Cheap DIY colorectal screening kit is trialled
Dr Meri-Sisko Vuoristo - Pirkanmaan Syöpäyhdistyksen, Tampere, Finland
We are doing, really, a randomised study on colorectal cancer screening on a population level. So a lot of municipalities participate, not the whole Finnish population but the coverage is about 45% now. We screen only half of the patients and the other half serves as a control group.
What would you say about doctors already using these tests in other countries?
That test is used for diagnostic purposes also. This test is easy, it’s cheap, the test can be done at home, the screenees can do the test at home and send the test card to be analysed so in that way it’s practical.
What are the drawbacks?
People have to accept the test, they have to participate. So, of course, there might be some aversion when doing that at home, but anyway you have to take the stool samples. In Finland we have noticed that the acceptance is quite good because two out of three participate.
What is the protocol you are using in this study?
We test people aged from 60 to 69 years old and they have the test every two years, male and female. So everybody who is willing to participate takes five rounds. This is the other half and the other half serves as a control so they do nothing, they are not contacted in any way.
How practical was it to implement this programme?
People accepted it quite nicely, they were ready to participate. The programme has also shown that the whole screening chain is feasible, it’s practical, it can be done. Because if the person tests positive he or she has to be referred for further examination which usually means a full colonoscopy. So this whole chain includes also the usual primary healthcare levels, so they have to have access to do these colonoscopies or refer patients to colonoscopies to hospitals.
If you do detect an early case you can save costs on therapy later on?
The purpose is to find cancer so early that it’s easier to cure and the treatment is easier for the patient and there’s less costs. Also, you can prevent, I hope, some cancers by taking out adenomas which are precancerous lesions which can turn to cancer later. So in that way you can also reduce the incidence of cancer.
What are the issues with the view that screening is reducing the mortality rate of colon cancer?
It has been shown that with this test bowel cancer mortality can be decreased but this Finnish study is a real population-based study; in previous trials there has been some selection of the population where they do this trial. In our country we really screen a normal population so in that sense it’s more informative and also, obviously, because you compare the control group and the screened group.
What would you like cancer doctors to take from this, especially those treating older patients?
For an oncologist, oncologists usually treat patients who have cancer so for them the message is only that this is something we have to study further. But the message to the GPs is that if there’s a screening programme going on we advise to participate in that.
What about doctors’ opinion on how valuable screening is?
There are many debates going on, especially on prostate cancer but also on breast cancer screening these days. Perhaps it also reflects the financial problems many countries suffer from because you have to divide resources to many different directions.
Would you advise primary care physicians to be more cautious in recommending patients for this treatment?
At this point I can only say that when we study enough we know. But for those patients who have symptoms, even mild ones, which could point to colorectal cancer of course it’s necessary to have their bowel examined by full colonoscopy in those cases.