Good morning, Madam Speaker. Thank you very much for giving me the opportunity to speak in the House on this topic of paramount importance and which has had profound consequences for so many people here in Ontario and across our country. Of course, I am speaking to the private member’s motion calling for an assessment to expand the Ontario lung cancer screening program.

This is an easy one to support. I’m proud to support it. In fact, the Ontario lung cancer screening program began in 2017 under the Ontario Liberal government, so of course I would want to see this not just continue but succeed.

However, I’m going to begin by echoing the comments from the member from Nickel Belt that this motion could go so much further. For example, why is it calling for an assessment of the expansion of the Ontario lung cancer screening program as opposed to demanding an expansion of that? Why is it even a private member’s motion, which is strictly symbolic, instead of a private member’s bill, which we could all vote on and compel the government to expand the Ontario lung cancer screening program? Why is it that the government member won’t walk across to the Minister of Health and just ask her to expand the Ontario lung cancer screening program?

These are all things that could allow us to devote our time in the chamber to things that require a debate. There’s no question in anyone’s mind in this chamber that all of us agree to the expansion of the Ontario lung cancer screening program. After all, lung cancer is the leading cause of death from cancer in Canada.

And so, I don’t think a lot needs to be said about the merits of expanding the program. Every person in this chamber agrees to it, and I certainly do. The medical community would like to see this happen as well.

Instead, I would like to focus on the things that need to happen in order for us to be able to successfully and effectively fight cancer—lung cancer and all other kinds of malignancies here in this province. I also want to address a little bit some of the challenges that we may face in expanding the Ontario lung cancer screening program, because I am hoping that all of us will vote in favour of this.

The first challenge with the Ontario lung cancer screening program, if it were to be expanded, is that the majority of people in the province don’t know about it. Physicians may know about it. Nurse practitioners may know about it. But the majority of patients and people who are actually at risk don’t know that the program exists. But under this government, we have successive cuts to public health and health promotion activities which could allow people to know that.

Under this government, we have seen the worst health care system performance in our province’s history. We have more people in our province’s history than ever been who don’t have access to primary care: 2.3 million people don’t have it right now; 4.4 million won’t have it by 2026. If you don’t know about the program and can’t self-refer, and you’re one of a growing number of millions of people in our province that don’t have access to a nurse practitioner or a family doctor, how are you supposed to get referred to the Ontario lung cancer screening program?

But let’s say, against all odds, you’re able to surmount all of those challenges. The next thing is you’ve got to be able to find somewhere to get screened. I agree: We do not have enough screening sites. I believe we have five right now. Regrettably, the direction that this government has chosen to go with Bill 60 is to create integrated community diagnostic and surgical service centres. The idea is to be able to increase access to diagnostic and surgical services, but one of the challenges with it that has been brought forward time and time again is that many of the providers for that will be private, for-profit entities that will seek to create these centres in urban centres where the economies of scale and large enough numbers of patients can be generated.

Consequently, people in rural and northern areas will have greater difficulty in being able to access these services. These diagnostic and surgical service centres will draw diagnostic and technological resources away from suburban and rural hospitals and therefore make it more difficult for people to access lung cancer screening in their communities, instead forcing them to make the difficult choice between taking days off from work and travelling—mind you, without adequate funding to the Northern Health Travel Grant, which this government also voted against—and moving to one of these lung cancer referral centres, or not going altogether. So this is something that needs to be addressed if we actually want to expand the Ontario lung cancer screening program and make it a success, and I’m wholeheartedly committed to making it a success along with the member who introduced this motion.

But again, I want to emphasize: If this government was serious about fighting cancer, if this government was serious about detecting malignancies before they become a problem, when they are in a treatable phase, when they haven’t even become cancer yet, then they would have also taken a number of other steps. I understand the Canadian Cancer Society is here, so I know that they’ll agree with me that we need to bring PSA testing under public funding. This government has repeatedly voted against that. How can this government say they are serious about fighting cancer, about screening for cancer, when they repeatedly, time and time again, in the face of the Canadian Cancer Society, which is sitting right here—how can they vote down funding testing for PSA?

This is a government that, again, has chosen not to fund take-home cancer drugs.

This is a government that has not committed to delivering a family doctor for every single person in this province.

And the final thing: I salute the member who introduced this motion for enumerating many of the risk factors for lung cancer and for cancer generally. I agree we don’t talk enough and people don’t know enough about things like asbestos and radon. We could do more work to help people quit smoking and raise awareness around issues such as vaping and children.

