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A retired RCMP officer says the ColonCheck home screening program saved his life

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Len Clace almost threw away the colon cancer home screening test he credits with saving his life nearly five years ago.

Clace, then a 58-year-old retired RCMP officer, was surprised to receive the test in the mail from CancerCare Manitoba's ColonCheck program in October 2008.

"I wasn't sick, I didn't have any symptoms - why did they send it to me? I felt I was in fairly good shape," he says, reflecting on his first thoughts upon receiving the test.

"I never went to the doctor unless I was really sick, and because I thought I was in good health, didn't bother with things like annual check-ups. Finally, I thought I might as well do the test - it wouldn't hurt."

Known as a fecal occult blood test (FOBT), it didn't hurt. And it probably saved his life. The free test, which is done in the privacy of one's home, involves collecting small stool samples and mailing them to a lab in a supplied envelope.

Within a few weeks of submitting his test for analysis, Clace received a call from ColonCheck informing him of the results. The test revealed microscopic amounts of blood in his stool - a sign that he may have colon cancer. The ColonCheck staff member suggested that he undergo a follow-up test known as a colonoscopy, which is a much more definitive test for colon cancer. Clace agreed, and a date for the procedure was set.

"A follow-up colonoscopy showed that I had two cancerous tumours in my colon," says Clace. In addition, a CT scan done in connection with his diagnosis revealed that Clace had an abdominal aorta aneurysm (a potentially life-threatening enlarging of the aorta). "The aneurysm was repaired before it had a chance to rupture," says Clace.

Colorectal cancer (cancer of the colon and rectum) is the second leading cause of cancer-related death in Manitoba. Canadian Cancer Statistics 2012, a report released by the Canadian Cancer Society, estimates that 870 people were diagnosed with colon cancer in Manitoba last year, and 330 people died from the disease.

Yet colon cancer can be successfully treated up to 90 per cent of the time, when detected early. That's why, in 2007, Manitoba Health and CancerCare Manitoba created ColonCheck, one of the first provincial colon cancer screening programs in Canada, and the latest of three screening programs, after BreastCheck and CervixCheck.

Prior to ColonCheck, screening for colon cancer was the responsibility of the primary health-care provider. People like Clace who didn't get annual check-ups wouldn't be diagnosed until the disease was possibly in its later stages.

ColonCheck addresses that problem by sending home screening tests to all eligible Manitobans between 50 and 74 years of age who haven't completed one in the past two years, or haven't had a colonoscopy or flexible sigmoidoscopy in the last five years.

Dr. Kathleen Clouston, Interim Program Manager of ColonCheck, says the program was initially rolled out in stages, beginning with eligible Manitobans living in the Assiniboine and Winnipeg regions. In 2012/13, ColonCheck achieved full coverage and mailed out 94,790 tests to eligible Manitobans in all regions of the province. Going forward, tests will be mailed to all eligible Manitobans every two years after they have completed a test.

Since its inception in 2007, more than 70,000 men and women have completed ColonCheck's home screening test. And Clouston says the results have been significant.

Between Jan. 1, 2009 and Dec. 31, 2011, there were 850 follow-up colonoscopies as a result of the home screening tests. Over 470 adenomas and advanced adenomas (precancerous polyps/growths) were found. Of those, 36 cases of colon cancer were diagnosed.

Clouston says it is important for eligible Manitobans to carry out the home screening test because people with early stage colon cancer often show no symptoms, other than microscopic amounts of blood in the stool. "One of the biggest misconceptions is that you should only do the test when you're feeling the symptoms of colon cancer," says Clouston. "But you can be walking around feeling perfectly healthy and still have a pre-cancerous polyp or colon cancer in the early stages. The amount of blood these tests detect is so small you wouldn't be able to see it with the naked eye."

Clouston says if more people did the home screening test, it would reduce the number of colon cancers found in the later stages. Research has shown that colorectal cancer screening every two years results in a 17 to 25 per cent reduction in mortality rates.

"If we catch colon cancer at an early stage, it's much more treatable. If the test is abnormal and we find polyps, they can be removed and it doesn't even get the chance to become cancer."

The numbers suggest the message is being well-received. ColonCheck reported a 30 per cent response rate to the home screening test over the last year, compared to 23 per cent in 2009/10. In addition, a significant number of people are getting tested after consultations with their health-care provider. One survey suggests that as many as 64 per cent of eligible men and women have been screened for colon cancer in Manitoba - the highest rate of any province in Canada.

