotherapy and surgery. However, most provinces want to wait for Canadian proof that the scanners are worth the money before deciding to pour millions into them.

Mary Anne McCormick paid for the Vancouver PET scan last week. It found that the bulky mass in her chest after treatment for lymphoma was not cancer, thereby eliminating the need for 20 radiation treatments.

"It bothered me because it was so expensive, but it was worth it," the 44-year-old Calgary student said. "It should be funded because it will save money."

There are at least eight such scanners across Canada in hospitals and universities, but only two are used on patients. They are in Vancouver and Sherbrooke, Que., and one more is to begin operating later this month in Edmonton. The Hamilton Health Sciences Corporation does a mixture of research and disease detection on patients, while scanners in Toronto, Montreal, Vancouver and Ottawa are used primarily for research.

"You need this test for modern cancer care," said Dr. Brian Lentle, medical director of the Vancouver PETScan Centre on the UBC campus, which is owned by International PET Diagnostics Inc., a B.C. company led by architect Denis Tusar.

Over the past few months, 47 patients at the centre have paid for PET scans; 84 others have had them covered through a charitable donation, and one was paid by the Workers' Compensation Board of B.C., Dr. Lentle said.

"It's not fair that there is not clarity and some people are having it paid for and some are not," Dr. Lentle said of the medical tool, which costs roughly $5-million to set up. He said 30 of the machines are needed across Canada.

Last year, the B.C. Cancer Agency and the Vancouver Hospital asked the province to finance a scanner, but were turned down, chief executive officer Dr. Simon Sutcliffe said.

"They want to know what the evidence is that patients will be benefited, what the nature of those benefits would be and the cost of those benefits," said Dr. Sutcliffe, who added that he is gathering such data on cancer patients.

The cash-for-scan arrangement has attracted the eye of the federal government. However, it decided that since PET scans aren't financed under the B.C. health plan, the Canada Health Act isn't being violated, Health Canada spokeswoman Tara Madigan said.

Dr. Francois Benard, assistant professor of nuclear medicine at the University of Sherbrooke, said 2,000 PET scans have been done at his institution on 1,700 patients since 1999 and there's a waiting list of 275 people.

"It's the most sensitive test that exists right now for cancer imaging," Dr. Benard said of the publicly funded scanner. "It's a standard of care and we're behind" in Canada.