Both sexes need more colorectal screening, study says
ANDRÉ PICARD
From Tuesday's Globe and Mail
September 11, 2007 at 11:49 AM EDT
Only one in six Canadians has been screened for colorectal cancer even though it is one of the easiest cancers to detect early and can be cured with prompt intervention, a new study says.
"Despite the evidence that testing reduces deaths from colon cancer, only 17.6 per cent are participating in screening," Ryan Zarychanski, a physician and clinical researcher at the Ottawa Health Research Institute said in an interview.
"The message doesn't seem to be getting through."
The research, published in today's edition of the Canadian Medical Association Journal, was based on a 2003 survey of 12,776 people across Canada who, according to medical guidelines, should undergo screening.
The study shows that the single biggest predictor of whether a person is screened is a recommendation from a physician.
But Dr. Zarychanski said these discussions are not taking place often enough.
"There is a lot of room for improvement at the family doctor level," he said. The researcher added that patients also have a role. "People have to take some responsibility and initiate the discussion."
It is recommended that women and men aged 50 to 74 be screened for colorectal cancer every two years. Those at high risk, notably those with a family history of the disease, should be tested earlier.
The easiest and most cost-effective test is a fecal occult blood test, which detects minute traces of blood in stool and can be done at home.
Screening can also be done using sigmoidoscopy or colonoscopy, but there is little evidence that these invasive tests work better for early detection.
(In both a sigmoidoscopy and colonoscopy, the doctor uses a scope, inserted in the rectum, to search for abnormal or cancerous growths in the colon.)
Colorectal cancer is the second-leading cause of cancer death in both women and men. But the new research shows men are far more likely to be screened, probably because of a mistaken belief that colorectal cancer is a male disease.
An estimated 20,800 new cases of colorectal cancer will be diagnosed in Canada this year, and 8,700 people will die from it - 4,700 men and 4,000 women - according to the Canadian Cancer Society.
Alan Barkun, director of the division of gastroenterology at McGill University Health Centre in Montreal, said that those deaths could be avoided if Canada had a "more robust and coherent approach to early detection and treatment."
In an editorial also published in today's edition of the CMAJ, he said the "extraordinarily low" number of people being screened for the disease was a big part of the problem, and the shortcoming needs to be addressed urgently.
"A concerted effort to combat this cancer must begin with the adoption of colorectal screening as a national health priority," Dr. Barkun said.
When the data for the new study was being collected, there were no organized screening programs for colorectal cancer in Canada.
Earlier this year, however, three provinces (Alberta, Manitoba and Ontario) announced plans for screening, though each province is taking a different tack.
Ontario is making fecal occult blood tests available through doctors' offices and increasing funding for colonoscopy for those who test positive on those tests.
Manitoba is providing the test kits in physicians' offices, but also mailing them directly to residents over the age of 50.
Alberta is beginning with an education campaign urging members of the public to get screened, and looking at distributing test kits at a later date.
Currently, organized province-wide cancer screening programs exist only in two areas: mammography for breast cancer and Pap testing for cervical cancer.
Barry Stein, president of the Colorectal Cancer Association of Canada, decried the fact that provinces are moving so slowly on colorectal cancer screening despite overwhelming scientific evidence of the benefits.
"A lot of provinces are studying the problem, but our experience is that just because a province says it's going to do screening doesn't mean it's going to do it," he told the CMAJ.
He noted that when colorectal cancer is detected early, the mortality rate is low, with 90 per cent of patients surviving five years or more.
From Tuesday's Globe and Mail
September 11, 2007 at 11:49 AM EDT
Only one in six Canadians has been screened for colorectal cancer even though it is one of the easiest cancers to detect early and can be cured with prompt intervention, a new study says.
"Despite the evidence that testing reduces deaths from colon cancer, only 17.6 per cent are participating in screening," Ryan Zarychanski, a physician and clinical researcher at the Ottawa Health Research Institute said in an interview.
"The message doesn't seem to be getting through."
The research, published in today's edition of the Canadian Medical Association Journal, was based on a 2003 survey of 12,776 people across Canada who, according to medical guidelines, should undergo screening.
The study shows that the single biggest predictor of whether a person is screened is a recommendation from a physician.
But Dr. Zarychanski said these discussions are not taking place often enough.
"There is a lot of room for improvement at the family doctor level," he said. The researcher added that patients also have a role. "People have to take some responsibility and initiate the discussion."
It is recommended that women and men aged 50 to 74 be screened for colorectal cancer every two years. Those at high risk, notably those with a family history of the disease, should be tested earlier.
The easiest and most cost-effective test is a fecal occult blood test, which detects minute traces of blood in stool and can be done at home.
Screening can also be done using sigmoidoscopy or colonoscopy, but there is little evidence that these invasive tests work better for early detection.
(In both a sigmoidoscopy and colonoscopy, the doctor uses a scope, inserted in the rectum, to search for abnormal or cancerous growths in the colon.)
Colorectal cancer is the second-leading cause of cancer death in both women and men. But the new research shows men are far more likely to be screened, probably because of a mistaken belief that colorectal cancer is a male disease.
An estimated 20,800 new cases of colorectal cancer will be diagnosed in Canada this year, and 8,700 people will die from it - 4,700 men and 4,000 women - according to the Canadian Cancer Society.
Alan Barkun, director of the division of gastroenterology at McGill University Health Centre in Montreal, said that those deaths could be avoided if Canada had a "more robust and coherent approach to early detection and treatment."
In an editorial also published in today's edition of the CMAJ, he said the "extraordinarily low" number of people being screened for the disease was a big part of the problem, and the shortcoming needs to be addressed urgently.
"A concerted effort to combat this cancer must begin with the adoption of colorectal screening as a national health priority," Dr. Barkun said.
When the data for the new study was being collected, there were no organized screening programs for colorectal cancer in Canada.
Earlier this year, however, three provinces (Alberta, Manitoba and Ontario) announced plans for screening, though each province is taking a different tack.
Ontario is making fecal occult blood tests available through doctors' offices and increasing funding for colonoscopy for those who test positive on those tests.
Manitoba is providing the test kits in physicians' offices, but also mailing them directly to residents over the age of 50.
Alberta is beginning with an education campaign urging members of the public to get screened, and looking at distributing test kits at a later date.
Currently, organized province-wide cancer screening programs exist only in two areas: mammography for breast cancer and Pap testing for cervical cancer.
Barry Stein, president of the Colorectal Cancer Association of Canada, decried the fact that provinces are moving so slowly on colorectal cancer screening despite overwhelming scientific evidence of the benefits.
"A lot of provinces are studying the problem, but our experience is that just because a province says it's going to do screening doesn't mean it's going to do it," he told the CMAJ.
He noted that when colorectal cancer is detected early, the mortality rate is low, with 90 per cent of patients surviving five years or more.
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