Colorectal cancer (CRC), a malignancy of the large intestine, is the third most common cancer among Filipinos.

More than 17,000 Filipinos were estimated by Globocan to have been diagnosed with cancer in the colon or rectum in 2020. Around 10,000 persons were also estimated to have died from the disease last year, despite it being one of the most treatable and preventable cancers. CRC is a preventable disease, as screening can prevent this cancer through the removal of precancerous lesions via a procedure called a colonoscopy. Thus, it can reduce death through early detection and treatment of cancer.

The fight against colon cancer has been a very challenging battle in the Philippines. There is no national population-based CRC screening program in the country. The plans on prevention and early detection initiatives for CRC by the Department of Health (DOH) under the National Integrated Cancer Control Act (Nicca) has yet to be formulated and was further halted by the COVID-19 pandemic.

The pandemic has severely challenged the provision of routine health care, including screening of CRC. What is alarming is that this interruption has resulted in a delayed diagnosis of colon cancer, possibly in a more advanced stage.

Screening and prevention of cancer

As the lead advocate of the CRC screening campaign of The Medical City, I recently initiated a forum in collaboration with Kaiser Permanente (KP), an American integrated health-care consortium and the largest nonprofit health-care plan.

The webinar was titled “Colorectal Cancer Screening: Best Practices and Challenges of a Cancer Screening during the Pandemic and Beyond.”

KP’s cancer screening programs are probably America’s best, if not one of the world’s best programs. Its quality of care has been highly rated around the world, and this is attributed to its strong emphasis on preventive care.

Their best practices on CRC screening was the subject of the lecture of Dr. Theodore Robert Levin, the clinical lead for CRC screening at KP Northern California. It was timely as the implementation of Nicca aims to expand the health benefits of Filipinos to include screening and prevention of cancer.

According to Levin, KP Northern California implemented an organized CRC screening, consisting of a direct-to-patient annual mailed fecal immunochemical test (FIT) outreach to eligible patients in a large community-based population in 2006. Opportunistic colonoscopy was allowed as a screening option by request.

Levin published their results in 2018 and demonstrated that the implementation of such program rapidly increased the participation of patients and the up-to-date status of screening from 38.9 percent in 2000 to 82.7 percent in 2015 (as compared to 66 percent nationally in the United States).

The higher rates of screening were associated with a 25.5-percent reduction in annual colorectal cancer incidence from 2000 to 2015, and a 52.4-percent reduction in cancer mortality.

During the pandemic in America, KP’s program was stopped for three months, but they were able to rapidly resume the FIT outreach due to numerous employed strategies. The FIT outreach is particularly relevant due to limitations in access to colonoscopy and population fears of in-person visits because of COVID-19.

P620-M budget

Dr. Eric Tayag of the DOH talked about “Recalibrating Nicca Amidst the COVID-19 Pandemic.”

Filipino patients have developed increasing mortality and morbidity, worsening mental health status, a big decrease in provider visits, and declining health services coverage, he said. The good news is that the government has budgeted a total of P620 million for Nicca and cancer assistance fund.

Tayag recommended complementing the care given at cancer centers with telemedicine during the pandemic.

Gastroenterologists and other physicians should promote the option of using FIT as a screening option among our patients. Filipino patients are still worried about the potential risks of transmission during endoscopic procedures, and their dwindling financial resources.

The FIT test may be used to stratify patients as to who needs the colonoscopy more urgently than others, given the limited health resources of our country. When the DOH plans a population-based screening program in the future, this can result in diagnosing cancers in the earlier stages when these can be effectively treated and lead to an eventual decrease in mortality.

When asked what would be his advice to Philippine health policy makers on starting a CRC screening program, Levin said “to start small based on your resources, use the FIT, build from there, and prove your concept.”

We can hope that once this pandemic is over, screening measures to prevent CRC in the country can be finally realized. —CONTRIBUTED INQ

The author is a Philippine and American board-certified gastroenterologist and lead advocate for CRC screening of The Medical City.