The Dose20:51How often should I be having colonoscopies?
Colorectal cancer is the fourth most common cancer in Canada, but if caught early, many people have a good chance of surviving. But screening for it is key. Dr. Jill Tinmouth, lead scientist at the colorectal cancer screening program at Ontario Health and gastroenterologist at Sunnybrook Health Sciences Centre, speaks with guest host Dr. Peter Lin about colorectal cancer screening.
For some, a colonoscopy might be scary; others just put it off as a time commitment that can wait. But physicians and advocates agree that it’s important that people not be afraid of the screening procedure and get it done.
“Whatever you think you’re going through for a colonoscopy is no comparison to going through multiple surgeries, chemo, all sorts of treatment and potentially dying from it and the stress not just on you [but] on your family,” said Barry Stein, president and CEO of Colorectal Cancer Canada.
Stein also survived colorectal cancer.
“I would say that’s the biggest incentive to do it.”
Colonoscopies are part of the screening process for colorectal cancer in Canada. Screening in most provinces and territories often starts with an at-home stool test for the average-risk person before a colonoscopy is done, when needed.
With colon cancer being the second most common cause of cancer death in Canada, doctors say it’s an important procedure to have when necessary to catch cancer early.
FITs like Nova Scotia’s are the common first step in colorectal cancer screening in Canada for the average-risk person. (Nova Scotia Health)
Treatable when detected early
A recently published study and subsequent headlines have sparked discussions about the effectiveness of colonoscopies in detecting colorectal cancer.
A randomized controlled trial’s results published in the peer-reviewed New England Journal of Medicine found that among those invited to do a colonoscopy, there was an 18 per cent reduction in later colorectal cancers and no significant reduction in deaths.
But many of those invited never followed through.
When only people who actually had the colonoscopy were analyzed, the study’s authors found the procedure reduced the number of colorectal cancers by 31 per cent and associated deaths by 50 per cent.
Some American experts stress the trial’s results should not be misinterpreted as evidence that a colonoscopy is a bad screening test. Like any test or procedure, there are limitations.
But research shows that when colorectal cancer is detected early, it is 90 per cent treatable, according to the Canadian Cancer Society.
Improving cancer screening rates in diverse communities
A Toronto community health centre that primarily serves Black and immigrant patients dramatically improved its cancer screening rates after launching a targeted campaign several years ago. Cancer screening rates tend to be lower in some diverse communities.
Recently released cancer prevalence data from the society shows that colon cancer is the fourth most diagnosed cancer in the country, but that it can be more survivable than other cancers like lung cancer when caught early.
“Colorectal screening has been a revolution, as well as fecal occult blood testing, to help diagnose colorectal cancer in an earlier stage,” said Dr. Christian Finley, a thoracic surgeon and professor at Hamilton’s McMaster University and a member of the Canadian Cancer Society’s cancer statistics advisory committee.
“Over a long period of time, this appears to have borne fruit and we’re seeing a change in the numbers and stage of cancers that we’re seeing.”
But if you or someone you know is still hesitant to get their colon examined, here’s what experts say you should know about colonoscopies.
Who should get screened
If you’re 50 to 74 years old and at average risk of getting colorectal cancer, you should be getting screened every two years, according to the Canadian Cancer Society.
In most provinces and territories, screening for colon cancer starts with an at-home poop test — commonly a fecal immunochemical test (FIT).
As part of the non-invasive FIT, a patient is required to collect a sample of their stool and ship it to a lab for analysis.
The FIT looks for blood in the stool, a common sign of colorectal cancer. Other signs include anemia (low blood count caused by low iron), unexplained weight loss, new diarrhea, new constipation and abdominal pain, gastroenterologist Dr. Jill Tinmouth told CBC’s The Dose guest host Dr. Peter Lin.
Before a colonoscopy is done, patients will need to drink a liquid solution to clean out their colon. (Jean-Paul Pelissier/Reuters)
If the FIT comes back abnormal, then colonoscopy is often the next step, said Tinmouth, who is also the lead scientist at the colorectal cancer screening program at Ontario Health.
If the FIT results are normal, then screening through the at-home test can be done every two years, she added.