These numbers taken together paint a positive picture for the future, says Clouston. "Colon cancer is not discussed the way some cancers are. There's a lack of education and awareness, but I think that's changing."

Under the program, tests completed and returned to Cadham Provincial Laboratory are quickly analyzed. Test results are then mailed to the participant, as well as his or her doctor, if requested by the participant.

If a test shows an abnormal result, a ColonCheck staff member will call the individual to discuss the results. Clouston says it is important to remember that even if a test shows an abnormal result, nine times of out ten it won't be because of colon cancer.

"Three out of ten will have some type of benign or precancerous adenoma (fleshy growths usually resembling the shape of a mushroom)," says Clouston. "Abnormal results can also be due to small fissures or hemorrhoids."

The individual's primary health-care provider is also alerted to the abnormal test result and given the opportunity to allow ColonCheck to proceed with a referral for a follow-up colonoscopy. If the physician has agreed to ColonCheck's direct referral process, the follow-up co-ordinator will respond immediately by consulting with the participant to set a date for a colonoscopy.

About 77 per cent of primary-care providers approached allow ColonCheck to automatically refer their patients when an abnormal test result is obtained. The program's primary healthcare educator is working with doctors and nurses across the province to increase awareness of the benefits of this process.

The educator is also working to build partnerships with as many health-care providers as possible to support distribution of ColonCheck home screening tests to their patients.

Both of these initiatives will increase screening rates and the efficiency of ColonCheck over time by making it easier for patients and physicians to take advantage of the program.

The process has also been streamlined by clinics that use electronic medical record (EMR) software. "By using the EMR, all they have to do is click the ColonCheck button, and a message is sent to us that they have given one of our tests to a patient," says Clouston. "Once we have this information, we are able to send a reminder letter to anyone who does not complete the test within eight weeks of receiving it. Health-care providers really like this as it helps them ensure their patients do the test."

Clouston says ColonCheck can move quickly to set up an appointment for a colonoscopy when one is necessary. "We have a nurse practitioner working with us that helps us maintain a wait-time to colonoscopy of under eight weeks."

While the response rate to the home screening test has been improving, efforts have been made to make it even easier to complete.

"One of the biggest challenges that kept people from doing the test were the diet and medication restrictions," Clouston explains.

In the past, people were told not to eat red meat or take certain medications for a period of time before and during the test. But a review of research on the issue by a Winnipeg physician demonstrated there was no evidence to support the restrictions.

As a result, ColonCheck adopted changes to eliminate those specific restrictions, although other restrictions, such as limiting the consumption of vitamin C, remain. The changes, adopted last June, have made it easier for people to fit the test into their daily routine. Since then, the participation rate has increased by 1.7 per cent, and the response time has also improved, with people submitting the test for analysis in an average of 41 days rather than 56.

Nonetheless, Clouston says raising awareness about the importance of screening remains a priority. "Women are used to going for mammograms, but they're not as familiar with the importance of doing the home screening test. That's the advantage of CancerCare Manitoba's triscreening program. Together we can talk about breast and cervical cancer, but also talk about colon cancer and encourage men as well as women to be tested."

In addition, ColonCheck's health educators are working to increase awareness of the importance of getting screened. "They're always on the go, visiting health fairs or businesses in the community," says Clouston. "We've worked with the Winnipeg Health Region to attend flu clinics and we have been to the Reh-Fit Centre. We're always looking for innovative ways to increase awareness."

Clace had his colon removed in May 2009. Since his cancer was diagnosed while it was at an early stage, he did not need radiation or chemotherapy. His cancer has not returned.

"I think fear of the unknown keeps a lot of people from doing the test," says Clace. "I've talked to people who don't want to know, but they're eventually going to know and it's going to be too late," Clace says. "Having cancer is a bigger pain in the butt than taking this test. I just wish people would get checked and get checked early."

To reduce your risk of colon cancer, CancerCare Manitoba recommends maintaining a healthy body weight, getting regular exercise, and limiting the amount of alcohol you consume. Talk to your doctor if you have any symptoms of colon cancer such as a change in the shape of your stool (ribbon-like stool), stomach cramps, any persistent change in bowel movements, or noticeable blood in the stool.

Spending a few minutes doing the test ultimately gave Clace more time to spend with his family. He is married with two children, four stepchildren and 11 grandchildren. "I don't take life for granted any more. It's too precious - we have to live life like there might not be a tomorrow," he says. "I lucked out. I got a second chance."

To request a home screening test, visit www.ColonCheck.mb.ca or call 204-788-8635 or 1-866-744-8961. You can also contact your primary-care provider.

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