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Lack of screening program 'very short-sighted'

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Heather Logan, director of cancer control policy for the Canadian Cancer Society's national office, said before a screening program can be undertaken, there have to be enough resources to ensure prompt investigation after a positive test result. "It's really important that this is done right," she said.

Without prompt follow-up, doctors say patients could be left worrying for months about whether a positive test spells cancer. Of those whose feces tests positive for hidden blood, 30 per cent will have polyps and 2.2 per cent will have colorectal cancer. The remaining cases could be attributed to hemorrhoids, colitis or other non-cancerous conditions, said Derek Jonker, a medical oncologist at the Ottawa Hospital Regional Cancer Centre.

"I would certainly recommend that the province certainly use the fecal occult blood testing, preferably on a yearly basis on everyone aged 50 to 74," said Dr. Jonker, who specializes in gastrointestinal cancer.

At least one dozen European countries have some form of colorectal cancer screening program. Of those, Finland has the highest compliance rate, with 70 per cent of the target population participating. Australia has a compliance rate of 45 per cent. In Canada, the test is recommended for those aged 50 and older. But, according to Canadian Cancer Statistics 2006, participation is low, ranging from 13 to 14 per cent of men in British Columbia, Saskatchewan and Ontario -- down to 4 per cent of women in Newfoundland and Labrador.

With a fecal occult blood test, a patient is an active (if not exactly enthusiastic) participant, having to take a small sample of feces every day, for three days, then house it in a special cardboard box to which a chemical solution is later added.

The sample should be taken before it has hit the water of the toilet bowel, leaving some puzzled at precisely how to complete this task. An Internet search reveals a sure-fire method: placing plastic wrap over the toilet seat.

In some cases, colorectal cancer can be stopped before it begins. Found in the colon -- a hollow, muscular tube some five feet long -- a polyp can be flat or hang like a cherry from a stem. Polyps can exist for five to 10 years before causing cancer and, while not all polyps necessarily cause cancer, their surgical removal is recommended.

According to Canadian Cancer Statistics for 2006, if 70 per cent of the target population aged 50 to 74 had the fecal occult blood test every two years, the death rate for the disease would drop by 17 per cent.

"There's good evidence it reduces the risk of developing extensive cancer and certainly, if you have a polyp, it's removed," said Brent Schacter, chief executive officer of the Canadian Association of Provincial Cancer Agencies.

But Linda Rabeneck, regional vice-president for Cancer Care Ontario and lead author on a study published in the May issue of American Journal of Gastroenterology, found a telling 19 per cent of Ontario patients were diagnosed because they experienced dangerous complications, including bowel obstruction, perforation at the site of the tumour or emergency admission to hospital.

Her study identified more than 41,000 cases of colorectal cancer in Ontario through health-record databases between 1996 and 2001. It found women and low-income Ontarians are more likely to have serious complications at the time they are diagnosed.

Overall, the study suggests that women and low-income Canadians are not being sent as often as men and financially better-off patients for tests to detect colorectal cancer at a point where it could be more easily treated.

"These clearly represent failures in access to screening and access to diagnostic tests," said Dr. Rabeneck, vice-president of Toronto Sunnybrook Regional Cancer Centre. "The system, if you will, has failed these patients in an important way."

Dr. Rabeneck's study used census data from Statistics Canada to define high and low income. In Ottawa, low-income neighbourhoods were defined as having an average income, adjusted for family size, of less than $29,626 -- which certainly includes Mr. St. Coeur, who, until the time of his diagnosis, operated a skidder (a four-wheel tractor used to haul logs).

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