Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of colorectal cancer screening participation in remote northern Canada: A retrospective cohort study
Heather A Smith, Andrew D Scarffe, Nicole Brunet, Cait Champion, Kami Kandola, Alisha Tessier, Robin Boushey, Craig Kuziemsky
Heather A Smith, Department of Surgery, University of Ottawa, Ottawa K1Y4E9, Ontario, Canada
Heather A Smith, Andrew D Scarffe, Telfer School of Management, University of Ottawa, Ottawa K1N6N5, Ontario, Canada
Nicole Brunet, Faculty of Medicine, University of Ottawa, Ottawa K1Y4E9, Ontario, Canada
Cait Champion, Department of Surgery, Northern Ontario School of Medicine, Sudbury P3E2C6, Ontario, Canada
Kami Kandola, Department of Health and Social Services, Government of the Northwest Territories, Yellowknife X1A1P5, Northwest Territories, Canada
Alisha Tessier, Department of Surgery, Stanton Territorial Health Authority, Yellowknife X1A0H1, Northwest Territories, Canada
Robin Boushey, Division of General Surgery, University of Ottawa, Ottawa K1H 8L6, Ontario, Canada
Craig Kuziemsky, Office of Research Services, MacEwan University, Edmonton T5J4S2, Alberta, Canada
Author contributions: Smith HA and Kuziemsky C designed the research study; Smith HA, Kandola K, Tessier A, and Brunet N performed the data collection; Smith HA and Scarffe AD conducted the data analysis; Smith HA, Scarffe AD, and Kuziemsky C wrote the manuscript; and all authors have read and approve the final manuscript.
Supported by University of Ottawa Telfer School of Management Research Grant, No. 603430; Natural Sciences and Engineering Research Council Innovation Grant, No. RGPIN-2019-04884; and the Northern Scientific Training Program.
Institutional review board statement: This study was approved by the Aurora College Research Ethics Committee, protocol No. 20190404.
Informed consent statement: Our data collection was only retrospective and, therefore, no participant consent was required for ethics approval of this study.
Conflict-of-interest statement: All authors confirm no conflict of interests.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at
hsmit037@uottawa.ca STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Heather A Smith, MD, Academic Research, Department of Surgery, University of Ottawa, 975 Parkdale Ave, WM150b, Ottawa K1Y4E9, Ontario, Canada.
hsmit037@uottawa.ca
Received: September 5, 2020
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
ARTICLE HIGHLIGHTS
Research background
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).
Research motivation
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.
Research objectives
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.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
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.
