I was disappointed by the tone of Richard Schabas's commentary on colorectal screening.1 Phrases such as “It is now time to act” do not suggest thoughtful weighing of the risks involved with widespread screening initiatives.
The recommendations of the National Committee on Colorectal Cancer Screening2 clearly describe the potential benefits and risks of screening but also emphasize the need for adequate informed consent. For the family physician, this means ensuring that the patient knows the motivation for the test, giving advice on diet and the test procedure, explaining the concepts of false-negative and false-positive results and their rates, and clarifying the need for colonoscopic follow-up of positive results and its associated morbidity. Anything less would be inadequate in the current Canadian legal environment.
The time required for a family doctor to provide such education, follow-up and counselling can be significant. Physician resources are finite, and widespread deployment of fecal occult blood screening could be undertaken only at the expense of other medical services. Specifically, measurable increases in family physician workload, surgical consultations and colonoscopic waiting lists are predictable.
Evidence-based analysis cannot effectively weigh important factors such as patient anxiety and longer waiting lists arising out of false-positive results. We fail our patients by concluding that what is not easily quantified is irrelevant.
Ted Mitchell Family Physician Hamilton, Ont.