However, one risk factor that she did not mention, a leading risk factor for cancer in our province and in our country, is alcohol. So you can imagine how perplexed I am that this government—with, admittedly, a limited budget in health care and, just provincially, a government that has a record debt and deficit unprecedented in our province’s history—rather than investing a billion dollars in health care, in cancer screening, in fighting malignancies, instead chose to commit to invest that $1 billion in a risk factor for cancer by trying to bring beer to convenience stores a mere one year early. This government is twisted in knots and cannot get its priorities straight.

So I’m going to keep my remarks brief. I think I have made it clear that I entirely and wholeheartedly support expansion of the lung cancer screening program. However, I think and hope that I’ve also illustrated the folly in the way this motion has been presented. I hope that people will take away from this that this should have been a bill, or even better, it should have been a conversation with the Minister of Health. It should have been not a request for an assessment to expand the lung cancer screening program; it should have been a demand to expand the lung cancer screening program. It should have called for including funding for PSA testing. It should have called for take-home cancer screening.

I don’t know which minister brought it in, but it should have called for the government to instead invest their billion dollars not on bringing beer to convenience stores one year early, but to invest it in health care, in getting a family doctor for everyone, in supporting this program. It doesn’t.

It’s a flawed motion that we’ll support nonetheless because I and the people in the House will stands with patients in Ontario. We do want to fight cancer, and we’re committed to showing this government the right way to do it.

I’m pleased to rise this afternoon in support of the bill by the member for Niagara Falls. I would like to say at the outset that I cannot imagine a better champion for this cause, because the member unquestionably has a moustache for Movember.

But prostate cancer is not a joke. It’s a really big deal. It is the fourth most common cause of cancer in Canada, and it impacts one in nine men. It kills men, and it cannot be ignored.

I’ll touch briefly on the risk factors because I will come back to them momentarily. Those risk factors include increased age, certain ethnicities like African Americans or people from Black communities, smoking and family history.

In the vast majority of cases, prostate cancer is asymptomatic. Less commonly, men may present with lower urinary tract symptoms—difficulty urinating, blood in their urine—and sometimes it is discovered when, sadly, the cancer is already metastatic; in other words, it has already spread.

This debate is important just for the very fact that it raises awareness about prostate cancer. This discussion is really important, and it is really important that all men have a discussion with their doctor about prostate cancer and their individual risk. So I’m glad that we’re talking about this today.

Now, at the risk of being a little bit too graphic, I will touch on a little bit about how we detect prostate cancer, because ultimately, the decisions that we make will be consequences that men across this province have to face. In order to detect prostate cancer before it develops symptoms, there are two ways: a digital rectal exam which involves a physician taking a gloved finger and inserting it into a man’s rectum to palpate their prostate; the other way is a blood test.

Now, I do want to be clear. There is what we call equipoise and a divergence of opinion about how to screen and test for prostate cancer. The reason is that there isn’t a perfect screening test. In fact, there rarely is a perfect screening test for anything. There are what we call false positives with the PSA test—that is, the blood test. There are also false negatives with the rectal exam. But it is largely accepted that men should have a discussion with their health care provider about their individual risk for prostate cancer and decide together, based on their individual risk and their risk tolerance, about whether they should get a test.

In my own clinical practice, when I’ve had that discussion with male patients, many men have decided that it is the right thing for them to do to get screened for prostate cancer. I know that plays out in clinics across our province. But health care is more difficult to access: Fewer people have access to a trusted family doctor, and those that do may have difficulty seeing them in person. So for those who even have an appetite for getting tested with a digital rectal exam, it may not be possible at all. The PSA test may, by default, be their only option.

Certain marginalized populations are especially vulnerable and have a decreased ability to be able to pay for that test. I mentioned the risk factors for prostate cancer: men who are either from Black communities or African American, who are disproportionately represented in less affluent communities, are the ones who are more likely to have prostate cancer and less likely to be able to afford the test. In my work with Indigenous communities—another community that is going to be less likely to be able to pay for a test—I’ve treated patients who were sodomized. Again, forgive me for being graphic, but they were sodomized. A digital rectal exam is a no-go for those individuals and it would have to be a PSA test.

And so I want to reiterate that we don’t have a perfect test for screening for prostate cancer. We rarely have perfect screening tests. But men should have the choice, based upon their own values and their risk tolerance, which is in compliance with professional recommendations. They should have the opportunity to discuss with their doctor and seek out screening for prostate cancer if they so choose. For many men the best way to do that, they will decide, is with the PSA test. It should be covered so that they can get the care they need.