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Provincewide cancer-screening program will start on Vancouver Island

Nov 06 2012
Dr. Carl Brown looks over at a video screen as he operates on colon cancer patient Janice O'Mara. 

Dr. Carl Brown looks over at a video screen as he operates on colon cancer patient Janice O'Mara.

Photograph by: Arlen Redekop, PNG , The Province

The Vancouver Island Health Authority will be the first region to roll out a provincewide colorectal cancer-screening program to assist in early detection of the disease, the provincial government announced today.

The new program will be phased in on Vancouver Island, starting on April 1, and in place in all health authorities by the summer of 2013.

“In its earliest stages, colorectal cancer can have absolutely no symptoms, but catching it early greatly increases the survival rate,” said Health Minister Margaret MacDiarmid, in a news release this morning.

Colorectal cancer, the second leading cause of death from cancer in adults, can develop from small growths in the colon and rectum. The polyps can become cancerous, but if detected early are easily removed during a colonoscopy.

Health experts and politicians have often called for a national or provincial colorectal screening program, similar to those for breast and cervical cancers.

In 2009, the B.C. government introduced a pilot colorectal cancer screening program in Penticton, Powell River and parts of Vancouver.

According to the Ministry of Health, by July the program had completed more than 15,000 screenings. Pre-cancerous lesions were removed from hundreds of patients and 46 cases of cancer had been detected. However, the province lagged in implementing the successful programs provincewide, argued critics. The B.C.-wide program announced today will build on those programs.

A provincewide screening program was a major health plank in the NDP’s 2009 election platform and NDP leader Adrian Dix has committed to move forward with it if elected next year. The cost of screening is relatively inexpensive but the cost of treatment and death are high, Dix had advocated.

“I’m just happy it’s moving forward,” Dix said in a phone interview today. “It makes sense in terms of public policy and I’m very pleased. The sooner we get it going the better.”

Dix’s mother survived colon cancer.

“It’s really taking a step we need to take and one I’ve been advocating for years,” Dix said.

According to the Canadian Cancer Society, an estimated 23,300 Canadians will be diagnosed with colorectal cancer this year and 9,200 will die of it. In B.C., the society projects there will be 2,880 new cases this year and 1,200 people will die from it.

The publicly funded $20 fecal immunochemical tests — which people can do at home — will be provided through doctors every two years to people in the 50-74 age group, as well as to people with a family history of colorectal cancer.

A key part of the screening program is that it will send notices to patients, similar to the way in which notifications are sent to women to have a mammogram to detect possible breast cancer. The colorectal screening program will send reminders to patients and doctors to let them know when rescreening is needed.

Research shows that provincewide programs that are run like public health programs, where people in high-risk categories don’t need a doctor’s referral and are contacted to be screened, have a much higher uptake.

The Canadian Cancer Society has been calling for such a screening program.

“Colorectal cancer screening is a proven methodology for reducing cancer deaths,” Barbara Kaminsky, CEO of the Canadian Cancer Society for B.C. and the Yukon, said today. “We are delighted with the commitment that has now been made to a provincewide program.”

If the cancer is detected at its earliest stages, the chance of survival is more than 90 per cent.

Barry D. Stein, president of the Colorectal Cancer Association of Canada, a survivor of late-stage colon cancer, told the Times Colonist in July that such a program is long overdue.

“Coupled with healthy lifestyles, screening will not only help prevent the disease, but will catch more people with early-stage disease and provide them with a better opportunity for a cure,” Stein said, in a news release.

Every province has some type of screening program, with the exception of Quebec, which is rolling out a demonstration project this year, Stein told the Times Colonist in July.

Earlier this year, a year-long study by general surgeon Dr. Hamish Hwang, published in the B.C. Medical Journal, showed that nearly half of patients being treated for colorectal tumours in Vernon didn’t learn they had the disease until they turned up in the city hospital’s emergency department with severe complications such as bowel obstructions, hemorrhages or perforations.

The advanced age of the general Vernon population and the lack of an effective provincial colorectal cancer screening program in B.C. were partly to blame, the study indicated.

Countries with a national screening program, such as Germany, Italy and Australia, have far fewer cases of people with colorectal cancer in emergency rooms than in countries such as Spain, Norway and Ireland, where there isn’t a national screening program, the study says.

“Colorectal cancer screening in Canada, in terms of both rates and adherence to guidelines, is poor, and screening in B.C. may be worse than in other provinces,” the study says.

A colorectal-cancer screening program, similar to those in existence for breast and cervical cancers, would reduce death rates by up to 83 per cent and reduce incidence by up to 81 per cent, according to a University of B.C. study in the Canadian Medical Association Journal in 2010.

In the study, which looked at the cost-effectiveness of colorectal cancer screening, the University of B.C. and Dalhousie University researchers concluded that, depending on the type of screening test used, incidences of colorectal cancer could be reduced by 44 to 81 per cent, and death rates could be reduced by 55 to 83 per cent, compared with no screening program.

And, even though programs to screen 100,000 people regularly after age 50 may cost about $70 million over the group’s lifetime, they are still cost-effective, largely because prevention avoids the expense of treatment.

Such treatment — which includes surgery, lab tests, doctor visits and chemotherapy — can range from $5,000 to $500,000 per patient each year, depending on the stage at which cancer is first diagnosed.

BY THE NUMBERS

23,300: Number of Canadians who will be diagnosed with colorectal cancer in 20129,200: Number who will die from it55 to 83: Percentage by which a colorectal screening program would reduce death rates$70 million: Cost of programs to regularly screen 100,000 people from age 50 until they die$5,000 to $500,000: Cost to treat a colorectal cancer patient for one year 1,600: B.C. men will be diagnosed with colorectal cancer in 2012; estimated 630 men will die of the disease. 1,250: B.C. women will be diagnosed with colorectal cancer in 2012;  an estimated 520 women will die of the disease.
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