The Vancouver Sun
Thursday 9 November 2000

Total-body scans launched in B.C.

Private clinic at UBC charges $2,500
Pamela Fayerman Vancouver Sun

The most advanced diagnostic technology for cancers and diseases of the brain and heart is now available in Vancouver--at the first private clinic of its kind in Canada.

Patients who want a total body scan at the Positron Emission Topography (PET) facility, located on the University of B.C. campus, will have to pay $2,500. The PETscan Centre is expected to get most of its business from referrals by oncologists and surgeons at the B.C. Cancer Agency who have, until now, sent their patients to Seattle for scans at even higher cost.

Dr. Simon Sutcliffe, the new chief executive officer of the B.C. Cancer Agency, said a U.S. research project on the technology showed that in nearly half of the cases studied, cancer management changed as a result of PET scans.

"In cancer, it is conceivable that you can undertreat or you can overtreat, whether we're talking about radiation, chemotherapy or surgery. Will we save more lives? Perhaps, but certainly lives can have a better quality as a result of PET scans."

PET technology is considered complementary and even superior to other diagnostic imaging techniques for most cancers because it is so good at showing biological activity within organs, at finding sites where cancer has spread, and detecting cancer in the earliest stages by imaging the chemistry and activity within tissue and cells.

Magnetic Resonance Imaging (MRI), CAT scans (CTs) and standard x-rays provide pictures of anatomy and structure; namely, the size and position of tumours.

PET patients are injected intravenously with a glucose solution and radioactive tracer agent before their body passes through the machine. Any cancerous tissue vigourously feeds on the glucose and three-dimensional images then appear on a computer monitor. The images can be faxed or electronically transmitted to a patient's doctor.

The process takes about two hours and the radiation exposure is said to be small--equivalent to that of a CT scan.

The new clinic was set up after the B.C. Cancer Agency and Vancouver Hospital tried unsuccessfully earlier this year to convince the provincial government of the need for a publicly funded PETscan program.

The PETscan Centre is owned by International PET Diagnostics Inc., a B.C. company led by architect Denis Tusar, who has so far invested $4 million for the equipment and renovations to the leased space in the B.C. Research and Innovation Complex on Wesbrook Mall.

Using information prepared for the presentation to the provincial government, Tusar determined that about 9,000 scans per year is a feasible volume projection.

"To a degree, it may seem like a [financial] gamble," said Tusar, who put up the bulk of the investment in the facility, along with a handful of friends and relatives, "but when you consider the number of new cancer cases in the province (17,000 a year), and consider the demographics of our aging population, it is certainly feasible to be profitable and at full capacity, doing 2,000 scans a year, by the one-year point.

"People pay this amount of money to have LASIK eye surgery and that's far from being a matter of life and death," he added.

Though he expects some Americans will find it cheaper to be scanned here, and out-of- province cancer patients may come too, he's not counting on the need for them to boost volumes.

The Vancouver centre is being billed as the "first dedicated clinical PET facility in Canada."

Although UBC has a small PET scan (for imaging brains alone,) it is used for research purposes only. Another PET scan is situated at McMaster University in Hamilton, Ont.--where some B.C. patients have gone--but it is not dedicated to clinical purposes alone.

The cancer agency's Sutcliffe said a philanthropic donor gave $150,000 to the agency last year to set up a trust fund to help cancer patients get access to PET scans after a relative of the donor went south of the border to be scanned at the University of Washington.

Sutcliffe said while the cancer agency has been using money in the trust fund to help cover the costs of nearly 100 patients it has sent to Seattle, the fund could soon be depleted and "anyway, we would like to see the government recognize this as a publicly insured, legitimate medical intervention ... since the evidence is increasingly there to show that PET scans are becoming the gold standard."

Sutcliffe said since PET scans are an uninsured test in B.C., there is no fee code for them in the Medical Services Plan. However, the B.C. government has, on occasion, agreed to pay $1,000 to the Hamilton clinic when the health ministry accepts it is critical to patient care.

Patients in B.C. have had to pay their own travel costs wherever they have gone to get their scan.

Though the UBC location was chosen because of its close proximity to TRIUMF, the particle and nuclear physics laboratory, the clinic is buying its radioactive tracer agent from a Seattle company because TRIUMF is not set up to commercially manufacture it.

"We're very happy to be neighbours, however, because there is an ongoing exchange of expertise and knowledge and we expect to be involved in a lot of research," Tusar said.

Dr. Brian Lentle, the UBC professor/radiologist/nuclear medicine specialist who is medical director of the private centre, said the advantage of this technology for B.C. cancer patients is huge.

Sutcliffe conceded that some well-heeled people might not balk paying for a full-body analysis of their metabolic functioning, even if they don't have cancer.

But Lentle said a doctor's referral is required before the clinic will scan people because "there should be some suspicion, a clinical indication, for this before one has a scan."

Tusar does admit that as the CEO of the company, he was anxious to be the first to have a scan.

"I got a clean bill of health. My brain was imaged too, and Brian [Lentle] was surprised to see I had one," he joked.

PETSCAN CLINICAL APPLICATIONS

HEAD, NECK, BRAIN TUMOURS
- To differentiate recurrent tumours from radiation scarring.
- To differentiate tumours from other brain infections and disease.
- To look for cancer spread.

BREAST CANCER
- To evaluate response to treatment.
- To check for recurrence and spread.

COLORECTAL CANCER
- To rule out spread prior to surgery.

LUNG CANCER
- To distinguish benign from malignant nodules and determine the stage of the disease.

OVARIAN, PANCREATIC, THYROID CANCERS
- To differentiate benign from malignant tumours, look for spread of cancer.

NEUROLOGY
- To differentiate dementia from Alzheimer's disease.
- To localize the origin of seizures in epilepsy patients.
- To evaluate extent of disease in stroke patients.

CARDIOLOGY
- To distinguish healthy heart muscle from dead or dying tissue.
- To identify coronary artery disease, evaluate heart and vessels before transplant.

pfayerman@pacpress.southam.ca

This article was downloaded from www.vancouversun.com and appeared in the Vancouver Sun, Thursday, November 9, 2000 edition, cover page and continued on A14 - "CLINICAL OFFERS"