Randomized comparative trials have shown that screening can reduce the mortality from colorectal cancer. However, due to difficulties of implementation, as observed in various countries, the expected benefits might not be achieved. The Committee recommends that the following conditions be met prior to implementing a provincial program:
Accessibility to colonoscopic examinations should be governed by the implementation of clinical, quality and performance standards that will be applied to all clienteles in all services offering this examination in Québec.
Individuals with a high risk of colorectal cancer, primarily those identified by a family history of colorectal cancer, should be so informed, and they should have access to screening that corresponds to their specific risk.
A demonstration project to show the feasibility of a program targeting average-risk individuals should be carried out before implementing a program at the provincial level.
The effectiveness of the colorectal cancer screening program for average-risk individuals must meet the following requirements:
The target population must be restricted to persons aged 50 to 74. Each person must be invited individually and must be provided with information, tools and, when needed, support for making an informed decision whether or not to participate in screening.
The screening program must be integrated with a global policy to combat colorectal cancer, which will include a primary prevention component designed to promote healthy lifestyles associated with a lower risk of colorectal cancer.
Screening must be based on a fecal occult blood test (FOBT) every two years, followed by a complete colonoscopy if the result is positive. The choice between the guaiac test and the immunochemical test must be based on the results obtained during the demonstration project.
FOBTs must be available without requiring referral from a family physician. The tests must be analysed in a central laboratory meeting high quality assurance criteria.
The screening program must provide for monitoring mechanisms and for the measurement of performance and quality indicators. It must also be shown that it has no significant negative impact on the other aspects of colorectal cancer control or on clinical services (colonoscopy, for example).