Options for a Provincial Colorectal Cancer Screening Program Being Explored

CANCER CARE N.S.--Options for a Provincial Colorectal Cancer Screening Program Being Explored

Cancer Care Nova Scotia and its gastrointestinal (GI) cancer site team will host a one-day symposium Friday, March 28, to discuss priorities for Nova Scotia around colorectal cancer screening. Participants will include health professionals and policy makers, as well as representatives of the Canadian Cancer Society.

The decision to host the symposium follows the recent release of recommendations from the National Committee on Colorectal Cancer Screening, which suggests screening be made available to Canadians, aged 50 to 74 years, through organized programs. The recommendations are based on evidence that fecal occult blood testing and colonoscopy could reduce colorectal cancer deaths by 15 to 33 per cent in a population of 50 to 74 year olds.

Colorectal cancer can develop from non-cancerous growths called benign polyps. These growths may be present for many years before becoming cancerous. Screening individuals who are at average risk of developing colorectal cancer with the fecal occult blood test will help to identify many of these growths before they become cancerous.

"As the provincial cancer agency responsible for cancer control, we advocate and support evidence-based decisions around prevention, early detection, care and treatment of cancers," said Dr. Andrew Padmos, commissioner, Cancer Care Nova Scotia. "The symposium will be an opportunity for discussion and debate around the many issues involved in the development of any screening program."

Issues expected to be discussed include: ensuring standardized procedures for testing and follow-up of both average risk and high risk Nova Scotians; implementing a systematic means for tracking and evaluation; providing detailed information to patients and physicians about risks, benefits and how the test is administered; and allocating resources to accommodate demand.

Participants will also have an opportunity to hear from Dr. Heather Bryant, chair of the national committee on colorectal cancer screening. Dr. Verna Mai, head of screening programs for Cancer Care Ontario, will share information about how Ontario is responding to the national recommendations.

"The benefits (of colorectal cancer screening) are similar to, if not better than breast cancer screening," said Dr. Geoff Porter, surgical oncologist and chair, Cancer Care Nova Scotia's GI cancer site team. "From a population health point of view, we have information we can work with to decrease the number of people dying with colorectal cancer. However, we must recognize and address specific issues, some which may be relatively unique to Nova Scotia, before any colorectal cancer screening program can be considered."

Among the issues of concern to Dr. Des Leddin, a gastroenterologist and head of the GI division at Capital Health, is what to do with fecal occult blood test results once they are processed.

"Even though the vast majority of people who test positive won't have cancer, they still need to be followed up," he said. "It's a huge issue, with significant implications for both health professionals and patients."

Currently, there is no organized colorectal cancer-screening program in Canada. Some people are being screened, but it is being done in an ad-hoc manner.

In addition to representatives from Cancer Care Nova Scotia, the GI site team and division, the symposium is expected to attract gastroenterologists from across the province, medical officers of health and vice presidents of medicine from all health districts; laboratory medicine and technicians; GI nurses, family doctors, diagnostic imaging, as well as representatives from the Canadian Cancer Society, colon cancer support group, Department of Health and Office of Health Promotion.

Individuals who do not attend the symposium can participate in the debate by going to the Cancer Care Nova Scotia Web site www.cancercare.ns.ca before April 30 and expressing their opinion about the best option(s) for Nova Scotia.

Cancer Care Nova Scotia is a program of the Department of Health, created to reduce the burden of cancer on individuals, families, and the health-care system through prevention, screening, education and research.

Following is background information on the national committee's recommendations and on colorectal cancer screening:

The national committee on colorectal cancer screening recommends:

• Colorectal cancer screening be made available to Canadians in an organized and structured environment.
• Screening be offered to adults 50 to 74 years of age, using unrehydrated Hemoccult II or equivalent as entry test.
• Individuals be screened at least every two years.
• Positive tests be followed up with colonoscopy, with options of barium enema and flexible sigmoidoscopy where appropriate.

Methods of colorectal cancer screening:
Fecal occult blood testing requires patients to provide a stool sample for testing in a laboratory for the presence of invisible (to the naked eye) amounts of blood. For the one in 50 patients who test positive, further testing will be required. These tests may include a colonoscopy, a flexible sigmoidoscopy or barium enema.

During a colonoscopy, a colonoscope is inserted into the bowel and passed the whole way around. The purpose of the test is to see if there is anything present that might be bleeding. If a cancer is present, it can almost always be detected. Most often, however, hemorrhoids or veins are the cause of the bleeding. The benefits of colonoscopy include earlier detection of cancer and the removal of growths called polyps, which can become cancerous if left alone. Risk: About one in 3,000 people who undergo the test will develop a tear in the bowel, which can require surgery. A smaller number could even die as a result of test complications.

A flexible sigmoidoscopy allows a doctor to look at the lining of the rectum and the lower part of the colon, take biopsies and remove polyps. Risk: Although rare, sigmoidoscopy, like colonoscopy, can lead to a tear in the bowel (one or two per 10,000).

A barium enema is an X-ray of the large intestine. It is helpful in determining if polyps exist. Risk: Biopsies cannot be taken during this test.