Dr. Alain Sotto's presentation from the Business of Aging Summit 2012 held at the MaRS Discovery District April 30, 2012.

1. Cancer Prevention Programs in the Workplace:
The Next Corporate Standard
Business of Aging Conference: Innovation
Vignette
Toronto, April 30, 2011
Dr. Alain Sotto, Hon B.Sc., MD, CCFP(E.M.), F.C.B.O.M.
Chief Physician of Ontario Power Generation (OPG)
and
Occupational Medical Consultant for Toronto Transit Commission (TTC)
alain.sotto@opg.com / alain.sotto@ttc.ca

2. OBJECTIVES
• Review Canadian Cancer stats and costs
• Why implement cancer screening in the workplace?
• Are there any corporate cancer standards?
• Summary of OPG & TTC Colon Cancer screening program
• Sample of Colon Cancer workplace presentation

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4. Cancer in Canada for 2011
• Cancer surpassed Heart Disease as leading cause of death after 2007
• 4 most common cancers: Lung, Prostate, Breast, Colorectal account
for over 50% of All cancers
• In 2011:est. 177,800 new cases: 75,000 deaths in Canada
• On average 487 diagnosed & 205 will die every DAY with cancer
• Over 1 in 3 will get cancer & Over 1 in 4 Canadians will die from it
• Cancer is still the biggest concern and yet only 41% of Canadians
surveyed have gone for screening within the past year*
• 36% of Canadians also report never having been tested for cancer*
See cancer.ca *Sanofi-Aventis Healthcare Survey 2011
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5. Cancer Matters to Canadian Workplaces!!!!
• Cancer: 3rd highest cause of LTD & has longest duration of STD claims
• Expensive: lost productivity, disability, benefit costs & Newer drugs $$$
$
• Cost of Biologics per patient per year: $1,000 – $70,000 !
• E.G. Avastin, Tarceva, Gleevac, Sutent, Tykerb etc..
• Canada ranks 13 out of 14 western countries for new Cancer treatments
• Ontario spends 46% of total budget on health care !!!
• Studies show 60 - 80% of cancer patients want to eventually RTW
• Estimated impact of cancer in Canada for next 30 years(2004 - 2033)1
– $543 B wage-based productivity costs to Canadian economy.
– $199 B reduction in corporate profits. 5
1- Risk Analytica - Life at Cancer Risk (2004 – 2033)

