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Colorectal Cancer Screening Under-Used Prevention Tool in Canada: Study

Posted on: Monday, 10 September 2007, 21:00 CDT

By HELEN BRANSWELL

TORONTO (CP) - Despite the fact that screening seemingly healthy people for colorectal cancer has been proven to save lives, the important public health tool is under-used in Canada, a new study suggests.

The authors and others put the problem down to two things: the "ick" factor and the lack of organized provincial screening programs across the country.

"Unlike breast and unlike cervical screening, where we have provincial and national campaigns - organization on a national level - this does not exist for colon cancer screening whatsoever," lead author Dr. Ryan Zarychanski of the Ottawa Health Research Institute said in an interview.

"I think that's one important fact. Another one is that this is a really uneasy part of the body to talk about. And a lot of people don't want to go to their family doctor and talk about their rectum and bleeding from their anus and their bowel habits. That's difficult to say in conversation."

But unless screening programs are put in place and utilized, Canadians will continue to die needlessly of this disease, said an editorial in the Canadian Medical Association Journal, which published the study in Tuesday's issue.

Written by Dr. Alan Barkun, director of gastroenterology at McGill University Health Centre and Dr. Ken Flegel, senior associate editor of the journal, the editorial noted that the country's death rate from colorectal cancer could be halved if a "robust and coherent" approach to early detection were put in place.

"The proportion of patients screened for colorectal cancer has been extraordinarily low in Canada," Barkun and Flegel wrote. "It is abundantly clear that to stay the present course of inaction will continue to cost thousands of lives."

The Canadian Cancer Society estimates 20,800 Canadians will be diagnosed with colorectal cancer this year and 8,700 will die from it. It is the second most fatal form of cancer for Canadian men and the third most fatal form for Canadian women.

The tragedy is that when caught in the early stages, colorectal cancer has a high cure rate. And screening seemingly healthy people over age 50 has been proven to catch growths when they are either in the pre-cancerous phases or in the early stages of cancer.

Screening can be done by testing stool samples for minute traces of blood, or by snaking a scope up into the colon so that a doctor can check for pre-cancerous growths that should be removed.

But colorectal cancer is one of the forms of the disease that has no evident symptoms in the early stages. So in many cases the disease is not diagnosed until the cancer is advanced, at which point the prognosis is poor.

Zarychanski and his co-authors looked at data from the 2003 Canadian Community Health Survey to see what percentage of people in the target age range had undergone recent colorectal cancer screening. The survey only asked about screening in British Columbia, Saskatchewan, Ontario and Newfoundland and Labrador, using those provinces as representative of the national population.

Only 17.6 per cent of people reported having been screened within the recommended time frame - the previous year or two.

People who had regular contact with their family doctor were more likely to have been screened than those who did not, but even then the numbers were low. About one in five people who had seen a doctor four or more times in the previous year had undergone screening.

Zarychanski said he's been told that may be because family doctors aren't sold on the merits of colorectal cancer screening. But he doesn't believe that, noting another study showed that 53 per cent of Canadian physicians had been screened for colorectal cancer.

"It clearly shows that doctors value screening," he said.

Currently no provinces have fully operational colorectal cancer screening programs, though Ontario, Manitoba and Alberta are in the process of phasing in programs that were announced this year.

Dr. Brent Schacter, CEO of the Canadian Association of Provincial Cancer Agencies, said Saskatchewan, British Columbia, Quebec and Nova Scotia are looking at following suit.

"Some provinces are a little bit further ahead on this than others, but generally all are moving in the same direction," Schacter said from Winnipeg.

Schacter disagreed with the criticism that provinces have been slow to screen for this type of cancer, saying a lot of work needs to be done to ensure that the necessary resources are in place before a program begins.

The cheapest test - the one that tests stool for blood - is known to produce a substantial number of false positive readings. Anyone who tests positive must be offered a colonoscopy or sigmoidoscopy (similar to a colonoscopy), and officials need to be certain they can provide all those additional tests in a timely fashion, Schacter said.

"To put a population based program into effect is a large commitment in terms of financial resources within a department of health," he said. "It's taken time. But I'm actually very optimistic that programs are going to be in place shortly."

Schacter said provincial authorities were also concerned about whether the "ick factor" would deter people from completing the stool tests - called a fecal occult blood test - that is the most affordable option for population wide screening.

"There's been a lot of concern over time that there may be some resistance to collecting for occult blood testing in stool. But it turns out that when this has been looked at critically that it isn't a barrier," he said.

"Patients will do it if they're informed of what needs to be done and how it needs to be done correctly. They will do it."

Source: Canadian Press

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