Research Profile - Calling attention to the colon
Can a letter and a helpful, knowledgeable voice on the telephone encourage more people to undergo colorectal cancer screening?
It' s a no-brainer, really.
Colorectal cancer, the second deadliest cancer for men and women after lung cancer, is very often preventable. It commonly starts as a pre-cancerous polyp in the lining of the large intestine. Remove the polyp and you eliminate the source of the cancer. All it takes is a screening procedure to detect the polyps. One type of screening is stool testing, which is recommended every one or two years for people over the age of 50.
"Although it's obvious why people should take the test, the rates of screening are about 50% or less," says McGill University's Dr. Maida Sewitch. "So people aren't getting it done. Even when they get a recommendation for screening from their doctor, often they're not following through with it."
Funded by the Canadian Institutes of Health Research, Dr. Sewitch is leading a pilot project aimed at increasing colorectal screening numbers.
At a Glance
Who – Dr. Maida Sewitch, Assistant Professor, Department of Medicine, McGill University, Medical Scientist, McGill University Health Centre, Associate Member, Division of Clinical Epidemiology and Community Studies, St. Mary's Hospital Center.
Issue – Colorectal cancer, the second most deadly cancer that affects both women and men, can be prevented by regular screening to check for pre-cancerous polyps and early stage cancer. Yet less than half of Canadians who are at risk for the disease do the screening.
Approach – Dr. Sewitch has launched a pilot project to study the effectiveness of a call centre to increase the rate of screening. Patients have been sent letters inviting them to call in to find out about the benefits of screening and to arrange to get their screening kits.
Impact – Improved screening would lead to earlier detection and treatment, and fewer deaths.
Working with Montreal physicians and three hospitals, Dr. Sewitch's team has sent out about 1,000 letters to men and women inviting them to call in to find out more about colorectal cancer and how to get screened. Those who call in will talk to a project coordinator who can answer their questions and arrange to send out a kit to do a fecal occult blood test at home.
Dr. Sewitch says that a likely reason for the low numbers for colorectal screening – other than the ick factor – is simply the inconvenience. Doing the at-home test can require altering dietary habits and drug regimens. And doing the test itself can be tricky.
"The good thing about the call centre idea is that even though the instructions come with the kit, people can still call if they have questions," says Dr. Sewitch. "It's always easy when you're reading about it on a piece a paper, but when you go to do it, maybe it's not so easy."
Inconvenience aside, doing the test makes great sense. "It can save your life," says Dr. Sewitch. "This will empower patients to take charge of their health."
The project is patterned after the Quebec breast cancer screening program in which women turning 50 begin receiving annual letters to remind them to get a mammogram. The letters come with a prescription to book an appointment. Studies show that over several years breast cancer screening programs reduce the mortality rate by 25%.
Colorectal screening, however, can be more complicated. Unlike just going for a mammogram, patients usually either have to do the multi-day fecal occult blood test at home or go for a colonoscopy, which involves a trip to a clinic for a procedure often done under "conscious sedation." Other options include having a sigmoidoscopy (usually a flexible device that probes part of the large bowel) or a barium enema.
What's needed, says Dr. Sewitch, is a bit of encouragement to get people over their reluctance. She hopes the letter/call centre combination will provide the incentive needed to help people save their own lives.
"We did a study on determinants of who goes for colorectal screening – the barriers and facilitators – and this approach just seemed to make sense. The physicians don't always have the time or they don't always have the right information. Patients are sometimes embarrassed to ask. If we remind patients and they have a person at the other end to talk to about it, it could help. That's what we'll find out."
The study
Dr. Sewitch and her colleagues have sent out 1,000 letters to Montrealers aged 50 and older inviting them to call in to get more information about colorectal cancer and to find out about getting a test kit sent to them.
After filling out a consent form, participants will be sent the test kit that, upon completion, they can send to a designated lab. The lab will analyze the results and forward the results to the participants' doctors, who will follow up on positive results.
The researchers will gather data on the volume of calls to the call-in centre, the number of kits sent out, the number of tests completed and the follow-through by the doctors.
"We'll get the numbers all the way along and get an idea if we could do a randomized trial on the effectiveness of sending these kits out to primary care patients."
By the numbers
According to the Canadian Cancer Society:
- 22,500 Canadians will be diagnosed with colorectal cancer in 2010, 12,400 men and 10,100 women.
- Odds of getting colorectal cancer are 1 in 14 for men, 1 in 15 for women.
- 9,100 Canadians will die from colorectal cancer in 2010.
- Colorectal cancer is the 4th most commonly diagnosed cancer and the 2nd leading cause of cancer death in Canada.
"People may not know about the importance of getting tested, especially if they don't have a primary care physician. Or maybe their physician didn't tell them about it during their regular check up. And there is embarrassment: this is a part of the body most people don't necessarily want someone to be poking around with. For people who find it difficult to talk about, maybe speaking about it over the telephone will be easier than in person."
-- Dr. Maida Sewitch