An article in the Canadian Medical Association Journal warns that not enough Canadians are being screened for the nation's second deadliest killer disease; colorectal cancer.
New research revealing that fewer than 18 per cent of at-risk Canadians are being checked for the disease is forcing doctors to get over their own "ignorance and reticence" and start persuading patients to be screened for colorectal cancer.
The article goes on to say that thousands of lives are being lost because Canada lacks a national colon cancer-screening program and because doctors are failing in their duty to recommend screening. Experts predict 20,460 cases of colorectal cancer will be diagnosed in Canada this year, with 8,700 deaths being forecast. This makes it the second-leading cause of cancer-related deaths in the country behind lung cancer.
According to Canadian recommendations, people who are 50 or older - and at average risk - should have a fecal occult blood test (FOBT) every one to two years, or should undergo periodic sigmoidoscopy, where a short, flexible tube with a light at the end is inserted through the rectum and into the colon. Average risk denotes no personal or family history of the disease, inflammatory bowel disease or other risk factors.
Lead researcher Dr. Ryan Zarychanski and colleagues wanted to know whether regular contact with a family doctor increased the likelihood that a patient would receive the screening. The study included 12,776 men and women aged 50 years or older who were at average risk for colorectal cancer. The researchers found only about 23.5 per cent of eligible people reported any history of colorectal cancer screening. That dropped to 17.6 per cent, however, when only up-to-date screening was considered.
"This means the doctors believe in it themselves. The message is just not getting translated to the patients they take care of," says Zarychanski, a physician researcher at the Ottawa Health Research Institute. "We've made remarkable progress in reducing deaths due to breast and cervical cancer. But in colon, we just seem to have gone nowhere in the last 10 years."
Many people are diagnosed at an advanced stage where the cancer has spread, typically to the liver, causing widespread liver disease and requiring chemotherapy and sometimes multiple surgeries. "It's obviously a huge loss of life and can be a painful death," says Zarychanski, a hematologist and intensive care doctor at the Ottawa Hospital. "The idea of screening is to get (to an) early disease that you can deal with before its untreatable", he stresses.
Zarychanski acknowledges the embarrassment factor. "It's sort of an uneasy part of the body to talk about and bring up even with your doctor, about your bowel habits and bleeding from your rectum and using words of that nature." With the fecal occult blood test, patients have to smear a bit of their stool onto a card that's sent to a lab where it's checked for microscopic evidence of blood, which could be a harbinger of a cancer growing within the bowel. During a colonoscopy, a long tube with a camera is inserted into the rectum and the bowel checked from the inside. Yet, that should be no excuse he believes.
"The key with screening is to try to get it before it even becomes cancer," says Montreal lawyer Barry Klein, diagnosed with colorectal cancer in 1995. By the time it was caught it had spread to his liver. He had nine surgeries in total and was given a 30-per-cent chance of surviving five years. The disease moved to his lungs. "With very aggressive surgery and lots of treatments, we've been able to have no evidence of the disease that we can see," vouches Klein, president of the Colorectal Cancer Association of Canada.
According to experts, colon cancer is curable if caught early, with 90 percent of patients surviving five years. "The great majority of tumors don't just arise as a cancer," says Dr. Alan Barkun, director gastroenterology at McGill University and one of the authors of the CMAJ editorial. There can be a 10- to 12-year lag time before a benign polyp develops into cancer, making the disease an ideal one, biologically, for screening, says Barkun.
Another finding from the report was that fewer women then men, and fewer non-whites than whites were being screened. Also, the proportion of screening varied from 20 per cent in Ontario to 13 per cent in Newfoundland and Labrador but was low in every province sampled.
In the U.S., 63 per cent of people at-risk underwent screening in 2000. In the U.K. almost 60 per cent of those eligible are being reached through a national program. Says Zarychanski: "Talk to your family doctor and insist on screening if you're eligible for it."