Colorectal cancer screening

Issue: BCMJ, vol. 52, No. 10, December 2010, Page 499 Letters

This letter is in regard to screening for colorectal cancer. I live and work in BC, so I am reporting on the situation in this province, but I am sure it applies nationwide in Canada. 

Colorectal cancer is the fourth most common cancer in Canada today. There are 2400 new cases diagnosed in BC every year. The province is currently developing a study to test the effectiveness of yearly hemoccult in preventing colorectal cancer. So far the evidence suggests that yearly hem­oc­cult decreases the incidence of curable cancer by, at best, 40%. 

Col­on­oscopy is not currently recommended as a screening test, but studies have shown that screening colonoscopy begun at the age of 50 and done every 10 years after that decreases the risk of colorectal cancer by at least 80%. That’s a difference of 40% or 960 cases per year that could be prevented with screening colonoscopies. 

I was recently at a medical conference in Portland, Oregon. The presentation on colorectal cancer suggested that the standard of care for prevention of colo­rectal cancer should be regular screening colonoscopies. Hemoc­cult tests were to be used only on patients who refused colonoscopy. 

Un­fortunately, the gastroenterologists in BC are far too busy to perform screening colonoscopies, and our provincial health plan does not cover that procedure anyway. I was recently visiting my sister in England, and there colon­oscopies are done by specially trained nurses. It is not difficult to persuade patients to have a screening colonos­copy if it’s paid for and if they can be assured that, if they undergo this 30-minute test, they are almost assured of never developing colon cancer. 

In­stead of wasting limited health care re­sources on studies of the usefulness of hemoccults, we should be training nurses to do colonoscopies and making this a covered procedure so that we can begin screening all Can­adians for colon cancer. This would cause an enormous decrease in the incidence of this cancer and would be a huge saving of health care dollars that would have been spent on the care of colon cancer patients.

I think the BCMA should take a stand on this issue and try to bring about changes in the health care system so that nurses can be trained to do colonoscopies, provincial health plans will cover the procedure, and Canadians will become informed of the benefits of routine colonoscopy to prevent colon cancer. 
—Gwen Isaacs, MD 

Gwen Isaacs, MD,. Colorectal cancer screening. BCMJ, Vol. 52, No. 10, December, 2010, Page(s) 499 - Letters.

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