Report in English with a Dutch summary (KCE reports 45A)

KCE reports vol.45 Screening for Colorectal Cancer: Appendices 141
other implementation and feasibility issues
Despite strong evidence about early detection and prevention of colorectal
cancer deaths through screening with the fecal occult blood test (FOBT),
statistics show that Ontario s screening participation rates include only 15% in
eligible individuals.
The results of the project will be used to inform the development of a
provincial colorectal cancer screening policy, enhancing the potential for highquality,
accurate, and timely population-based colorectal cancer screening and
follow-up program in Ontario
In March 2006, Toronto launched a program to train nurses to perform flexible
sigmoidoscopy. So far the program has trained six nurses at two sites in
Toronto. In addition, the report from a one-year pilot project on FOBT has
recently been submitted to the Ministry of Health and Long-Term Care
(MOHLTC) with a request for funding for a provincial FOBT screening
program. The design of the program is similar to that in the UK with a central
program office, regional offices and colonoscopy hubs. There are also plans for
an information system, quality assurance and ongoing monitoring of
participation rates, positivity rates, referral rates, adverse events and evaluation
of outcomes.
In order to raise public awareness for colorectal cancer a National Colorectal
Cancer Campaign was set up in 1997 and has become a national campaign 591.
7.13.2 Groups at increased or high risk
The Ontario familial colon cancer registries collect personal and family health
information from Ontario residents who have a family history of colorectal
cancer. The registries participate in Cancer Family Registries (CFR), an
international assembly made up of 10 participating sites from Australia, the
United States and Canada.
7.14 NEW ZEALAND
7.14.1 Average risk groups
The implications of a program for colon cancer screening for New Zealand
were examined in 1998 by a National Working Party on Screening for
Colorectal Cancer 592. The working party recommended against establishing a
national population based screening program for colorectal cancer with FOBT,
given the modest potential benefit, the considerable commitment of health
sector resources and the small but real potential for harm. There was also a
lack of evidence from randomised controlled trials that a screening program
with other modalities such as flexible sigmoidoscopy, colonoscopy or double
contrast barium enema will reduce the incidence of people dying from
colorectal cancer.
In order to update the conclusions of the working party on colorectal cancer
screening, the New Zealand Ministry of Health s national screening unit
requested New Zealand Health Technology Assessment (NZHTA) to
undertake a systematic review of the new (since 1997) evidence on colorectal
cancer screening 219.
Consistent with the findings of the Working Party on Screening for Colorectal
Cancer, high quality evidence was found that FOBT screening with the guaiacbased
FOBT Hemoccult reduces mortality from colorectal cancer. FOBT as a
screening test however raised several issues concerning other aspects of how