6. Cancer Really Does Matter to Canadian Workplaces !!!
• 78% of Canadian employees surveyed in 2008 identified CANCER as their
biggest health risk; however, few know how to prevent it.2
– Just 45% identified smoking cessation; 38% named diet; 28% said
exercise.
– Cancer screening clinics @ work + Concern for Cancer was rated 1st
out of the 5 conditions @ 8.4/ 10!!
{Cancer(8.4), Heart disease(8), DM(7.3), Mental Illness (6.7),Obesity (6)}
• 90% of Canadians believe their employer has a role to play in cancer
prevention. 2
• With simple lifestyle- changes over 40 % of cancers could prevented!!!!
2 – Sanofi Aventis Healthcare Survey (2008)
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7. Why do Cancer Control Strategies in the Workplace??
• Workplace programs are ideal for 17 million working Canadians
• Reduce mortality, morbidity (via Primary and Secondary prevention)
• Enhances morale, loyalty, employee Engagement + employer image
( i.e. OPG--Top 100 in Canada / TTC--Top 75 in GTA).
• There is no integrated national worksite strategy for cancer control.
• Cancer agencies + other public health programs promote prevention and
screening, but don’t target workplaces ??
• There are no workplace standards for cancer prevention / management.
• No incentives / recognition for companies that ‘get it right’. ISO’s, ACE
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8. Case Studies: Colon Cancer Screening Program at OPG &TTC
• Colon cancer is the number 2 cancer killer in Canada
• It is also 90 - 95% preventable!!
• I Approached Sr. HR Directors & Executives of why we need to do this.
(Done within HR: OPG Wellness & TTC Occupational Health dept.)
• Basically:...ROI = 1.” if we can save one life- then it is the right thing to do”
• Wellness Goal: 4 E’s—Educate + Empower + Engage + Enable employees
with Knowledge Transfer on Colon Cancer Screening
• Communication campaign - face to face presentations, posters, email
messages, internal newsletters, brochures, video etc..
• Engaged Union support & Executive advocacy roles—key!
• Facilitate and improve access to Colonoscopy screening clinics
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9. Colon Cancer Screening Program--TTC
• Sr. HR Director, champion-- engaged Executive leadership team( top
6)
• TTC Union President and EVP asked to sign letter of endorsement for
program
• Managers requested multiple face to face presentations to employees
by Dr. Sotto - including shift workers
• Communication: TTC Colon Cancer Screening brochure & Referral
forms attached to pay stubs & Coupler (internal) newsletter articles:
• Managers volunteered to be advocates/ ambassadors encouraging their
staff to get screened via personal testimonials etc..
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10. Colon Cancer Screening Program--TTC
• TTC Management were surprised by employee interest and uptake
• Partnered with Colonoscopy clinics like Sunnybrook-WCH, North
York Endoscopy & others Clinics
• Colon cancer program was open to spouses and family members
• Colonoscopy Referral forms sent with brochure and given at Dr.
Sotto’s presentations & on TTC intranet website
• TTC Colon Cancer Awareness DVD + Forms were sent to 13,000 –
March 2010
• Educational materials given in partnership with Colorectal Cancer
Association of Canada (www.colorectal-cancer.ca): Barry Stein
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11. Colon Cancer Screening Program--OPG
• V.P. with colon cancer presented his story & I presented the medical
• Communication strategy: 12,000 email messages with brief 3-5 minute
video on importance of colon cancer screening, Newsletter, Wellness
intranet, Face to face presentations, Video with Darryl Sittler- advocate
• Very successful program!!!
• Brief videos sent to ALL employees by email with message on Breast,
Prostate, Colon cancers
• Able to see how ees’ many watched video i.e.. over 5000 hits in 3-4
weeks for each video
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12. Colorectal Cancer 2011 -- The Number 2 Cancer Killer!
• 22, 200 Canadians Diagnosed: 12,500 Men + 9,700 Women
• 9,100 Canadians will die of it: 5,000 Men + 4,100 Women
• Accounts for 12% of all new cancer cases and 12 % of all cancer
deaths
• 61 Diagnosed every Day!!
• 24 will Die every Day!!
• Life-Time Risk of Developing Colorectal Cancer (CRC)
• Men: 1/13 (7.7%)
• Women: 1/16 ( 6.25%)
• 1/ 28 for M & 1/ 32 F will Die
*Canadian Cancer Society, 2011
• 5- year Survival is 63% M & 64% F 12

13. Audrey Hepburn
( 1929-1993)

14. Happy 50 th Birthday !!!!!!!!!!
Women
Men
Mammogram
PSA + DRE
Breast Exam
FOBT
PAP
Colonoscopy
FOBT
Colonoscopy

15. N e w C a s e s o f C o lo r e c t a l
C a nc e r
Rate per 100,000
500
400
300
200
100
0
20-24 30-34 40-44 50-54 60-64 70-74 80-84
Age

16. What are the symptoms of Colon Cancer ?
• Most often, NONE!!
It is silent but deadly!!
• Usual symptoms:
• Rectal bleeding
• Anemia
• Abdominal discomfort
• Change in bowel habit
• Unexplained Wt. loss
You are at Average Risk, if > 50 and healthy!
and You are at High Risk if Age >40: AND
• If Family history of Polyps / Colon, Uterine, Ovarian, or Inherited
Breast Cancers
• If has Ulcerative or Crohn’s colitis
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17. Colon
Cancer
• 95% colon cancers develop from Adenomatous polyps, which grow
slowly, usually over a period of 10-15 years!!.
• 2/3 of polyps are Adenomas which are pre-cancerous &
• 1/3 are Hyperplastic (i.e. Low risk for Cancer)
• Screening tests play a key role in detecting and removing polyps
before they become cancerous
• Diagnosis of Early stage colorectal cancer--- improves your 5 yr-
survival to 90 % 17

