CFP -- Rapid Responses for Kolber et al., 55 (2) 170-175

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Research:
Michael Kolber, Olga Szafran, Juhee Suwal, and Mark Diaz
Outcomes of 1949 endoscopic procedures: Performed by a Canadian rural family physician
Can Fam Physician 2009; 55: 170-175 [Abstract] [Full text] [PDF]

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Rapid responses published:

Rural Family Physician Scope of Practice: Val E. Ginzburg (19 February 2009)

Rural Family Physician Scope of Practice 19 February 2009

Val E. Ginzburg,
Rural Family Physician, Endoscopist
Assistant Professor, University of Toronto
Send letter to journal:
Re: Rural Family Physician Scope of Practice

val.ginzburg{at}utoronto.ca Val E. Ginzburg

I have read with great interest the article by Dr. Kolber and applauded him for providing his patients with important screening alternative. I am too a Rural physician that performs endoscopies and have gone through a training in endoscopy to provide safe and quality service.
While current North American recommendations do not support population screening with colonoscopy but support FOBT screening (less expensive and less sensitive alternative), in United States patients are being screened more often with colonoscopy then in Canada.
Although colonoscopy was available for a long time there were no large RCTs done to compare colonoscopy to FOBTs screening. Multiple small studies were conducted that demonstrated benefits for detections adenomas and cancers. Current evidence show that the sensitivity for detection of cancer by FOBT is about 50% while by colonoscopy is over 90% (1). Knowing the information it is difficult to deny one to have colonoscopy done as an alternative.
Recently, I was pleased to see a publication for patients on cancer screening by Cancer Care Ontario that lists colonoscopy as one of the options for screening. This provides patients with more educated understanding of their options.
In Canada, one of the concerns is a cost and provider availability. While constantly improving patients care, we should look forward and assess our resources especially in rural areas.
I believe that we have to broaden training of rural physicians to provide comprehensive care including endoscopies to improve health care in rural areas. This will provide better screening for selected patients and will shorten wait time to diagnosis of colorectal cancer that is a second and a third cause of mortality from malignancies among males and females in Canada, respectively.
References: 1. Pignone M. Screeing for colorectal cancer in adults at average risk:summary of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine 2002; 137 132-41.