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Recognizing that screening rates for Colorectal Cancer in Ontario (the second leading cause of cancer related deaths) were relatively poor (about 24% including colonoscopy) and that strong evidence supported population based screening with Fecal Occult Blood Testing (FOBT)* the Ministry of Health and Long Term Care (MOHLTC) in Ontario launched a new and innovative cancer screening program called Colon Cancer Check (CCC). This initiative seeks to screen every Ontarian aged 50-74 of average risk for CRC through at least FOBT and at risk individuals with colonoscopy.
Location of Innovation:
Ontario
Description of Innovation:
The Provincial Primary Care and Cancer Network (PPCCN) was officially launched on October 30, 2008 and represents a powerful initiative and strategy of Cancer Care Ontario to engage primary care providers (Family Physicians, Nurse Practioners and Pharmacists (PCPs)) to become more involved in their patients’ cancer journey. The network consists of a Provincial Lead (Dr. Cheryl Levitt) and 13 Regional Leads representing the different Local Health Integration networks across Ontario. Strong clinical evidence supports the critical role of PCPs in improving clinical outcomes, patient experiences and quality of care from health promotion, prevention, screening and early diagnosis through to survivorship, recovery or palliative care.
Recognizing that screening rates for Colorectal Cancer in Ontario (the second leading cause of cancer related deaths) were relatively poor (about 24% including colonoscopy) and that strong evidence supported population based screening with Fecal Occult Blood Testing (FOBT)* the Ministry of Health and Long Term Care (MOHLTC) in Ontario launched a new and innovative cancer screening program called Colon Cancer Check (CCC). This initiative seeks to screen every Ontarian aged 50-74 of average risk for CRC through at least FOBT and at risk individuals with colonoscopy.
This initiative has two main objectives:
1) To reduce mortality from colorectal cancer through an organized screening program and
2) To improve the capacity of primary care providers to participate in comprehensive colorectal screening.
If Colorectal Cancer is detected early, 90% can be cured. If only 50% of the population is screened using FOBT 1500 lives will be saved by 2020 and 5500 live will be saved by 2030**. This major benefit to the people of Ontario is not only manifested in lives saved and diminished suffering, but also accrues significant reductions in waiting times and
huge cost savings in investigation, surgical, chemotherapy and radiation treatments.
Ontario was the first jurisdiction in North America to launch screening of its at risk (ages 50-74) population. (Since then Alberta, Manitoba, Nova Scotia, BC & Saskatchewan have begun to launch similar screening programs.) I submit that it is only in the presence of a universally accessible public healthcare system that such a potentially advantageous (in terms of lives and cost savings) screening program of all eligible individuals could be accomplished. In any system where there are financial barriers to health care accessibility, it is virtually certain that not every eligible citizen would be able to access such a program, and hence would be at a distinct disadvantage in having an opportunity to receive early detection of a potentially curable yet very serious cancer. Only universality of access enables scientifically supported population based cancer and other disease screening programs in an equitable and ethically sound manner. CCC as part of the PPCCN strategy is just the latest innovation in population based cancer screening where both individuals and society will get the most “bang for the buck”.
*In 3 randomized controlled trials, FOBT has been shown to reduce colorectal cancer mortality by 15-33%. (Mandel JS et al. NEJM 1993;328:1365-71. Mandel JS et al. JNCI 1999; 91: 434-37.Hardcastle JD et al. Lancet 1996;348:1472-77. Kronberg O et al. Lancet 1996;348:1467-71.)
**Provided by: Erasmus University Medical Center + Cancer Care Ontario Source: MISCAN Model, Ontario Cancer Registry, Ontario Population estimates
Population:
This initiative seeks to screen every Ontarian aged 50-74 of average risk for CRC through at least FOBT and at risk individuals with colonoscopy.
Outcome measures:
This initiative has two main objectives:
1) To reduce mortality from colorectal cancer through an organized screening program and
2) To improve the capacity of primary care providers to participate in comprehensive colorectal screening.
If Colorectal Cancer is detected early, 90% can be cured. If only 50% of the population is screened using FOBT 1500 lives will be saved by 2020 and 5500 live will be saved by 2030**. This major benefit to the people of Ontario is not only manifested in lives saved and diminished suffering, but also accrues significant reductions in waiting times and
huge cost savings in investigation, surgical, chemotherapy and radiation treatments.
Evidence of success:
*In 3 randomized controlled trials, FOBT has been shown to reduce colorectal cancer mortality by 15-33%. (Mandel JS et al. NEJM 1993;328:1365-71. Mandel JS et al. JNCI 1999; 91: 434-37.Hardcastle JD et al. Lancet 1996;348:1472-77. Kronberg O et al. Lancet 1996;348:1467-71.)
Website link:
N/A
Supporting literature (if any):
Article cited: Levitt, C.A. and Lupea, D. Provincial Primary Care and Cancer Engagement Strategy. Can Family Physician. Vol. 55, No. 11, November 2009, pp.e55 - e59
Your Name:
Sandy Buchman MD CCFP FCFP |
