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Lack of screening program 'very short-sighted'

Colorectal cancer will kill thousands of Canadians this year. So why isn't more being done to prevent it?

From Friday's Globe and Mail

Marc St. Coeur was doubled over in pain, passing blood. With no family physician, he went to an Ottawa hospital emergency department, where doctors detected the source of his problem: His rectum was blocked with cancer.

On the East Coast, Linda McAlpine had been ill for a week, suffering flu-like symptoms. She was barely able to stand when a friend's doctor stopped by her Halifax home, noticed her grey pallor and whisked her to the emergency room. Surgeons removed a large tumour that was obstructing her colon.

Mr. St. Coeur and Ms. McAlpine don't know each other, but they share a diagnosis of advanced colorectal cancer, in 2005 and 2003, respectively, and neither of them had family doctors.

Given that Ms. McAlpine, 59, is a woman and Mr. St. Coeur, 48, worked in a low-income job, they also represent the two groups of patients most likely to present with serious complications at the time of diagnosis.

"Cancer has a funny way of creeping up on people," Mr. St. Coeur said. Especially when there's no colorectal screening program in Canada, offering the chance to detect cancers in an early stage -- or even before they begin.

An estimated 20,000 Canadians are expected to be diagnosed with colorectal cancer this year; some 8,500 will die of the disease, making it the second biggest cause of cancer death, the Canadian Cancer Society says. Given that organized, colorectal cancer screening programs can reduce death rates by 15 to 33 per cent, the question arises: Why doesn't Canada have one?

Barry Stein, president of the Colorectal Cancer Association of Canada, has long been pushing for such a program. "It's very short-sighted to not have a program like this," Mr. Stein said in a telephone interview from Montreal. "We will be paying the costs, whether it's human costs or financial costs, loss of productivity, those things we don't actually calculate or think about."

Ontario said in April that it wants to be the first in Canada to start a colorectal screening program -- but so far, no program has been announced. British Columbia is studying a proposal by the BC Cancer Agency to start such a program. Alberta plans to have a program up and running some time next year. Manitoba expects to make recommendations in six to 12 months on resources required. Quebec is studying the feasibility.

So what's the holdup?

For one thing, doctors warn that screening programs would create a crush of patients who, having tested positive in fecal occult blood tests -- finding blood in the stool -- would require colonoscopies.

"Clearly, there is no way we have the resources [in Canada] that would be directed to colonoscopy," said William Paterson, president of the Canadian Association of Gastroenterologists, a national group of specialists that specialize in diseases of the digestive system. He said gastroenterologists do roughly half of all colonoscopies, a procedure in which a thin, flexible viewing instrument looks at the interior lining of the rectum and colon. General surgeons do the other half.

As it is, only 41 per cent of patients across Canada who test positive in fecal occult blood tests are able to obtain a colonoscopy within two months -- the association's maximum recommended waiting time. In Ontario, where a screening program seems closest to becoming reality, doctors are meeting that two-month maximum only 31 per cent of the time, he said.

Although Dr. Paterson stressed the importance of screening programs, he wonders how doctors will be able to meet the increased demand.

"One of my concerns is that if everybody is going off to do screening on patients, who is going to look after the sick people?" he asked.

Those people, he said, include chronic diarrhea sufferers, who may have ulcerative colitis. They should have a colonoscopy within two months, but 10 per cent of them are waiting one year and still have not seen a gastroenterologist or undergone the procedure, he said.

Dhali Dhaliwal, president and chief executive officer of CancerCare Manitoba, said the resources required for a screening program will be massive. Unlike similar programs for breast and cervical cancer, colorectal cancer screening would include both genders.

"The limitation will be the capacity of gastroenterologists and surgeons," Dr. Dhaliwal said. ". . . Everybody has plans in the pipeline."

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