Quebec, a distinct colorectal cancer society

The Quebec healthcare system is particularly discouraging when it rejects an inexpensive solution, used everywhere else in Canada, and – this is the most important – that could save lives.

A striking example: Quebec is the only Canadian province that does not have a systematic screening program for colorectal cancer.

Yet the medicine is clear and crystal clear: everyone should be screened for colorectal cancer (colon and rectum) every two years between the ages of 50 and 74.

Rest assured: this is a simple stool test. This test could save your life: we potentially avoid five deaths out of 1000 people who take the test¹.

Between 2007 and 2014, the nine other Canadian provinces created a systematic screening program based on this fecal test. It is obviously on a voluntary basis, but we facilitate access to the test and we remind people to do it.

All Ontarians age 50 and older receive a reminder letter every two years suggesting they get tested, which they can get through their doctor, nurse or 811. If they don’t get tested , they even receive a reminder letter four months later.

Colorectal cancer may be the second most common type of cancer in terms of death, but it is generally treatable if detected early.

Hence the importance of having a systematic screening program.

Quebec has none. Of course, you can ask your family doctor to do a stool test. And many family doctors suggest it to their patients. But the Association of Gastroenterologists and the Federation of General Practitioners of Quebec have long been calling for a systematic screening program (always on a voluntary basis), based on the model of other provinces.

You would no longer need to visit your family doctor just to do a fecal test, and you would increase the participation rate in the test.

“We would save lives, complex and invasive treatments for patients, and financial costs for the health care system,” says D^D Mélanie Bélanger, President of the Association of Gastroenterologists of Quebec.

In practice, about 5% of stool tests are positive. Note: this does not mean that 5% of people have colorectal cancer. If the stool test is positive, then a second test is done: a colonoscopy. Among the patients who undergo a colonoscopy, 10% have colorectal cancer (we can start treating it more quickly, which significantly increases the chances of recovery), 40% have lesions that are not yet cancerous (the lesions are removed during the colonoscopy, before the cancer forms), and 50% are finally negative (the patient is reassured for 10 years).

In Quebec, 31% of 50-74 year olds have had a screening test (stool test) for two years. A systematic screening system would be inexpensive and would do better.

The Legault government agrees in veiled terms that the status quo is not acceptable. “It is our goal to have a systematic screening program,” said the office of the Minister of Health, Christian Dubé.

Implementing such a systematic screening program is not rocket science. Quebec has had a similar program for breast cancer since 1998. And it can take inspiration from what Ontario has been doing since 2010.

We need faecal tests accessible without necessarily seeing a doctor (for example via a nurse at the CLSC or by mail), a good awareness campaign (for example reminder letters from the age of 50), and an easy-to-manage system for physicians who will need to communicate test results to patients.

When it comes to colorectal cancer prevention, we don’t have to remain a separate society.