Rural scope of practice

I read the article by Dr Kolber and colleagues1 with great interest, and applaud them for providing patients with an important screening alternative. I too am a rural physician who performs endoscopies and I have also gone through training to provide safe and high-quality service.

Current North American recommendations support population screening with fecal occult blood testing (FOBT)—a less expensive, less sensitive alternative to colonoscopy. American patients, however, are being screened more often with colonoscopy than Canadian patients are.

Although colonoscopy has been available for a long time, no large randomized controlled trials have compared colonoscopy with FOBT. However, multiple small studies have demonstrated its benefits for detecting adenomas and cancer. Current evidence shows that the sensitivity for detection of cancer by FOBT is about 50%; by colonoscopy it is more than 90%.2 Knowing this, it is difficult to deny patients colonoscopy as an alternative.

Recently, I was pleased to see a Cancer Care Ontario publication for patients that listed colonoscopy as an option for screening. This provides patients with a more educated understanding of their options.

In Canada, concerns include cost and provider availability. While constantly improving patient care, we should look forward and assess our resources, especially in rural areas.

We have to broaden the training of rural physicians to provide comprehensive care, including endoscopy, to improve care in rural areas. This will provide better screening for patients and will shorten wait times for diagnosis of colorectal cancer, which is the second and third most common cause of mortality from malignancies among men and women in Canada, respectively.

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