Published online Dec 28, 2020. doi: 10.3748/wjg.v26.i48.7652
Peer-review started: September 5, 2020
First decision: September 30, 2020
Revised: October 15, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: December 28, 2020
Processing time: 110 Days and 12.8 Hours
Screening provides earlier colorectal cancer (CRC) detection and improves outcomes. However, it remains poorly understood if these benefits are realized with screening guidelines in remote northern populations where access to colonoscopy is limited. This study provides a critical contribution to this knowledge gap by providing an overview of the participation in, and impact of, CRC screening guidelines in a remote northern region of Canada that experiences higher rates of CRC: The Northwest Territories (NWT).
Previous studies suggest that remote and indigenous populations may experience significant geographic and systemic barriers to accessing CRC screening as well as a higher rate of CRC than other populations. To optimize CRC screening, a better understanding of current participation and screening outcomes in northern populations is critical.
This study aimed to evaluate the participation and outcomes of CRC screening in a remote northern population. In particular, we sought to understand the effectiveness of screening in the NWT and identify factors which may contribute to the likelihood of advanced neoplasia being detected among participants. Realizing these objectives will help inform future CRC screening in the NWT and our understanding of CRC screening access and effectiveness for northern populations.
A population-based, retrospective cohort study was conducted of individuals who underwent CRC screening in the NWT in the last 5 years. This is the first study to review the results of CRC screening in a remote northern population.
Screen-detected cancer cases were not detected earlier than clinically-detected cases which suggests screening was not particularly effective and warrants further research. Potentially contributing to this trend were the findings that individuals experienced a higher incidence of CRC if they had signs and symptoms of CRC at screening, experienced long colonoscopy wait-times, or were indigenous. Further research is needed to further characterize the risk of CRC among indigenous individuals and inform strategies to improve colonoscopy access in the NWT.
These findings suggest that critical gaps in colonoscopy access, triaging of eligible individuals, and knowledge of CRC risk among indigenous individuals may be impairing the CRC screening effectiveness for this remote northern population. This highlights the importance of pragmatic evaluation of CRC screening in remote and indigenous populations.
Further research is needed to inform colonoscopy access for remote populations and to optimize screening for indigenous populations. Research in other northern regions is crucial to inform the generalizability of our findings.