Health Care Professionals

ColonCancerCheck

Your Role - Frequently Asked Questions

Why screen for colorectal cancer?
Colorectal cancer screening can mean the difference between life and death. If detected early, colorectal cancer can be cured - and even prevented in some cases.

ColonCancerCheck funds screening for all average risk men and women, who are 50 years of age or older, every two years using the Fecal Occult Blood Test (FOBT). This test is the only colorectal cancer screening method that has been proven in randomized controlled trials to reduce mortality from colorectal cancer (Level A evidence). The Canadian Task Force on Preventive Health Care and the Ontario Expert Panel on Colorectal Cancer support the use of FOBT as directed by the ColonCancerCheck program.

What are the goals of the ColonCancerCheck program?
The program goals are to reduce mortality from colorectal cancer through an organized screening program and improve the capacity of primary care to participate in comprehensive colorectal cancer screening. Colorectal Cancer Check's goal is to increase screening from approximately 20 % to 55% within five years and to 65% within 10 years.

How is ColonCancerCheck using evidence to improve the quality of services?
In support of ColonCancerCheck, new evidence-based colonoscopy and FOBT quality standards were developed by an expert panel through Cancer Care Ontario's Program in Evidence-Based Care (PEBC). The comprehensiveness of these standards makes them the first of their kind in Canada. Their development and adoption will ensure consistent high quality delivery of ColonCancerCheck across the province by monitoring quality and ensuring those participating in the program meet quality standards.

ColonCancerCheck will be adopting the guidelines for colonoscopy surveillance intervals outlined in "Guidelines for Colonoscopy Surveillance After Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society" that were published in Gastroenterology in 2006. Further information about these standards is forthcoming.

Through the Colonoscopy Interim Reporting Tool (CIRT), specialists in participating hospitals will report completed colonoscopy procedures to the colorectal cancer screening program. Using this information, the program can improve the quality of services and measure the success of ColonCancerCheck.

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How is ColonCancerCheck supporting health care providers?
As part of ColonCancerCheck, clinical and patient counseling tools - including information bulletins, guidelines, decision aids and information for patients about screening, preparing for a screening test and completing the FOBT - are being developed for family physicians and other health care providers. Additionally, a multi-faceted Continuing Education program is being rolled out in partnership with the Ontario College of Family Physicians, the Ontario Pharmacists' Association, the Nurse Practitioners' Association of Ontario and the Registered Nurses' Association of Ontario.

How can individuals without a primary care provider (unattached) access screening?
Participants who don't have a family physician will be able to obtain an FOBT kit at pharmacies (or request one through Telehealth Ontario).

What is the Fecal Occult Blood Test (FOBT)?
The Fecal Occult Blood Test (FOBT) is a simple test used for colorectal cancer screening that is completed at home and requires the collection of three stool specimens. The test can detect invisible (occult) amounts of blood in the stool.

What would cause a false positive FOBT result?
The number one cause of a false positive result is hemorrhoids, but a false positive could also be caused by regular use of NSAIDs or occult bleeding from the upper GI.

Why is the FOBT test being used to screen those people considered to be at average risk?
FOBT is the only method of colorectal cancer screening that has been proven in randomized control trials to reduce mortality from colorectal cancer. The Canadian Task Force on Preventive Health Care, an independent panel funded through a partnership of the federal and provincial governments, made the following recommendation: "There is good evidence to include annual or biennial fecal occult blood testing (grade A recommendation) in the periodic health examination of asymptomatic people over 50 years of age." This recommendation is consistent with that of the Ontario Expert Panel on Colorectal Cancer.

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What test is recommended for people at increased risk?
Those who are at increased risk of colorectal cancer due to one or more first degree relatives (parent, sibling or child) with colorectal cancer should begin screening at age 50 or 10 years earlier than the age at which the relative was diagnosed. For these people colonoscopy is the recommended screening modality.

Are patients with +FOBT under the age of 50 part of ColonCancerCheck?
Patients under 50 years of age should only be referred as part of the program if they have a family history of colorectal cancer. For those at increased risk because of family history, screening using colonoscopy should begin at the age of 50 years, or 10 years earlier than the age of the relative's diagnosis, whichever comes first.

Other cases of patients under 50 with a positive FOBT such as those who completed an FOBT because they were symptomatic, or simply received a screening colonoscopy without family history are not supported by clinical evidence and are not part of the program and should follow the usual course of care.

If another test is proven to be more effective than the guaiac test (gFOBT), will the program replace the gFOBT test with a new test?
Other methods of screening are in development or being evaluated. The gFOBT will be the first test to be used in the program. Others will be considered as scientifically peer-reviewed evidence becomes available.

Why is the program using the guaiac test (gFOBT) rather then the Immunochemical test for (iFOBT)?
Based on the research and the experience of other jurisdictions, the provincial colorectal cancer screening program at this time is implementing the guaiac fecal occult blood test (gFOBT) test. As new evidence becomes available, other options will be considered.

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Should average risk participants who have had a positive FOBT followed by a normal colonoscopy be recalled for FOBT screening by the program?
At this time there is no evidence that individuals at average risk who have a positive FOBT followed by a normal colonoscopy should undergo subsequent screening using FOBT. Therefore, the program will not recall them for a repeat FOBT. Follow-up will be according to the recommendation of the endoscopist based on his/her clinical judgment. Note that current clinical guidelines recommend repeat colonoscopy at ten years for individuals at average risk whose colonoscopies are negative. The program will revisit this issue when more evidence becomes available.

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For More Information

For more information about ColonCancerCheck, call ServiceOntario INFOline at 1-866-410-5853.
Hours of operation : 8:30am - 5:00pm, Monday to Friday.
TTY 1-800-387-5559.
Email : ColonCancerCheck.moh@ontario.ca or
Visit : Cancer Care Ontario