The Quebec Association of Gastroenterology Position Paper on Colorectal Cancer Screening - 2003

Abstract

Colorectal cancer is a leading cause of death and the third most common cancer in Canada. Evidence suggests that screening can reduce mortality rates and the cost effectiveness of a program compares favourably with initiatives for breast and cervical cancer. The objectives of the Association des gastro-entérologues du Québec Task Force were to determine the need for a policy on screening for colorectal cancer in Quebec, to evaluate the testing methods available and to propose one or more of these alternatives as part of a formal screening program, if indicated. Fecal occult blood testing (FOBT), endoscopy (including sigmoidoscopy and colonoscopy), barium enema and virtual colonoscopy were considered. Although most clinical efficacy data are available for FOBT and sigmoidoscopy, there are limitations to programs based on these strategies. FOBT has a high false positive rate and a low detection yield, and even a combination of these strategies will miss 24% of cancers. Colonoscopy is the best strategy to both detect and remove polyps and to diagnose colorectal cancer, with double contrast barium enema also being a sensitive detection method. The Task Force recommended the establishment, in Quebec, of a screening program with five- to 10-yearly double contrast barium enema or 10-yearly colonoscopy for individuals aged 50 years or older at low risk. The program should include outcome monitoring, public and professional education to increase awareness and promote compliance, and central coordination with other provincial programs. The program should be evaluated; specific billing codes for screening for colorectal cancer would help facilitate this. Formal feasibility, effectiveness and cost-effectiveness studies in Quebec are now warranted.

How do physician assessments of patient preferences for colorectal cancer screening tests differ from actual preferences? A comparison in Canada and the United States using a stated‐choice survey

“…Health Canada established a National Committee on CRC screening and recommended FOBT testing every two years as the modality of choice in 50- to 74- year olds (Coombs et al, 2002) Nonetheless, only Ontario has announced province-wide population-based (FOBT) screening (Ontario Ministry of Health and Long-Term Care, 2007). Several other Canadian provinces are considering screening programs, and all endorse FOBT as the preferred modality (Barkun et al, 2004; BC Cancer Agency, 2003; Cancer Care Ontario and Action Cancer Ontario, 2004; Cancer Care Ontario and Canadian Cancer Society, 2003). …”

Colorectal Cancer Screening: Physicians’ Knowledge of Risk Assessment and Guidelines, Practice, and Description of Barriers and Facilitators

“…These findings are inconsistent with the scientific evidence in support of screening FOBT (7,8) and FS (42,43) in reducing mortality from CRC, and the lack of evidence for colonoscopy. Nonetheless, use of FS has declined while colonoscopy use has increased (44), owing to recent studies (45,46) and media coverage (47) documenting the advantages of colonoscopy, as well as the backing of organizations that develop the guidelines (48). Other barriers either were not or should not have been associated with reported practice behaviours.…”

Canadian Physicians’ Choices for Their Own Colon Cancer Screening

“…The Quebec Association of Gastroenterologists has recently responded to these challenging questions (14). The task force stated, with respect to the role of colonoscopy in CRC screening, that higher quality data are not forthcoming.…”