Thank you very much for the question.

I completely agree with you. It's far better for the patient if we discover early-stage disease. Our cure rates are much higher; there are better outcomes with earlier-stage disease, and it's cheaper. It's cheaper to treat someone when they have early-stage disease and they're cured. All the costs that go with advanced disease or metastatic disease are avoided. Those costs are tremendous. Forget about the oncologist's cost. Forget about the chemotherapy or radiotherapy costs. It's the costs of visits to the family physician, the emergency departments, the drain on home care. These patients can be quite ill.

To come back to your main point, the role for governments, I think we have to mention prevention. That's key. There's prevention in terms of smoking cessation and there's a lot of literature and a lot of educated smart people around who know a lot about smoking cessation strategies that can work. There's also radon testing and reduction and the idea of having a mandatory test. Should I be able to buy a house without knowing what the radon levels are in that particular house? There should be some sort of registry perhaps, because unless people are forced to do it, I don't think people are going to do it.

Then there's screening, and we talked a lot about screening. The screening needs to be integrated. I think there are a lot of great ideas. For example, we could have a mobile CT scanner. We have to think through all the steps that go with screening. If you find something, it's no good unless we can get a needle into, and we can do a biopsy. Who's going to do that biopsy? If I live in Rankin Inlet and the mobile CT comes to town and they scan me, that's great. There's a higher likelihood that I'll actually participate. But if they find something and it needs to be biopsied, now I need to fly to Ottawa or Montreal, so we need to think that through. Things needs to be integrated, because one doesn't work without the other.

The need for integration is a key finding from our assessment over the last two years in terms of lung cancer wait times in the Ottawa region. In the health care system we don't do a great job of talking to each other from primary care to tertiary care to palliative care and survivor care.

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