Colon cancer checks show low uptake

Less than half of Canadians in the targeted age group of 50-plus are getting tested for colorectal cancer, despite a high level of awareness about the benefit of being routinely screened, a national survey suggests.

Less than half of Canadians in the targeted age group of 50-plus are getting tested for colorectal cancer, despite a high level of awareness about the benefit of being routinely screened, a national survey suggests.

The survey, commissioned by the Canadian Partnership Against Cancer, polled 3,153 people aged 45 to 74 regarding their understanding and attitudes about getting checked for colorectal cancer, the second leading cause of death from cancer in both men and women. 

While 95 per cent agreed that detecting colon cancer early greatly improves chances of survival, only 44 per cent of respondents overall said they were up to date with screening.

National guidelines suggest people 50 to 74 should get a stool test at least every two years. The fecal occult blood test (FOBT) and fecal immunochemical test (FIT), both performed at home, involve sending a tiny sample of stool in a special kit to a medical laboratory, which checks for microscopic signs of blood in the stool. The presence of blood can indicate one or more malignancy-prone polyps inside the colon, or large bowel.

"While the number of Canadians getting screened for colon cancer is on the rise, the survey demonstrates the majority of Canadians at risk are still not actually getting checked for colon cancer," said Dr. Heather Bryant, the organization's vice-president for cancer control.

Bryant said physicians often believe patients are reluctant to talk about the risk of colorectal cancer because of embarrassment about discussing a private part of their anatomy and the ick factor of bowel movements.

But the survey suggests that the bulk of respondents aren't as negative about the topic as had been assumed.

"For example, only about five per cent of people say they'd be embarrassed to talk to their doctor about the test," she said Wednesday. "Only about 12 per cent of people say, 'Gee, now that you've described this test to me, I think it's a little gross.' So people were actually much more positive about it and accepting.

"However, when they were talking about it being a screening test, they really were thinking if they had symptoms they would go in and get the test," Bryant explained. "And the message that we're trying to get through with screening is it's a valuable test for you to do on a regular basis as part of a healthy wellness approach and it's not about waiting until you get symptoms."

The major symptoms of colon cancer are blood in the stool, a change in bowel movements and abdominal pain.

Checklist for physicals

An estimated 22,000 Canadians were diagnosed with colorectal cancer in 2009, and the disease kills about 9,100 a year, Canadian Cancer Society statistics show. Only lung cancer causes more deaths from malignancy.

"Studies show screening prevents deaths from colon cancer," Heather Chappell, director of cancer control policy for the society, said in a statement. "Based on 2009 statistics, about 1,500 lives each year could be saved if a greater percentage of Canadians were screened."

Yet the survey found that 60 per cent of respondents did not realize they should be routinely screened before the appearance of any symptoms, while just 29 per cent recalled discussing testing with their doctor.

"Most family docs that I know have a checklist for the tests needed at certain ages, and colon cancer screening is certainly on that list now for many docs," said Dr. Jeff Sisler, a family physician in Winnipeg. "But it's concerning that in this survey patients didn't necessarily recall those kinds of conversations."

"The truth is that there's many different kinds of tests and issues that come up in the course of a checkup," he said. "So colon cancer screening competes with immunizations and diabetes and high cholesterol, mammography and Pap smears.

"There's a whole host of things that need to happen in the half-hour visit, and it's certainly possible that family doctors sometimes don't emphasize it to the extent that patients recall it."

Patient's responsibility

Dr. Anne Doig, president of the Canadian Medical Association, agrees that doctors have a responsibility to raise the subject of colon cancer screening.

"But there's also a responsibility on patients to take that and say, 'If my doctor forgot to tell me, I need to ask.' It's a two-way street."

Doig, a family doctor in Saskatoon, said patients also need to be receptive and act on their doctor's advice. Some patients "shut down" at the mention of colorectal cancer screening, possibly because they erroneously believe that means an automatic colonoscopy — a diagnostic test typically ordered only if a fecal blood test is positive. (Those with a family history of the disease or at high risk due to inflammatory bowel disease may need routine colonoscopies.)

"I can see it happening talking to them in the office. They're really not listening, even though you're saying to them, 'No, no, no. I'm not talking about a scope, I'm talking about you just doing a little stool test."

Bryant stresses that it's important that colorectal cancer be detected at its earliest stages because treatment at that point can be highly successful.

"And so this is one where you have a very simple test, it can be done in the privacy of your own home, and you can actually dramatically change the chances of survival," she said. "We can't say that for every single cancer."

The survey is considered accurate within 2.1 percentage points, 19 times out of 20.