People who are at high risk for colon cancer may need to be tested at a younger age or more frequently, according to the society.
If you’re 75 and older, the Canadian Cancer Society recommends people speak with their primary care provider on whether they should continue getting stool tests.
Prep for the test
The colon must be clean for a colonoscopy. This prep, as it’s known, is a “major inconvenience,” according to Harvard Medical School, that takes longer than the actual procedure — but is necessary for the colonoscopy to work.
Patients will also need to eat a liquid diet at least a day before the colonoscopy.
“Having a clean colon is really important because … it’s a bit of a twisty, turny space and so getting all the stool out maximizes our ability to pick up polyps and to find cancers,” said Tinmouth.
The procedure
A colonoscopy is a quick day procedure often done by a gastroenterologist.
“The way colonoscopy works is it’s a long, skinny tube that’s flexible. It’s got a light and a camera on the end and we’re able to sort of look directly at the lining of the colon. And so you take a prep, you clean everything out and we get a very nice look using that instrument,” said Tinmouth.
Yukon Morning8:32Colonoscopies — when and why you might need one
You don’t have to post a video of your colonoscopy online like Canadian actor Ryan Reynolds, but routine colorectal cancer screening should be on your to-do list, says house doctor Raj Bhardwaj. Elyn Jones spoke with him to learn more.
A colonoscopy can also find polyps — which can sometimes be cancerous — that are removed during the procedure.
Often the patient is mild or moderately sedated for the colonoscopy so that they’re not uncomfortable, says Tinmouth.
If sedated for the procedure, the patient may not be able to drive for a period of time afterward.
Finley acknowledged it can be hard — especially for those with lower socio-economic status, who work marginal jobs, or have to get childcare — to find time to get the procedure done.
“They don’t have the luxury of taking time off work to get those tests,” he said, adding the Canadian Cancer Society’s recent study on cancer prevalence shows that for colorectal and lung cancer, lower-income patients are much more likely to be newly diagnosed but are less likely to survive compared to wealthier patients.
“One of the big things we see in this study is it’s not a level playing field for people.”
How effective is a colonoscopy?
There is significant research showing that screening reduces the number of colorectal cancer diagnoses and deaths by finding precancerous polyps and early-stage tumours before symptoms begin.
Tinmouth emphasizes that colonoscopies are just one way to screen for colorectal cancer.
She adds that the recently published study on colonoscopies’ effectiveness “gives you an idea of how it’s a good test, but it’s not a perfect test.”
In most provinces and territories, routine screening for colorectal cancer for the average risk person starts at the age of 50 with an at-home poop test. (Submitted by Donna Hatt)
Other doctors have also noted that only 42 per cent of the 28,220 people invited to get the colonoscopy done as part of the study actually had the procedure done.
What if I’m uncomfortable or afraid of the procedure?
Stein and Tinmouth agree that people shouldn’t be afraid of colonoscopies.
“I think people get embarrassed and shy about the bowels, poop and all of that kind of stuff,” said Tinmouth.
“But really these are, as my mom would say, normal bodily functions. Everybody has them and does them.”
Stein was diagnosed with colorectal cancer that spread to his liver and lungs in 1995 and was told he had a 15 per cent of surviving the next five years of his life.
Now living with no evidence of the disease, he encourages people to keep up on their routine screening.
“From a practical point of view, [it’s] what we know will save lives and reduce the risk of going through what I went through — thirteen surgeries, all sorts of cancer treatments and being told that I was going to die and have a five-year survival and so forth,” he said.
“To avoid all that pain, suffering, the stress on your family, doing a simple screening test is nothing.”
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
CALGARY – Alberta’s health minister says a new agency responsible for primary health care should be up and running by next month.
Adriana LaGrange says Primary Care Alberta will work to improve Albertans’ access to primary care providers like family doctors or nurse practitioners, create new models of primary care and increase access to after-hours care through virtual means.
Her announcement comes as the provincial government continues to divide Alberta Health Services into four new agencies.
LaGrange says Alberta Health Services hasn’t been able to focus on primary health care, and has been missing system oversight.
The Alberta government’s dismantling of the health agency is expected to include two more organizations responsible for hospital care and continuing care.
