Dr. Catherine Dubé

We spend so much time arguing about which screening test we should use that it takes away from the bottom line that more people should get screened.

 

Colorectal cancer is the second leading cause of cancer death in Canada. What role could screening play in reducing these deaths?

Screening works. It’s a proven, effective way of decreasing the likelihood of developing colon cancer and of dying from it. That’s because colon cancer is typically a slow growing cancer. This gives us ample opportunity to look for signs that it might be present through screening, and cancers that are detected through screening are generally treatable

Who should get screened and when?

We know screening works and we know colorectal cancer is common, so it’s very important to get the population at risk—all Canadians over the age of 50—screened. That’s the most important thing.

What we see in Canada, despite the programs that have been going on in individual provinces, is that participation in screening isn’t high enough. We spend so much time arguing about which screening test we should use that it takes away from the bottom line that more people should get screened. There are several ways to screen and it’s not a “one size fits all.” Some people, like those with a family history of colorectal cancer, might best be screened by colonoscopy, while an average risk Canadian might find it much easier to do a stool test in the comfort of their own home. For others, sigmoidoscopy is a very good option, because it is safe and relatively easy to do and because there is a lot of good research that says it works.

Why aren’t more Canadians between the ages of 50 and 74 getting screened?

People have misconceptions about screening. Firstly, many people think you need to have rectal bleeding or abnormal bowel movements to have colon cancer. I’ve seen this even among physicians. But it’s not true. The second misconception is that you need a family history to be at risk. Once again not true. If we look at the proportion of people who have colon cancer, three quarters of them have no family history. Their only risk factor is really their age. Another problem is that many people think the only way to screen is by doing a colonoscopy and are afraid of that test. Finally, we’re only now starting to fund screening programs all across Canada, so it will take time to get the numbers up. We can’t just rely on patients going to see their doctors. It needs to be much more systematic than that.

What more can be done to reach the people who should be getting screened but aren’t?

The FIT test is going to help a lot because it’s more attractive to physicians that the guaiac was. The guaiac developed a bad reputation because people said it missed so many things. FIT is also non invasive. We’re pretty good at doing pap tests, and FIT tests need to be done the same way.  It needs to become standard for everyone 50 or older. It will take some time to get that system going, and it needs to be ingrained in physicians from medical school onward.

What are the top things patients and their families should know about colorectal cancer screening?

1. Thousands of Canadians die from colon cancer every year, and screening works to decrease that risk.

2. Everyone over the age of 50 should be screened for colon cancer.

3. Let your doctor know if you have a family history, since you may need to start screening before the age of 50.

4. You don’t need symptoms to have colon cancer.

What are the top things doctors need to know about colorectal cancer screening that they might not already know?

1. Colorectal cancer is common and screening works – screening for colorectal cancer will decrease the number of people dying from it.

2. Any screening is good screening, as long as you use one of the recommended modalities.

3. Following provincial screening guidelines is a very important health-care intervention.