National Staging Initiative to standardize cancer stage information across Canada

Canadians can expect to benefit from more targeted investments in cancer screening and treatment as a result of a first-of-its-kind initiative that is standardizing the collection of cancer stage information across Canada. The initiative marks a change that cancer experts have wanted for more than 20 years, and that will help cancer system decision-makers to target areas of greatest need in cancer control.

Announced today by the Canadian Partnership Against Cancer (the Partnership) and the Canadian Association of Provincial Cancer Agencies (CAPCA), the National Staging Initiative represents a $20 million infrastructure and technology investment by the Partnership. Through participation from provinces, territories and national partners, the initiative is facilitating the national, systematic collection of standardized, population-based stage information for the four most common cancers - prostate, lung, breast and colorectal, which will account for 94,600 new cancer cases in 2010 alone.

"More than half of the 174,000 Canadians diagnosed with cancer this year will have one of these four cancers," said the Honourable Leona Aglukkaq, federal Minister of Health. "With investment and support by the federal government and collaboration among provinces and territories and non-governmental organizations, the National Staging Initiative will generate better data and better evidence - which will improve the cancer system and ultimately save lives. This is the reason the federal government funded the establishment of the Canadian Partnership Against Cancer in 2006 - to reduce the burden of cancer through a coordinated approach across the country."

Cancer stage is an assessment of the extent to which cancer has spread to other parts of the body at the time of diagnosis. There are four possible stages for any type of cancer.  For individual patients, doctors use stage information to assess the probable course of the disease and plan treatment. When stage data is gathered for an entire population, as it will be through this initiative, health care planners and policy makers can use the information to gain deeper insight into trends such as incidence, mortality, and survival, which can help to evaluate and improve the cancer control system. For example, a cancer that is being diagnosed at a later stage in a particular region could be an indication that a screening program is not having the desired impact.

"The collection of standardized stage data will provide a more complete picture of cancer in Canada," says Caroline Heick, Vice-President, Knowledge Management at the Canadian Partnership Against Cancer.  "The data that provinces and territories are capturing as a result of this initiative will tell us how early or late the four most common cancers are diagnosed among Canadians, and track whether this is changing over time. This information plays an important role in helping health system planners answer questions like 'Are screening programs effective in saving Canadians' lives?' and 'Which treatments are helping people live longer?'"

While provincial cancer registries have been collecting cancer data for years, the National Staging Initiative is an unprecedented collaboration that provides a way to share common language for reporting stage data. As a result, stage data can be shared across jurisdictions and reported for Canada as a whole, while also enabling provinces and territories to use the information for their own planning purposes.

"The strength of the National Staging Initiative is that it builds on what currently exists in the provinces to allow for the collection of standardized 'apples to apples' data," said Heather Logan, Executive Director of the Canadian Association of Provincial Cancer Agencies. "This major step forward in cancer control is the result of many years of hard work by Canada's cancer control community. There has always been the will for a standardized collection system for cancer stage data, and now we have the right combination of partners and resources to make it a reality."

The National Staging Initiative leverages expertise and resources from across Canada and builds on existing provincial infrastructure, with provinces leading their own implementation and contributing financial and in-kind resources as required. In addition to its $20 million infrastructure and technology investment, the Canadian Partnership Against Cancer is providing national leadership to the initiative by coordinating the efforts of all partners to support the overall implementation, and by supporting the development of standards that ensure comparable and consistent data collection. Other organizations involved are the provincial and territorial cancer registries, Statistics Canada, the Canadian Council of Cancer Registries, the Public Health Agency of Canada and the Canadian Association of Pathologists. 

"As a Stage 3 colorectal cancer survivor, I can see how gathering consistent stage information across Canada will have an impact," said Archie McCulloch, a member of the Canadian Cancer Action Network, a volunteer-driven organization dedicated to ensuring patient interests remain a key priority on the national cancer agenda. "This type of information can be put to practical use for Canadians by driving changes that will result in more effective detection, diagnosis and treatment."

The approach to the National Staging Initiative varies by province, depending on the degree to which each jurisdiction is currently collecting stage data for its population. As an example, four provinces are planning and implementing electronic pathology reports that use a standardized checklist format. Pathology reports play a significant role in determining cancer stage. The standardized checklist for the reports was developed with the College of American Pathologists, which recently announced a memorandum of understanding with the Canadian Association of Pathologists to collaborate on the development of cancer protocols and content standards to help improve pathology reporting standards internationally.

Through the National Staging Initiative, stage data is being collected for prostate, lung, breast and colorectal cancers diagnosed January 1, 2010 or later, with a goal of collecting national standardized stage data for 90 per cent of these cases. It is expected that this data will be available beginning in 2012.