Helping unattached patients detect early cancers: CanScreen

While working in urgent care, walk-in clinics, and hospital settings during the pandemic, Dr Cal Shapiro was so disheartened to see unattached patients coming in with late-stage cancers that he and his colleague, Dr Stuart Bax, decided to do something about it.

Patients in BC currently require a relationship with a primary care provider or clinic to access the provincial breast, colorectal, and lung screening programs. To increase access to care, the two physicians decided to start a CanScreen pathway in spring 2023 so that unattached patients could obtain provincial cancer-screening services.

The physicians self-funded their program on a shoestring budget, setting up a website and all the virtual infrastructure necessary to manage their clinic.

Currently located on Vancouver Island, the service, supported by Shared Care, attaches BC residents to physicians for cancer screening and results. If the results are negative, the patient is discharged from CanScreen and returns to the unattached population. If cancer is discovered, or more testing is required, the patient is attached and supported by Drs Shapiro and Bax for the duration of their care.

"The project dramatically enhances cancer care for unattached patients and fills a very obvious gap in the provision of cancer screening," Dr Shapiro says. "We order the ultrasound, the MRIs, the CT scans, and lab work for all the patients that get diagnosed with cancer. We support them."

Dr Shapiro says the service was born out of necessity, with an "overwhelming demand for visits that could never be met."

There is often no time dedicated to prevention or screening. With such demand for appointments, many unattached patients are going unscreened or receive a late-stage diagnosis in the emergency department, Dr Shapiro says.

Since the CanScreen service started, the two physicians have assessed almost 2,500 patients and offered more than 2,000 screening tests. They have also detected at least 13 cancers, most of them breast cancers from mammogram screenings and a handful of colon or colorectal cancers.

"We picked up most of these patients at a relatively early stage where they're treatable and have a very good prognosis," Dr Shapiro says. "The whole idea is we catch people early enough, so they do not have to present later with a big breast lump or rectal bleeding that's going to lead to a diagnosis and potentially more aggressive treatment or treatment protocol. The service is working as intended."

Following CanScreen's success, Shared Care projects supporting cancer screening for unattached patients are underway in the Cariboo-Chilcotin and South Okanagan-Similkameen regions.