CMAJ • March 11, 2008; 178 (6). doi:10.1503/cmaj.1070176.
© 2008 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Colorectal cancer screening

Alan Barkun, MDCM MSc* and Ken Flegel, MDCM MSc{dagger}

*Chairholder, Douglas G. Kinnear Chair in Gastroenterology, McGill University, Montréal, Que.; {dagger}Senior Associate Editor, CMAJ

[The authors respond:]

We thank Roy Preshaw for his letter in response to our editorial on colorectal cancer screening.1 He unfortunately appears to have mixed up 2 separate rates reported in the US and Canadian studies. We correctly quoted the "ever-screened" rate in the United States as 63%2; the comparable rate in Canada is 23.5%.3 The difference between the "current-for-screening" rates in the 2 countries is similar in magnitude: 37% in the United States2 and 17.6% in Canada.3

Preshaw's assertion that colorectal cancer screening rates in Canada and the United States are not so different is thus incorrect. In fact, no assertion could be further from the truth. There are overwhelming data showing that "current-for-screening" rates are approximately 43% to 55% in the United States4,5 whereas Canadian investigators have reported dismal data. For example, a "current-for-screening" rate of only 14% in Canada was recently reported.6

The reasons for these differences are likely multifactorial. However, a recent US study indicated that among primary care physicians and adults at average risk of developing colorectal cancer, lack of patient awareness and failure of a physician to recommend screening are key barriers to screening.7 We therefore reiterate our plea for Canadian physicians to actively work to close this care gap; such action will ultimately save lives.

Footnotes

Competing interests: None declared.


REFERENCES

  1. Barkun A, Flegel K. Outliving colorectal cancer. CMAJ 2007;177:545.[Free Full Text]
  2. Peterson NB, Murff HJ, Ness RM, et al. Colorectal cancer screening among men and women in the United States. J Womens Health (Larchmt) 2007;16:57-65.
  3. Zarychanski R, Chen Y, Bernstein CN, et al. Frequency of colorectal cancer screening and the impact of family physicians on screening behaviour. CMAJ 2007;177:593-7.[Abstract/Free Full Text]
  4. Lemon S, Zapka J, Puleo E, et al. Colorectal cancer screening participation: comparisons with mammography and prostate-specific antigen screening. Am J Public Health 2001;91:1264-72.[Abstract/Free Full Text]
  5. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003;348:2635-45.[Abstract/Free Full Text]
  6. McGregor SE, Hilsden RJ, Li FX, et al. Low uptake of colorectal cancer screening 3 yr after release of national recommendations for screening. Am J Gastroenterol 2007;102:1727-35.[CrossRef][Medline]
  7. Klabunde CN, Vernon SW, Nadel MR, et al. Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults. Med Care 2005;43:939-44.[CrossRef][Medline]




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