Provincial Auditor reports Colorectal Cancer Screening Program improvements needed

In her 2020 Report – Volume 2, Chapter 21, Provincial Auditor Judy Ferguson reports the Colorectal Cancer Screening Program is following best practices in many areas of service delivery, but more work is needed to improve participation rates, reduce the wait times for colonoscopies, and determine a specified timeframe for providing colonoscopy results to patients.

“Two statistics reflect the importance of the Colorectal Cancer Screening Program. Colorectal cancer is the second leading cause of cancer death in Saskatchewan, and approximately 90 percent of colorectal cancers can be prevented or successfully treated if caught early,” Provincial Auditor Judy Ferguson said.

The Office notes the Colorectal Cancer Screening Program’s overall participation rate has remained relatively unchanged since 2014, with some decline in Northern Saskatchewan where participation rates are already lower. The Program helps screen individuals who may have a higher risk of developing colorectal cancer.

Saskatchewan’s participation rate is 47 percent over the two-year period 2018-2020. While the highest in Canada, it falls short of Canada’s national benchmark of 60 per cent.

The Office found the Saskatchewan Cancer Agency needs to use key performance indicators that are consistent with national good practice to measure the success of the screening program. In addition, it needs to analyze its promotional strategies to determine if they help to increase participation rates by raising awareness and educating residents at higher risk of colorectal cancer.

The audit found 22 individuals who waited longer than 60 days (i.e., the national benchmark) for a colonoscopy; the colonoscopy detected cancer. The audit also found 12 individuals who waited between 15 and 104 days for results from their colonoscopy; they were diagnosed with cancer.

The Saskatchewan Cancer Agency needs to work with the Saskatchewan Health Authority to reduce the wait time for colonoscopies, and determine a reasonable timeframe for providing patients with results from colonoscopies. The Agency collaborates with the Authority to deliver the Colorectal Cancer Screening Program.

“Increasing program participation would mean more individuals could be diagnosed early. Earlier diagnosis means improved quality of care and better health outcomes for individuals with colorectal cancer,” Ferguson said.

In Saskatchewan, colorectal cancer is the second leading cause of cancer death. It accounts for about 14 per cent of new cancer cases in the province. The number of new colorectal cancer cases in Saskatchewan is rising due to an aging population.

Colorectal cancer screening can identify apparently healthy people who may have a higher risk of developing colorectal cancer, so they can be offered treatment or management techniques at an earlier stage, and to make a difference to their health outcome.

Research shows effective screening for colorectal cancer reduces mortality; approximately 90 per cent of colorectal cancers can be prevented, or successfully treated if caught early.

Our analysis found the participation rate in the Agency’s colorectal cancer screening program has slowly decreased over the past six years to about 47 per cent.

Key Points

- $2.4 million was spent on the Colorectal Cancer Screening Program in 2019-20.

- Voluntary program targets residents aged 50 to 74 — about one quarter of Saskatchewan’s population.

- Almost 50 per cent of targeted residents participate.

- Lower participation rate in Northern Saskatchewan ranging from 23 per cent to 34 per cent (depending on the area) for the period 2018-20.

- Targeted residents receive a FIT kit generally every two years; they can self-administer and return the kit to any provincial lab or by mail free of charge.

- Targeted residents not completing the FIT kit receive reminders and another kit again in two years.

- If a self-administered FIT kit shows abnormal results, the individual is referred for a colonoscopy.

- In March 2020, the Agency’s analysis of screening program participation rates by postal code identified various difficult-to-reach and under-screened areas across northern Saskatchewan and various communities in southern regions (e.g., Swift Current, Herbert).