Colorectal cancer screening

I commend Ryan Zarychanski and colleagues for highlighting the importance of colorectal cancer screening in their recent article.1 I have a concern about their use of data from the 2003 Canadian Community Health Survey. Respondents to this survey were asked to recall their colorectal cancer screening history in the previous 10 years, and thus the survey most likely captured screening practices before 2001, the year when the first set of guidelines cited in the paper was published (Zarychanski and colleagues used recommendations released between 2001 and 2004 as reference standards to evaluate the adequacy of screening practices). It is not realistic to expect physicians to have incorporated the screening practices recommended in the guidelines into their clinical practice before the guidelines were published.

Zarychanski and colleagues imply that better screening can be achieved by increasing patients' contact with their family physician. Although I certainly agree that family physicians play a pivotal role in preventive health and early detection, I question the cost-effectiveness of encouraging patients to visit their family physician repeatedly to obtain appropriate screening. At a time when health care resources are scarce and family physicians are overworked, the low rate of participation in colorectal cancer screening would be better addressed by improving public awareness through education, by lobbying funding organizations for support to develop a national screening strategy and by recruiting additional family physicians to manage the anticipated challenges of population-based screening.