The case for colorectal screening

In the past three months, two major studies have called the benefits of mammograms into question, reigniting a years-long debate over the true value of the screening exam. But for some reason, the discussion about another screening test that is reliable and effective, not at diagnosing but actually helping to prevent the development of one of the biggest cancer killers, is much more muted.

Colorectal cancer is the second leading cause of cancer death in Canada, behind only lung cancer. The good news is screening programs can help spot polyps before they develop into cancer. The program has the potential to save countless lives.

Despite this, colorectal screening rates across Canada are fairly dismal and many provincial screening programs are riddled with problems. And those problems need to be fixed in order to bring down the mortality rate for this deadly disease, colorectal cancer experts say.

The basics

The Canadian Cancer Society estimates show that in 2013, approximately 23,900 Canadians would be diagnosed with colorectal cancer and 9,200 would die from the disease. Colorectal cancer starts as benign growths, or polyps, in the lining of the colon. Over time, the polyps grow and multiply and they may develop into cancer.

That's why colorectal screenings are so important. If the polyps can be found and removed before they become cancerous, it can save a person's life. Colorectal Cancer Canada estimates that early detection can prevent as much as 90 per cent of colorectal cancer cases.

Yet across Canada, the screening rates are hardly stellar. Individuals between age 50 and 74 are recommended for colorectal cancer screening. Rates vary from a high of 59.2 per cent of that age group in Manitoba to 38.5 per cent in Nova Scotia to a low of 28.3 per cent in Quebec, according to a report released last month by the Canadian Partnership Against Cancer.

"It's the second leading cause of cancer death in Canada and most people don't recognize that," said Dr. Heather Bryant, vice-president of cancer control at the Canadian Partnership Against Cancer. "I do think we need to increase the under-standing."

Exploring the "ick" factor

Although screening rates for colorectal cancer remain low, Bryant points out that in many provinces, screening programs remain relatively new. In some areas, such as Quebec and New Brunswick, programs are still in the planning and roll-out phases.

Still, it's clear that more needs to be done. One thing that may keep some people from getting screened is the anxiety over having a colonoscopy, said Barry Stein, president and CEO of the Colorectal Cancer Association of Canada. But what many people don't realize is that colonoscopies are only performed if initial screening identifies a problem. The first screening measure is a non-invasive stool test that is used to look for microscopic amounts of blood, which could be indicative of a polyp. If that test is positive, patients will be referred for a colonoscopy.

The problem is that some provinces, such as British Columbia, don't have the resources and funding in place to ensure that patients have access to timely colonoscopies, said Dr. Brian Bressler, clinical assistant professor of medicine in the division of gastroenterology at the University of British Columbia. "There's one pie and there's been nothing added to it," he said.

The lack of infrastructure to ensure patients receive the tests and follow-up procedures they need can deter doctors from encouraging patients to get screened, Bressler said. Too often, provincial governments place priority on wait times that are popular with the voting public, such as hip replacements or cataract surgery, he said. Screening programs can cost a lot to set up and might not resonate with voters in the same way, but they are vitally important, he said.

Bottom line

Not enough patients understand that colorectal cancer can be prevented, not only through screening, but through eating a healthy diet and being physically active, Stein said. If more people knew their actions can help prevent this deadly disease, they might be more willing to take the steps necessary to do so.