Colorectal cancer detection in a rural community. Development of a colonoscopy screening program.

PROBLEM BEING ADDRESSED Colorectal cancer (CRC) is a substantial cause of death and morbidity in Canada. Endoscopy screening by colonoscopy has been recommended, but widespread implementation is impossible because it is difficult to obtain, especially in rural areas.

OBJECTIVE OF PROGRAM To screen for CRC safely and effectively using colonoscopy performed by non-specialist endoscopists in rural areas.

PROGRAM DESCRIPTION Health providers and community organizations were informed about the screening program. Patients between the ages of 50 and 75 and those at high risk of CRC based on family history were screened. Measures of safety and effectiveness were monitored. In 2 years of screening, one of 152 patients was found to have CRC, and 23.7% had adenomatous polyps. There were no complications. Rates of CRC and adenoma detection and cecal intubation were similar to rates found in other screening studies.

CONCLUSION It was not difficult to design and implement a CRC screening program in our small rural community. Colonoscopies performed by family physicians have been effective, and there have been no serious complications.