Colorectal cancer screening

[Two of the authors respond:]

We thank Winson Cheung for his interest in our recent article.1 Although we acknowledge that the recommendations of the Canadian Task Force on Preventive Health Care were published just 2 years before the survey was conducted, all 4 randomized controlled trials were published 8 years before the data were collected.2^–5 The fact is that colorectal cancer screening was underutilized in 2003. The responsibility for providing primary care physicians with direction on screening for various cancers mostly lies with the appropriate specialists. In this regard, Canada has lagged behind other nations in developing national guidelines on colorectal cancer screening and in instituting screening programs. In no way should family physicians be made scapegoats for the low rate of colorectal cancer screening.

Colorectal cancer screening will most likely be introduced to patients through their primary care physicians, as is the case with immunization programs. Our irrefutable finding that increased contact with family physicians was associated with increased screening rates led us to conclude that “contact with a family physician increases the odds of screening.” However, this is not the only way to increase public participation in colorectal cancer screening; educational strategies and organized screening programs are also important mechanisms. Given that most patients will obtain their cancer screening information and advice from their family physician, the gastrointestinal specialty community (gastroenterologists, gastrointestinal surgeons and gastrointestinal oncologists) needs to do better at disseminating the relevant information to primary care providers and to the public.