18. W o r k p la c e S c r e e n in g is
Id e a l:
• Doing the screening testrwhen: n t i o n ! ! ! !
N o w Th a t’ s P e ve
Everything works well & Feeling fine!!
No complicating problems!!
Employees are usually at Work—so can
prevent disability & reduce costs!
SCREENING SAVES LIVES!!

19. P o ly p in t h e
C o lo n

20. How Common Are Polyps?
50%
30%
10%
50 60 70 80
Age (yr) 20

21. COLONOSCOPY
• For Average risk > 50 years old:1st FOBT
and then Colonoscopy if blood (MOH)
• If High risk : age > 40 or 10 years earlier
than the age of 1st degree relative’s Dx of
Colon cancer-whichever is first!
• Checks for polyps + any abnormalities of
ENTIRE large bowel/ colon
• Invasive; under mild sedation
• Needs bowel prep –KLEEN-PREP/
PICO-SALX
• “Gold standard” for finding Colon Cancer
and Polyps
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23. Katie Couric Effect: 20% increase in Colonoscopy rate
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24. Sunnybrook & Women’s College Health Sciences Centre
In Partnership with TTC
Physician Referral Form
For Colon Cancer Screening Program
Patient last name: Patient first name: D.O.B:
Address: City: Postal Code:
Home Phone: Work Phone: Cell Phone: Health Card Number:
Referring Physician: Referring Physician #:
Reason for Referral:
□ Screening Colonoscopy: If your patient is 50 years old or older and has no bowel symptoms. (This requires a screening colonoscopy as per the Canadian Association
of Gastroenterology).
Relevant Past Medical History:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Medications: Physician Name:________________________________
___________________________________________ Physician’s Signature:___________________________
Date: __________________________________________
___________________________________________
Stamp:
___________________________________________
___________________________________________
___________________________________________
___________________________________________
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25. Colon Cancer and Wine: Red or White?
Does drinking red wine reduce your risk of Colon Cancer?
• >3 g/ week of red wine reduced the incidence of colon cancer by
67%!!!!!!
• Colon Cancer Rates: 9.9% Abstainers;8.8% White wine;3.4% Red
wine
• Red wine has the more Resveratrol

26. Colon Cancer : Fish & Calcium/ Vit. D
A: Does eating fish 5X’s / week reduce your risk of Colon
Cancer?(Harvard PH)
• Men who ate fish >5 X’s / week reduced risk of Colon
Cancer by 40%!
B:Does Calcium and Vit D reduce the risk of Colon CA?
• >800 mg of Calcium /day reduced it by 26- 46%
• Vit D 1000 IU per day

27. SUMMARY: Key Points and ACTIONS for ALL!
• Cancer affects All employers: STD/ LTD, Drugs & Benefits, etc.
• CDN. employees believe their employer has role in prevention- 90%
• Prevention programs are well received in workplace & at low cost!
• Cancer screening advocates very helpful! e.g. Darryl Sittler
• Check: www.yourdiseaserisk.wustl.edu – Online Cancer assessment tool
• Need executive endorsement for workplace programs
• Need corporate cancer Tool-kits for Managers
• Need a Corporate Cancer Prevention Standard: www.controlcancer.ca
• Check Ontario site: www.coloncancercheck.ca
• Check CCAC: www.colorectal-cancer.ca
• Watch my Colon cancer DVD: Just do it!!!!!!!!!!!!!!!!!!!!!!!

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