Published: Friday, May 24, 2024
Three programs, for example, do not send invitations to patients to participate in CRC Screening, and of those who do, only four programs include a stool testing kit with the invitation. These measures are promoted worldwide and have been linked to increased screening participation.
Medscape Medical News reported that because each province and territory has its own colon cancer screening program, it is possible for screening experiences to vary depending on where you live. Jill Tinmouth MD, senior author and provincial medical director of Cancer Care Ontario in Toronto, Ontario Canada and lead scientist for ColonCancerCheck Program, said.
She said that using a standard set of criteria for assessing the quality of the programs was very important. It helps us understand the differences between them and allows us to make the case to improve individual programs where necessary. It is important to understand what should be achieved in order to offer the best screening services to all Canadians.
The study was first published in the Journal of the Canadian Association of Gastroenterology on 1 May.
Comparing Screening Programmes
Tinmouth and his colleagues worked with the Cancer Screening in Five Continents program (CanScreen5), an initiative of IARC which collects data about cancer screening programs around the world. The CanScreen5 data collection forms were sent to CRC screening program representatives in Canada’s 10 provinces, three territories and the District of Columbia between 2020 and 2021.
CanScreen5 includes 52 questions regarding the organization of a screening program, data collection and information system, protocol, invitations to screenings and further assessments, and quality assurance. IARC reviewed the CanScreen5 forms and Tinmouth’s research team compared programs using 25 questions, as well as general characteristics such age target for screening and type of screening used. The researchers compared Canada’s IARC statistics with those of 10 other countries that have a high incidence of CRC.
In total, 10 provinces as well as two territories provided data. Researchers contacted Nunavut’s representative, but the person declined to provide responses.
In 2007, the first CRC screening program in Canada was launched in Alberta. Manitoba and Ontario. The rest of the provinces began screening in 2009, and then from 2017 to 2020.
All screening programs met the criteria of leadership, governance and finance, as well criteria for accessing essential services. The responses were varied in terms of service delivery, information systems and quality assurance.
The study authors concluded that none of the provinces’ programs met the IARC-defined criteria for “organized screening programs.” British Columbia, Newfoundland and Quebec do not send invitations for eligible citizens to take part in screening. However, British Columbia and Newfoundland use more sophisticated follow-up processes and quality monitoring systems than Quebec.
Alberta, New Brunswick and Ontario are among the regions who do not include a stool-testing kit in their screening invitations. The programs instead send out a letter encouraging residents to speak to their primary healthcare provider about CRC testing.
Information systems and quality assurance were the areas where there was most variation between programs. All Canada’s screening programs collect data on outcomes but differ in the detail they provide, for example, cancer stage or treatment. Quebec has a more limited tracking system.
Tinmouth and his colleagues suggested collaborations between existing screening programs and smaller, newer programs as well as the use of multiple communication channels, including email, texting and social media, with patients.
Tinmouth said, “While it’s important to note how many programs are performing well, it’s interesting that none of Canada’s provincial or territorial programs meet all the criteria of IARC.” “I think that shows there’s room for improvement in all programs across the country.” This work is helping to identify how to improve. I hope that this will be helpful and motivate the programs.”
Improve Program Performance
The study authors note that countries have a wide range of CRC screening programs around the world based on IARC guidelines. CanScreen5 has received information from 79 countries. Only 37 of these countries have CRC screening programs. Even in countries that have national programs, there are significant differences between the approaches taken by invitation protocols, follow up, information systems and quality assurance.
The benefits of CRC Screening (both short-term and long-term – such as a reduction in cancer mortality and cancer incidence) as well as the reduction of costs for advanced cancer treatments, as well as the overall outcome, are now beyond doubt. CRC screening is effective,” Alaa Rosam, MD, gastroenterologist, and regional endoscopy leader for Ontario Health, Ottawa, Ontario Canada, said.
Rostom was not involved in this study but he planned and implemented a CRC screening program at Calgary Hospital and formerly chaired Ottawa Hospital’s gastroenterology department.
He said that to achieve maximum benefits, CRC-screening should be available to all those eligible. There must be systems in place for ensuring maximal participation and prompt colonoscopy follow-up for those who test positive. “These goals can be achieved best through organized programs rather than opportunistic testing.”
Tinmouth and his colleagues plan to quantify the screening performance of Canadian CRC programs in the next phase. This will include the proportion of participants by province or territory, the percentage of those who have a colonoscopy following an abnormal fecal result, and the total number of cancers found through screening.
Rostom stated that this information was extremely valuable in identifying gaps and areas for improvement. It could help improve our programs, provide greater value to payers and patients, and better integrate screening into a healthcare system under immense pressure. This information will help provincial programs and healthcare leaders to streamline and improve accessibility and equity. It can also reduce pressure on primary care and reduce downstream cancer costs.
The authors did not disclose any funding for this study. Tinmouth is the provincial medical director of cancer control and the lead scientist for the Ontario Health ColonCancerCheck Program. Rostom declared no relevant financial relationships.
Carolyn Crist, a journalist specializing in health and medicine, reports on the newest studies for Medscape Medical News MDedge and WebMD.