Re: colorectal cancer screening

Issue: BCMJ, vol. 53, No. 2, March 2011, Page 70 Letters
By: R.M. Preshaw, MD

Dr Isaacs has proposed BCMA supporting a Canada-wide population-based screening program for colorectal cancer by col­o­noscopy performed by nurses, based on the opinion of an unidentified ex­pert in Portland, and the fact that col­onoscopies are done in England “by specially trained nurses” [Colorectal cancer screening, BCMJ 2010;52:499-500].

Dr Isaacs has proposed BCMA supporting a Canada-wide population-based screening program for colorectal cancer by col­o­noscopy performed by nurses, based on the opinion of an unidentified ex­pert in Portland, and the fact that col­onoscopies are done in England “by specially trained nurses” [Colorectal cancer screening, BCMJ 2010;52:499-500]. She also states that BC is “currently developing a study to test the effectiveness of yearly hemoccult in preventing colorectal cancer.”

Others can defend the pilot already underway in BC to assess the use of an immunochemical fecal occult blood test in colorectal cancer screening,[1] but I take issue here with the implication that screening for colorectal cancer is performed in the UK by nursing endoscopists.

In England a bowel cancer screening program using semiannual fecal occult blood testing from age 50 to 74, with positive results followed by co­lonoscopy, has been underway since 2006.[2] Total cost is $110 million per year. Increase in workload for endos­copy units is estimated to be between 14% and 28%. Follow-up is by specialists who are accredited in screening colonoscopy. None of the publications on this program indicate that a significant number of studies are performed by nurse endoscopists.

Similar programs for population-based colorectal cancer screening using fecal occult blood testing have either been funded, or have already started, in Newfoundland, Nova Scotia, Quebec, Ontario, Manitoba, Saskatch­ewan, and Alberta: I find no mention of such programs in New Bruns­wick, PEI, Nunavut, Northwest Territories, or the Yukon.

On 4 October 2010, British prime minister David Cameron announced an extra $100 million to extend the bowel screening program using flexible sigmoidoscopy, based on a nationwide controlled trial of a single epi­sode of flexible sigmoidoscopy that reduced the death rate from colorectal cancer from an expected 272 over 11 years to 189 in a trial group of 57000.[3] 

This is a brave expenditure of public funds after a single trial; it is conceivable that nursing endoscopists would be used to perform flexible sigmoidoscopy in this program, but this proposal is not population-based screening using colonoscopy.
—R.M. Preshaw, MD
Saltspring Island

References

1. Colon Check. BC Cancer Agency 2010. http://coloncheck.bccancer.bc.ca/default.htm (accessed 2 February 2011).
2. NHS Bowel Cancer Screening Programme 2010. http://www.cancerscreening.nhs.uk/bowel/ (accessed 2 February 2011).
3. Atkin WS, Edwards R, Kralj-Hans I, et al. Once-only flexible sigmoidoscopy screen­ing in prevention of colorectal cancer: A multicentre randomised controlled trial. Lancet 2010;375:1624-1633.

R.M. Preshaw, MD. Re: colorectal cancer screening. BCMJ, Vol. 53, No. 2, March, 2011, Page(s) 70 - Letters.


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