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Large bowel endoscopy in Ontario: variation by geographic region and hospital type

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Despite declines in mortality and incidence rates from the mid-1980s to the late 1990s, colorectal cancer (CRC) continues to be the leading cause of cancer death in non-smokers in Ontario (National Cancer Institute of Canada 2003). Fortunately, CRC's long, identifiable pre-malignant phase makes it preventable and an ideal candidate for a screening program. It has been recommended that all asymptomatic, average-risk adults be screened beginning at age 50 years (Canadian Task Force on Preventive Healthcare 2001). Screening modalities include annual or biennial fecal occult blood testing (FOBT); FOBT with flexible sigmoidoscopy; flexible sigmoidoscopy alone every five years; and colonoscopy every 10 years. In the recently published ICES Research Atlas, Large Bowel Procedures in Ontario, utilization of the above procedures in Ontario was examined for the screen-eligible population aged 50-74 (Vinden et al. 2004). Although data limitations make it impossible to distinguish between screening versus diagnostic or treatment procedures, the results have important implications for any future population-based screening program.

This article highlights findings from the research atlas with respect to colonoscopy and flexible sigmoidoscopy among the screen-eligible (age 50-74) Ontario population. Both procedures, which at the present time are performed primarily in hospital settings, will play an important role in any future organized screening program.

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Citation

Schultz S, Rabeneck L, Vinden C. Healthc Q. 2004; 7(3):17-8.

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