What is CanPath?
The Canadian Partnership for Tomorrow’s Health (CanPath), formerly called the Canadian Partnership for Tomorrow Project, is Canada’s largest population cohort study that allows researchers to explore how genetics, environment, lifestyle and behaviour interact and contribute to the development of cancer and other chronic diseases.
It is a living population laboratory containing a wealth of data from more than 330,000 Canadians — the largest data collection of its kind in Canadian history — aged 30-74 who are voluntarily sharing their health and biological information over several decades. These data are studied by researchers to better understand disease risk factors to help unlock the mysteries of cancer and other chronic diseases.
Data are compiled, harmonized, de-identified and made accessible to researchers worldwide. Baseline and follow-up data from five regional cohorts have been harmonized across the country, creating a pan-Canadian resource of more than 2,300 measures of participant health and lifestyle factors, including, but not limited to: personal and family disease histories, medication use, sex and reproductive health, diet and nutrition, sun exposure, and alcohol and tobacco use.
How will CanPath improve the health of Canadians?
Cancer and chronic diseases such as diabetes and cardiovascular disease can take a long time to develop. As CanPath participants age, researchers look back at their health data to search for factors linked to disease onset. By analyzing information provided over time, researchers may be able to determine why some people develop certain cancers and chronic diseases and others do not.
These types of studies have in the past successfully pinpointed links between genetics, environment, behavioural factors and health on cancer development. For example, the British Doctors Study linked smoking to lung cancer, and the Framingham Heart Study connected obesity and heart disease.
How will individuals and communities benefit from CanPath?
Many CanPath participants have stories of cancer and other chronic diseases within their own families, while others simply believe in the value of scientific discovery to reduce the incidence of disease in the future.
The data and biological samples provided by CanPath participants enable researchers to better understand the interaction of genetics, environment and lifestyle factors related to cancer and other chronic diseases, as well as identify potential prevention strategies.
Can individual participants see their results?
Generally, participants will not receive individual results or be notified when their information is used by researchers in the future. No one — including family members, friends, employers or insurance companies — will be able to access any personal health information collected for CanPath.
There are some exceptions. If researchers discover something unexpected that could significantly affect a participant’s health (known as an incidental research finding) or reveal a serious condition that could be treated or prevented, CanPath staff will work in partnership with the Research Ethics Board to determine how this information should be communicated to the participant.
How can I help a new participant join the study?
Participants are currently being recruited for the Manitoba Tomorrow Project and recruitment for new participants for Healthy Future Sask will begin in 2023. If you know a resident of Manitoba or Saskatchewan between the ages of 30-74, they can contact these regional cohorts directly for more information or to participate.
I recently moved to a different province. Does this mean I should join a different cohort?
No, you remain a valued member of your original cohort. To continue to receive study invitations, please ensure it has your new contact information. Regional cohort contact information can be found here.
When will in-person testing resume for biological samples? What about brain or heart scans?
New biosamples are collected periodically. We expect to collect new biological samples as part of future studies. For brain and heart scans, check out this article from the Canadian Alliance for Healthy Hearts and Minds.
What other questionnaires or tests can I expect to receive this coming year (e.g., the next blood spot test for COVID-19)?
During initial recruitment for the COVID-19 antibody study, participants were streamed into two pathways: (1) to provide only one blood spot sample and (2) to provide three blood spot samples. CanPath recently received funding to invite those who donated one blood spot sample to provide a second sample, and invitations to these participants are underway. Those who consented to donate three blood spot samples will receive their invitations between March and May 2022. Other questionnaires and tests depend on funding and each regional cohort.
How is CanPath data being used internationally?
CanPath data is included in the International HundredK+ Cohorts Consortium (IHCC). This consortium is building a global research platform that involves more than 103 large population health studies in 43 countries, involving nearly 50 million participants. Projects and publications are already underway, such as a project led by Dr. Loneeke van Tuijl and Dr. Joost Dekker from the Netherlands. They developed a protocol for the PSY-CA consortium on psychosocial factors and cancer incidence.
How does CanPath ensure Indigenous peoples are included?
