Doubts over cancer screening programme

Questions about the proposed national colorectal cancer screening programme - and fears Dunedin Hospital will not cope with the resulting extra work - have been raised by senior doctors.

Otago District Health Board chief medical officer Richard Bunton is worried the hospital, which is already rationing colonoscopies, will not be funded for the extra work from the programme, which is still some years away.

"It makes no sense at all to introduce a screening test when there is not the resource to deal with the extra clinical demands that will flow as a result," Mr Bunton says in a report to go before the board's hospital advisory committee today.

Inadequate resourcing would negate the effectiveness of screening, he said.

The hospital's clinical leader of gastroenterology, Dr Martin Schlup, is critical of the decision to opt for faecal occult blood screening, which had been shown to have a "very very modest" effect on the death rate from the disease.

The Ministry of Health says the programme has the potential to save up to 100 lives a year, reducing the death rate from bowel cancer by up to 15%.

Health Minister David Cunliffe in May announced the Government would fast-track the screening programme.

A pilot programme involving a population of at least 400,000 is planned to start next year, with the programme going nationwide before 2014.

Planning would include increasing the colonoscopy capacity by funding boards for additional colonoscopy procedures, and organising additional training for colonoscopists, the Ministry of Health said, but no times for this have been given.

A report last year on national capacity indicated colonoscopy resources would need to increase by more than a fifth to cope with the programme.

Ministry of Health national clinical director, cancer programme, Dr John Childs, in written response to Otago Daily Times questions, said there had been significant additional funding to boards for colonoscopies and in the past few years a significant increase in colonoscopies had resulted.

Extra money was provided through specific funding for elective surgery.

Dr Schlup said in Otago the scarcity of senior doctors limited surveillance screening last year.

Pressure on colonoscopy services at the hospital from people with possible bowel cancer symptoms meant routine surveillance colonoscopies were stopped for people with a close family member with bowel cancer, even though they might meet national guidelines.

Only those identified as having a genuine hereditary syndrome now qualify.

Dr Schlup, who is also a senior lecturer in medicine at the University of Otago, wishes the Government had been more forward-thinking, using a research-based approach rather than ruling out options because there were no overseas randomised controlled trials to support them.

It could have looked at several options for screening by trialling them in areas within New Zealand to find out which worked best.

This could have included three trials, one using occult faecal blood, another a one-off colonoscopy at the age of 50 or 55 and a third using CT colonography which is able to create a three-dimensional picture of the bowel (with follow-up colonoscopy if lesions were found).

One of the unknown aspects of the faecal occult blood screening programme is whether prospective participants, who will have to collect their faeces on three days and place samples of them on special cards, are willing to get involved.

Dr Schlup said his experience was that New Zealanders were most embarrassed about talking about anything to do with their bowels.