Recommendations Raise Workload Issues for Colon Cancer Screening

Extract

In the United States, people age 50 or older have the “luxury” of deciding among colonoscopy, flexible sigmoidoscopy, fecal occult blood test (FOBT), and other tests for colon cancer screening. But for many others around the world, such screening—not to mention a choice in tests—is not part of their health care routine even though colorectal cancer is one of the top cancer killers.

Years after the discovery that colorectal screening can decrease cancer incidence and deaths, few countries have adopted widespread colon cancer screening programs, although some are inching their way to that goal.

The reason, say many experts, is the burden that extensive colon cancer screening places on colonoscopy services. Behind every colorectal screening test, no matter what kind, is the potential need for a colonoscopy. If results from an FOBT, a barium enema, or even a flexible sigmoidoscopy to examine the lower colon are positive, patients must be referred for a colonoscopy that can view the entire colon and remove precancerous polyps, if need be. But many countries cannot yet fulfill that need, and such recommendations have huge implications for countries with national health care systems such as Canada and the United Kingdom.