CanPath has over 7000 self-identified Indigenous participants in the national cohort. At present, to honour the First Nations Principles of OCAP (ownership, control, access, and possession) and other standards that guide Indigenous health research, CanPath does not release data on these participants to researchers. We are collaborating with Indigenous health leaders to develop proper data access procedures for their data.
What are the plans to include the Canadian territories in this study?
CanPath is just now completing the provincial map with the addition of Healthy Future Sask. Regional cohorts need a local champion to help get started. CanPath is open and willing to work with any health leader in the Territories to build a cohort.
For those who joined the program many years ago, are there plans for robust follow-up questionnaires or assessments to capture significant lifestyle changes or changes to work situations since our initial assessments?
Most participants joined between 2009-2015. A first follow-up questionnaire was completed between 2016-2018, and the COVID-19 questionnaires (2020-2022). We plan to implement regular follow-up questionnaires moving forward.
Is there a site we can visit to see what personal information we have on record with you and where we can update if necessary? Is data updated by invitation only?
Participants are welcome to contact their regional cohort directly to provide any update in contact information, including email address, mailing address, phone number, etc. Any information about changes in health conditions can be captured as part of regular questionnaires.
When I started as a participant, I chose not to provide blood or DNA samples. Can I donate still in the future?
Yes, you are welcome to provide blood or DNA samples in a potential future collection of biosamples.
Does CanPath work with data from ICES?
The Ontario Health Study has a data-sharing agreement with ICES that facilitates linking de-identified OHS data with other data holdings.
I wish to keep being informed about future studies. How can I find out about recent studies?
I have not been asked to participate in any studies for a long time, but my younger friends have. Am I screened out because of age?
Everyone who joined between 2009 and 2015 is and continues to be a participant. They would have completed a questionnaire then, been invited to complete a follow-up questionnaire between 2016 and 2018 and been invited to complete a COVID-19 questionnaire in 2020. There are sub-studies/projects that include participants based on requirements for the research, including age, sex, disease history, etc. You may wish to contact your regional cohort to ensure they have your up-to-date contact information.
Will there be more surveys to continue to monitor how participants’ health changes over time? How often do you send out questionnaire updates and how do the answers help you?
CanPath is following its participants over a period of 30+ years, including the use of questionnaires over time. This allows us to monitor how participants’ health changes over time.
How can you identify participants that have died over the years versus participants that do not want to participate any more or have moved and are not responding anymore?
Participation in all regional cohorts is voluntary. Family members can contact regional cohorts requesting that participants who have passed away be withdrawn from the Study.
Are study participants all health care workers or the general public?
Participants were recruited from the general public, though this would include health care workers.
How can participants in the study give feedback to poorly framed questions in questionnaires?
You are welcome to contact CanPath or any of the regions directly with feedback.
Is there a way to catch up on missed surveys?
Unfortunately, no, however when cohorts offer follow up questionnaires, they capture participants’ health histories. The best way not to miss a questionnaire is to keep your contact information up to date by contacting your regional cohort.
How does your study differ from the data collected in the USA Framingham studies?
A notable difference between CanPath and the Framingham Heart Study is that CanPath has recruited participants from across Canada while Framingham recruited participants from the town of Framingham, Massachusetts only. The Framingham study was started many years ago (before many CanPath participants were even born) and was much smaller than CanPath; with only 5209 participants which was large enough to study cardiovascular disease, whereas CanPath is designed to study rarer illnesses such as cancer. Framingham was later expanded to include offspring to create a multi-generational study. CanPath collected a lot of similar information to the Framingham study in the United States which was designed to study risk factors for cardiovascular disease. CanPath also focuses on cancer and other forms of chronic disease.
Are there any findings so far that indicate how seniors could improve their health through behavioural changes? Are there any actionable changes we can make based on studies so far?
Are there studies concerning hormone medications, early menses onset, late menopause, or late childbirth?
Yes! A project led by Dr. Isabel Fortier began in 2016 to explore different approaches to data harmonization by examining the determinants of age at menopause among participants of large population-based studies.
