Manitoba dead last in colon-cancer screening

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This article was published 18/02/2023 (1248 days ago), so information in it may no longer be current.

In the world of evolving health-care technologies, there is a spectrum of “early” to “late” adopters. Unfortunately, Manitoba tends to be a late adopter.

Manitoba was one of the last provinces to get digital mammography and remains one of the last provinces not to allow publicly funded ultrasound services in private X-ray clinics, which would be more convenient for patients.

And Manitoba is late when it comes to colon-cancer screening.

About 770 Manitobans get colon cancer every year, and 350 die from it.

Every province and territory except Manitoba has fully adopted a colon-cancer screening test called FIT (fecal immunochemical test). CancerCare Manitoba’s ColonCheck Program is still using the older FOBT (guaiac-based fecal occult blood test), which is less sensitive, less convenient and has more dietary restrictions than FIT.

FIT isn’t new. It was rolled out in Saskatchewan more than a decade ago. Although Manitoba was one of the first provinces to screen for colon cancer, in 2007, it is the last to fully adopt FIT.

Dr. Harminder Singh and Dr. Charles Bernstein, both Winnipeg internal medicine gut specialists, say FIT should have been implemented years ago. It is “absolutely appalling how delayed we are, compared to the rest of the country, in implementing FIT,” says Bernstein.

But ColonCheck is still mailing FOBT poop-testing kits every two years to Manitobans aged 50 to 74 who are at average risk of colon cancer. Those at higher risk, or those who are on colonoscopy wait lists, are sent a FIT screening test.

Stool-based screening tests are just one part of a colon-cancer screening program. For example, a positive stool test, with either FOBT or FIT, will lead to further testing, such as colonoscopy.

More than 110,000 Manitobans are screened for colon cancer every year using FOBT and about 1,200 are screened with FIT.

Overall, about one-half of those mailed a screening kit participate. That’s about one-quarter of new people invited to participate and three-quarters of those who have participated before.

The Canadian Partnership Against Cancer reports that Manitoba has one of the highest colon-cancer-screening participation rates in Canada and, based on research, this should increase further when FIT is introduced.

Participation rates actually went up during COVID-19, according to Dr. Donna Turner, chief of population oncology at CancerCare Manitoba.

FOBT requires smearing poop samples on a test kit card three days in a row and avoiding excessive amounts of vitamin C, which can cause a false negative result. FOBT detects colon cancers about 70 per cent of the time.

FIT requires a single stool sample with no dietary restrictions and detects colon cancers about 95 per cent of the time.

This means that out of 1,000 people with colon cancer, FIT will pick up 950 and FOBT will pick up 700 — missing 250.

The good news, says Turner, is that CancerCare Manitoba plans to transition fully from FOBT to FIT late next summer.

“It would be irresponsible to put out a new technology when the system isn’t ready,” says Turner, so work is underway to ensure that everything is in place for the transition to FIT. For example, because FIT is more sensitive, it’s expected to result in a higher number of positive tests, which would require more colonoscopies.

Turner acknowledges FIT is a better colon-cancer screening test but says: “We can’t go back and undo things, unfortunately.”

Manitobans waited far too long to transition to FIT and patients should not have to settle for “second-best” tests when it comes to life-and-death cancer diagnoses.

Still, if you receive a FOBT screening test, use it. Waiting for FIT tests to be fully implemented may put you at higher risk of missing colon cancer when it is still treatable.

Manitoba can do better, as it has in the past. It was ahead of the pack in getting a Gamma Knife unit to treat brain tumours and a Positron Emission Tomography (PET) scanner to image cancer.

Part of CancerCare Manitoba’s mission is “exemplary programs of prevention” and Shared Health’s value system includes being innovative.

Manitoba needs to live up to these ideals and stop being a late adopter.

Dr. Sandor Demeter is a Winnipeg physician, an associate professor in the department of community health sciences at the University of Manitoba and a fellow in the Dalla Lana School of Public Health Global Journalism program at the University of Toronto.