Advanced disease at presentation for Canadian patients with colorectal cancer despite provincial screening programs: A call to action

ObjectiveWe sought to evaluate the presentation and outcomes of patients with a diagnosis of colorectal cancer (CRC) at an academic Canadian center to identify strategies to improve the existing screening system for CRC.SettingRoyal Alexandra Hospital, Edmonton, Alberta, Canada.MethodsWe performed a prospective cohort study. Data collected included: patient demographics, presentation, treatment, and outcomes 1 year after study completion.ResultsOne hundred consecutive patients were included with a median age of 68 years (SD = 13.3). Most (58%) participants were male and 25% had a first-degree family history of CRC. Only 26% of CRC presentations were identified through screening. Of the screened patients, 81% had stage 0-2 disease, all underwent surgery and there were no deaths in this group 1 year after recruitment.In contrast, 74% of patients presented with symptoms, including bleeding (26%), anemia (22%), and obstruction (19%). Thirty-six (49%) received elective surgery, 33 (45%) underwent emergency surgery, and 5 (7%) did not receive surgery. One year after recruitment, 21 patients (28%) in this group were deceased. Within the symptomatic cohort, 55% of patients were outside the age range recommended for screening, 22% did not have a family physician, and 50% had not been offered regular screening.ConclusionsDespite an established screening program, a significant proportion of patients diagnosed with CRC at our center were not diagnosed via screening. Patients presenting with symptoms were more likely to have advanced disease, require more urgent surgeries, and experience worse outcomes compared to their screened counterparts. The current provincial approach to screening for CRC needs to be improved.