For more, refer to the CanPath publications webpage for past and current work, and watch for future studies that may include this topic and more.
I am already participating in another study. Will this be an issue?
No! We value your continued participation in your CanPath cohort.
We have not been asked to provide blood samples. Does every participant get asked to do so?
All participants were invited to provide biological samples when they joined the study (2009-2015). A subset of participants has been asked to provide blood spot samples for the COVID-19 research.
Cancer & Chronic Disease Questions
50% of Canadians will die of chronic disease or cancer. What is the average life expectancy for those with cancer?
Are any studies being conducted related to Small Vessel Disease, which occurs in almost everyone as they age and yet apparently can be minimized by lifestyle choices made earlier in life?
Yes! A project led by Dr. Hertzel Gerstein through the Canadian Alliance for Healthy Hearts and Minds found that small vessel disease characterizes much of the relationship between diabetes and vascular brain injury. However, additional factors are required to disentangle the relationship between diabetes and cognitive impairment.
Does CanPath have any plans to include a study on osteoporosis, particularly its treatment plans (e.g., medication, physical activity)?
The Atlantic PATH cohort is currently undergoing a project entitled Current Management and Health Care Quality for Patients with Hip and Knee Osteoarthritis (Principal Investigator: Dr. Cheryl Kozey, Dalhousie University).
Is CanPath data being used for any projects related to arthritis?
Arthritis is one of the most common conditions among participants. Find publications about arthritis using CanPath data at this link.
Are you looking for evidence of how, or when, cancer begins? Is blood data being used to track cancer initiation?
I have not been diagnosed with cancer. Are you watching to see if I develop cancer as I age?
One of the unique aspects of CanPath is that we follow participants over a period of 30 years. This allows us to follow participants as they age, including if they go on to develop cancer or other chronic disease.
Will brain health be a subject of upcoming research (e.g., dementia)?
Our data is collected to support a broad range of health research. For instance, the Canadian Alliance of Healthy Hearts and Minds (CAHHM) and the Prospective Urban and Rural Epidemiological (PURE) Study conducted research about visceral adiposity and cognitive function.
Stress & Mental Health Questions
Are you studying how stress may affect health?
A study out of Holland is using data from Ontario Health Study participants to better understand the possible factors influencing the relationship between cancer and depression or anxiety. Read more.
Is mental health and history of mental health in family members being tracked? Mental health is a serious health concern, just like cancer, diabetes etc. And COVID-19 isolation has not helped.
We agree that mental health is a serious health concern and have ongoing research projects. We have questions about mental health for participants and their immediate family members (biological mother, father, siblings, children) in the baseline and follow-up questionnaires. We also have questions about mental health in the COVID-19 questionnaire.
For Scientists & Researchers
What benefits can researchers derive from CanPath?
CanPath is a prospective cohort study that provides exceptionally detailed information to researchers around the world. The breadth and depth of unique data gives researchers unprecedented opportunity to examine the potential causes of cancer and chronic diseases, and ultimately to identify better treatment and prevent disease in the future.
Thanks to more than one billion pieces of data and hundreds of thousands of biological samples, scientists can investigate the complex interplay between lifestyle, genetics and environment, and how these factors influence the health of generations to come. Most participants have agreed to the linkage of their questionnaire and biospecimen data to their administrative health records and are open to being re-contacted for ancillary studies by their regional cohorts to collect additional data and samples.
CanPath allows researchers to tackle challenging questions at lower cost, in less time. It can save researchers time — sometimes up to a decade — associated with arranging and measuring their own population samples. Since the project will follow individual participants for 50 years, with the potential to collect additional data over time, its value will grow as the data set becomes larger over time.
CanPath has already attracted international collaboration. The platform’s wealth of information has been collected in such a way that researchers worldwide can apply CanPath data to their own work or combine CanPath data with other global cohorts, such as the UK Biobank or the European Prospective Investigation into Cancer and Nutrition (EPIC) study.
These new data linkages enrich the platform, improve the competitiveness of Canadian research and provide opportunities for made-in-Canada discoveries.