Colorectal Cancer Screening Program

Last week, every physician in Alberta received an envelope from Alberta Cancer Board containing Alberta’s first clinical practice guidelines for colorectal cancer screening. There isn’t much new in the protocol they advocate. This protocol has been used before and followed by many physicians in Alberta and around the world. What is new is that the protocol has now been formally accepted and promoted by various health organizations in Alberta.

Number one cancer killer in Alberta is lung cancer. What is the second leading cause of cancer death in Alberta? Of course, colon and rectal cancer. In 2004, 650 Albertans died of this disease. In Canada, 8,700 people died of colorectal cancer in 2007.

How many people over the age of 50 get screened for colorectal cancer each year? Less than 15 per cent. That is not good. Alberta Cancer Board hopes that this number will improve in the next few years.

Asymptomatic men and women who are 50 years or older, with no family history of colorectal cancer, are considered to have average risk for colorectal cancer and one of the following options is available for screening:
-Stool tests, also known as fecal occult blood tests (FOBT), yearly or bi-annually or
-Flexible sigmoidoscopy (60 cm. scope) every five years – checks rectum and left side of the colon. This is an office procedure. It picks up 50 to 70 per cent of advanced polyps and cancer or
-Combine fecal occult blood tests with flexible sigmoidoscopy every five years or
-Barium enema every five years (not used very often for screening) or
-Colonoscopy every 10 years

It is quite reasonable to choose any one of the above methods. This is better than no screening. Each method has advantages and disadvantages which your doctor will discuss with you.

It is of interest to note that Alberta Medical Association’s TOP (Toward Optimized Practice) program has launched Health Screen in Act10n (meaning 10 screening maneuvers) program to enhance screening practices among Alberta doctors.

The TOP pamphlet says that the campaign asks physicians to use a checklist of health markers when seeing patients for periodic health examinations to make sure that they have covered areas of importance which would improve the quality of their practice and enhance patient’s health in preventing disease.

Ten markers or maneuvers were selected were on the basis of best practice evidence available from various sources. These are: patient’s smoking behavior, blood pressure, tetanus/diphtheria vaccination status, PAP test, clinical breast examination, fasting glucose, lipids, mammography, colorectal cancer screening and bone density.

It would not be a bad idea for you to make a list of these markers and see where you stand. Even better would be to take the list with you when you see your doctor next time and see how you are doing. Human memory can be short or deceptive when it comes to remembering dates. Your doctor should be able to help you update your checklist.

It is not easy to stay healthy. It requires time, perseverance and sacrifice. Good luck.

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