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Canadians too 'squeamish' about testing for colorectal cancers

Aaron Harris for The Globe and Mail/aaron harris The Globe and Mail

Len Clace is a self-described "typical guy" – meaning he never went to the doctor unless he was really sick and, because he was in good health, didn't bother with things like annual check-ups.

But when he received a kit in the mail from Cancer Care Manitoba, urging him to complete a simple, at-home screening test for colorectal cancer, the 58-year-old retired Mountie said to himself: "What the heck, I'll do it."

It was a fortuitous decision.

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The test, which requires a person to collect small samples of feces and mail them to a lab, revealed blood in the stool, and a follow-up colonoscopy showed that Mr. Clace had two cancerous tumours in his colon.

"If it hadn't been for that screening test, cancer would still be growing in me – or maybe I would be dead," he said.

Yet fewer than one-third of people over the age of 50 have been screened for colorectal cancer in the past two years, according to a new report.

The Canadian Cancer Society says that if the figure could be increased to 80 per cent, 1,000 to 1,500 deaths a year could be averted.

"It's a simple test and it saves lives," said Gillian Bromfield, senior manager, cancer control policy at the CCS.

Only three provinces – Ontario, Manitoba and Nova Scotia – have well-organized screening programs, but all provinces and territories have committed to a program in the coming years.

Screening rates in the target group, men and women aged 50 to 74, range from a high of 47 per cent in Manitoba to a low of 16 per cent in Quebec.

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"Right now the participation rate in screening is pretty dismal," said Barry Stein, president and chief executive officer of the Colorectal Cancer Association of Canada.

"People are a bit squeamish about handling stool," he said. "But I can assure them that having cancer is a much bigger pain in the butt."

Mr. Stein was diagnosed with colorectal cancer 15 years ago and has been lobbying for better screening, treatment and education ever since.

There are two types of screening tests used in Canada: the fecal occult blood test (FOBT) and the more user-friendly fecal immunochemical test (FIT). If blood in the stool or antibodies that indicate the presence of a tumour are found, then a patient undergoes a colonoscopy. About 3 per cent of patients screened move to this second stage.

But the future of screening could be a simple blood test. One such test was approved for use in Saskatchewan earlier this week. It works by detecting a metabolite that is found in 90 per cent of those with colon cancer. But whether it is a good mass screening test remains to be seen.

In 2011, an estimated 22,200 Canadians will be diagnosed with colorectal cancer, according to newly published projections from the Canadian Cancer Society.

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An estimated 8,900 men and women will die of the disease this year.

Jeff Sisler, director of primary care oncology at Cancer Care Manitoba, said many of those deaths occur because cancer is detected late, and screening could significantly reduce mortality.

He said the biggest impediment to screening is that people are not conscious of the need to be tested even if they feel fine.

"People think they don't need to bother with the test if they don't have symptoms," he said. "But you want to get it early. That really improves your odds of survival.

Mr. Clace took his screening test in October, 2008, and was alerted to the abnormal results a few weeks later. He then underwent a second test, a colonoscopy.

The procedure involves guiding a long, flexible scope into the anus and slowly through the rectum and into the colon, where the physician can remove polyps and take biopsy samples that are tested for cancer.

Mr. Clace had two tumours in his large intestine and opted to have it removed completely. Because the cancer had not spread he did not need radiation or chemotherapy.

Today, he is in perfect health.

"I lucked out; I got a second chance," Mr. Clace said, urging others to be screened.

The five-year survival rate for colorectal cancer is 63 per cent. By comparison, it is 96 per cent for prostate cancer and 88 per cent for breast cancer.

Canadian Cancer Statistics, an annual publication of the Canadian Cancer Society, shows that in 2011 there will be an estimated 177,800 new cases of cancer. (That number does not include an additional 74,100 cases of non-melanoma skin cancer.) A total of 75,000 cancer deaths are expected this year. Cancer is principally a disease of aging; three in every five deaths occur in people over the age of 70.

Based on current incidence rates, about 40 per cent of women and 45 per cent of men in Canada can expect to develop cancer during their lifetimes. About 24 per cent of women and 29 per cent of men will die from cancer.

The leading cause of cancer death is lung cancer, followed by colorectal, breast and prostate cancers.

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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More

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