Another new agency, Recovery Alberta, recently took over the mental health and addictions portfolio of Alberta Health Services.
This report by The Canadian Press was first published Oct. 15, 2024.
Rana Van Tuyl was about 12 weeks pregnant when she got devastating news at her ultrasound appointment in December 2020.
Her fetus’s heartbeat had stopped.
“We were both shattered,” says Van Tuyl, who lives in Nanaimo, B.C., with her partner. Her doctor said she could surgically or medically pass the pregnancy and she chose the medical option, a combination of two drugs taken at home.
“That was the last I heard from our maternity physician, with no further followup,” she says.
But complications followed. She bled for a month and required a surgical procedure to remove pregnancy tissue her body had retained.
Looking back, Van Tuyl says she wishes she had followup care and mental health support as the couple grieved.
Her story is not an anomaly. Miscarriages affect one in five pregnancies in Canada, yet there is often a disconnect between the medical view of early pregnancy loss as something that is easily managed and the reality of the patients’ own traumatizing experiences, according to a paper published Tuesday in the Canadian Medical Association Journal.
An accompanying editorial says it’s time to invest in early pregnancy assessment clinics that can provide proper care during and after a miscarriage, which can have devastating effects.
The editorial and a review of medical literature on early pregnancy loss say patients seeking help in emergency departments often receive “suboptimal” care. Non-critical miscarriage cases drop to the bottom of the triage list, resulting in longer wait times that make patients feel like they are “wasting” health-care providers’ time. Many of those patients are discharged without a followup plan, the editorial says.
But not all miscarriages need to be treated in the emergency room, says Dr. Modupe Tunde-Byass, one of the authors of the literature review and an obstetrician/gynecologist at Toronto’s North York General Hospital.
She says patients should be referred to early pregnancy assessment clinics, which provide compassionate care that accounts for the psychological impact of pregnancy loss – including grief, guilt, anxiety and post-traumatic stress.
But while North York General Hospital and a patchwork of other health-care providers in the country have clinics dedicated to miscarriage care, Tunde-Byass says that’s not widely adopted – and it should be.
She’s been thinking about this gap in the Canadian health-care system for a long time, ever since her medical training almost four decades ago in the United Kingdom, where she says early pregnancy assessment centres are common.
“One of the things that we did at North York was to have a clinic to provide care for our patients, and also to try to bridge that gap,” says Tunde-Byass.
Provincial agency Health Quality Ontario acknowledged in 2019 the need for these services in a list of ways to better manage early pregnancy complications and loss.
“Five years on, little if any progress has been made toward achieving this goal,” Dr. Catherine Varner, an emergency physician, wrote in the CMAJ editorial. “Early pregnancy assessment services remain a pipe dream for many, especially in rural Canada.”
The quality standard released in Ontario did, however, prompt a registered nurse to apply for funding to open an early pregnancy assessment clinic at St. Joseph’s Healthcare Hamilton in 2021.
Jessica Desjardins says that after taking patient referrals from the hospital’s emergency room, the team quickly realized that they would need a bigger space and more people to provide care. The clinic now operates five days a week.
“We’ve been often hearing from our patients that early pregnancy loss and experiencing early pregnancy complications is a really confusing, overwhelming, isolating time for them, and (it) often felt really difficult to know where to go for care and where to get comprehensive, well-rounded care,” she says.
At the Hamilton clinic, Desjardins says patients are brought into a quiet area to talk and make decisions with providers – “not only (from) a physical perspective, but also keeping in mind the psychosocial piece that comes along with loss and the grief that’s a piece of that.”
Ashley Hilliard says attending an early pregnancy assessment clinic at The Ottawa Hospital was the “best case scenario” after the worst case scenario.
In 2020, she was about eight weeks pregnant when her fetus died and she hemorrhaged after taking medication to pass the pregnancy at home.
Shortly after Hilliard was rushed to the emergency room, she was assigned an OB-GYN at an early pregnancy assessment clinic who directed and monitored her care, calling her with blood test results and sending her for ultrasounds when bleeding and cramping persisted.
“That was super helpful to have somebody to go through just that, somebody who does this all the time,” says Hilliard.
“It was really validating.”
This report by The Canadian Press was first published Oct. 15, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
