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Colon cancer screening program bogged down by wait times

10/07/2014 05:00 EDT | Updated 12/06/2014 05:59 EST
As part of our series, Hacking the system: Making our system work for you, CBC Montreal looks at some of the lengths Quebecers go to try to navigate the health care system.

The only clue was a drop in her iron levels. Other than that, there was no alarm bells to warn Melanie Sleep’s mother there was something wrong, until she was diagnosed with a bowel tumour just over two years ago.

“The doctors told her that she had had the tumour undetected for at least four or five years, maybe longer,” said Sleep. 

Doctors told Sleep and her siblings they should all get colonoscopies.

However, Sleep was not considered a priority case — despite her mother’s medical history — and was told it would take up to two years to get tested.

“I know the wait times were long for a lot of things,” said Sleep, who lives in Saint-Lazare​. “But [that] seemed unacceptable.”

Sleep instead paid $500 at a private clinic. Half of the cost was covered by private health insurance.

Most patients opt to wait in the public system. According to Quebec’s health insurance board, the RAMQ, only about 1 per cent of colonoscopies are performed in private clinics.

Wait times vary across the province

Advocates for colorectal cancer patients say a pilot project designed to reduce colonoscopy wait times in Quebec’s public system is having mixed results.

Back in 2011, the province started testing out a home screening program for colorectal cancer at eight health centres in the province. The FIT test — or fecal immunochemical test — involves patients taking a stool sample and sending it to a lab where it’s tested for blood.

“It’s to find out who has a lesion in the colon that is bleeding,” said Dr. Josée Parent, president of the Quebec Association of Gastroenterologists. “Those are the lesions that are cancerous or pre-cancerous."

According to the health ministry, the test is 95 per cent accurate. Health minister Gaetan Barrette says the FIT test helps doctors avoid sending patients for unnecessary invasive tests. Once the program is rolled out across the province, all Quebecers between the ages of 50 and 75 would receive the test every two years.

“We are trying to select people who really need a colonoscopy,” said Barrette.

He says that for priority cases, “the wait list is much lower than it was.”

But Parent says while wait times have been reduced in some regions, such as Quebec City, the results are not as good in Montreal.

She says wait times at some hospitals are so long that doctors can’t guarantee priority cases will be seen within a reasonable time limit.

The pilot project did include $7 million to help hospitals reduce wait times.

But Parent says some of the measures were short-lived. The Montreal General hospital was able to open an extra endoscopy room using funds from the pilot project. But Parent says that only lasted six months.

“So it is frustrating to see there’s long waiting lists, and endoscopy rooms that are under-utilized,” she said.

The Montreal General Hospital says it is waiting to hear if the health ministry will come up with funds to re-open the extra room.

In an email, spokesperson Vanessa Damha acknowledges the hospital has a backlog of patients, like other health centres.

“Wait times and volumes have remained consistent... despite limited resources," she said. "Urgent cases are seen in a matter of days; less urgent cases are seen within months.”

Changing patients’ minds

Once the FIT program is rolled out province-wide, the health ministry faces the additional challenge of persuading both doctors and patients that the home screening test can be a safe, effective alternative to a colonoscopy.

“You can puncture the colon,” says Barry Stein. “It’s a little more difficult, you have to prepare for it. And there’s a certain cost factor to the health care system.”

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