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


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.



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

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