Tuesday, January 23, 2007

An Unwanted Journey: Day 0426 - Colorectal Cancer Screening for Ontario

The good news is that Ontario will spend about $193.5 million over 5 years for colorectal cancer screening in the province. The bad news is that only about 20% of people at average risk (over age 50) have been screened for colorectal cancer thus far. It doesn't appear that the government has figures for those with a family history of the disease who have been screened.

Starting in 2008, you will be able to go to your family physician or pharmacist, pick up a fecal occult blood test kit, take the samples, and then mail the sample in to a lab for testing. If the result is positive - meaning that microscopic amounts of blood are found in the stool sample - you will be scheduled for a colonoscopy, a far more definitive, yet more expensive and invasive procedure.

But it's all relative. As the story on CBC has it, over 20,000 people will be diagnosed in Canada with colorectal cancer this year. Of those, about 8,500 will die of the disease. Anything - almost anything at all - that the provincial government can do to introduce better screening is bound to be an improvement over the current situation.

In my case, a colorectal screening program might have gained me 2 more years in diagnosing the problem, maybe even 2 1/2 years. When I turned 50, if my family physician had been mandated to ask me to take a fecal occult blood test or, even better, a colonoscopy, we might have found the tumor at a smaller size and with fewer associated problems. That alone would have saved many thousands of dollars worth of medical treatment, not to mention the anxiety and loss of income for me.

Personally, I don't think the program introduced today goes far enough. In my view, because of the danger associated with delaying screening, it would make more sense to mandate an OHIP number cross-reference for all family members. Anyone 40 and over with a first-degree family relation history of the disease would then have his/her family physician notified of the need for a colonoscopy. That would save lives.

Fecal occult blood tests are better than nothing. I applaud the Ontario government for spending some money to save lives. But, the gold standard is still a colonoscopy, not the FOBT. Why not ensure that those at risk are strongly encouraged to have a scope test by using the OHIP information systems to link family physicians and trigger the suggestion for the test - at 50 for average risk; age 40 for a family history risk?

There may be an objection that the provincial medical records should not be used to cross-reference patients. But the first thing doctors ask is for a family history when trying to diagnose a condition. The disclosure could be anonymous; in other words, the triggering mechanism in the information system could be simply a notification that a first-degree family relation has been diagnosed with colorectal cancer and therefore OHIP is recommending a colonoscopy. The patient will, of course, have the right to deny treatment. But the right of survival seems to far outweigh the dangers of disclosure of private medical information, especially when safeguards can be put in place to help protect privacy.

In my opinion, lives are at stake here, and half-way measures, laudable as they might be, are not good enough!

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