Thousands more Ontarians should be checked for colorectal cancer

Despite a rise in the number of colonic evaluation procedures, which are used to screen for colorectal cancer (CRC), only 7% of Ontarians who should be screened had any form of invasive colonic evaluation procedure in 2001. This is one of many key findings released today in a new report from the Institute for Clinical Evaluative Sciences (ICES) on the state of colonic evaluation tests in Ontario.

The ICES Research Atlas, Use of Large Bowel Procedures in Ontario, examines colonic evaluation procedure rates on population, regional and hospital levels between 1992 and 2001, and provides recommendations to improve colonic evaluation rates province-wide.

Overview of Results:

• Over the last decade only 16% of “screen-eligible” Ontarians (individuals between the ages of 50 and 74 who should be regularly screened) had a colonoscopy.
• The number of colonoscopies performed over the study period has nearly tripled from over 63,000 in 1992 to more than 172,000 in 2001.
• Sigmoidoscopy and barium enema rates have fallen dramatically. Sigmoidoscopy rates have fallen by 40% while barium enema rates have fallen by 30%.
• Access to colonoscopy varies widely throughout the province. Some counties have procedure rates 2.5 times higher than the rates of the lowest counties.
• Relative to total hospital volume, colonoscopies were performed at more than twice the rate in small hospitals compared with teaching hospitals.
• Fecal occult blood testing (FOBT) screening rates among screen-eligible individuals remain very low, despite recommendations it should be carried out annually or biennially.
• Colonic evaluation procedures performed in Ontario, excluding FOBT, (i.e. barium enema, sigmoidoscopy and colonoscopy), rose from over 307,000 in 1992 to more than 359,000 in 2001.

“The good news here is that the number of people who should be receiving some sort of colonic evaluation has been increasing steadily since the 1990s,” said lead author and ICES adjunct scientist Dr. Chris Vinden. “However, thousands of Canadians still die each year from colorectal cancer – a cancer that is largely preventable with proper screening and without major lifestyle changes.”

Dr. Linda Rabeneck, senior author of the Atlas and a senior scientist at ICES, points out that, “the long, identifiable and treatable pre-malignant phase of colorectal cancer offers us an opportunity here that we haven’t been taking proper advantage of. If we bring colonic evaluation rates up to where they should be we would deal a major blow to colorectal cancer mortality rates in Ontario.”

In order to reduce the burden of colorectal cancer in Ontario, the authors recommend finding new ways to provide, fund and organize the delivery of colonic evaluation procedures. As well, an organized screening program needs to be established, which includes a public awareness campaign, screening invitations for eligible residents, the use of quality indicators, and continuous monitoring of resource use and outcomes.

"There is now a very strong scientific consensus that we can save lives with the early detection of colorectal cancer. The findings of this analysis are an important addition to the ongoing discussion about the need for regular screening in average risk adults 50 years of age and older," said Dr. Terry Sullivan, chief operating officer and vice president of research and cancer control at Cancer Care Ontario. "This study will help us work with the Ministry of Health and Long Term Care to plan an orderly expansion of capacity to deal with province-wide colorectal cancer screening."

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Julie Argles, ICES
• (416) 480-4055 ext. 1-3602 or cell (416) 432-8143
• [email protected]