Technical Information

​Percentage of Ontario screen-eligible individuals with an abnormal FOBT result, 50-74 years old, who underwent colonoscopy within six months of the abnormal screen date

Figures 1 and 2

In order to realize the mortality reduction expected from colorectal cancer screening, participants with abnormal screening results must receive timely and appropriate follow-up. (1) Cancer Care Ontario recommends timely colonoscopy after an abnormal FOBT to assess whether or not cancer is present. During colonoscopy, any pre-cancerous polyps can be identified and removed.¹

The proportion of individuals who receive a colonoscopy within six months of an abnormal FOBT is a measure of program coverage. This indicator also measures the success of the ColonCancerCheck screening program in encouraging and facilitating follow-up after an abnormal FOBT result.²

1. Cancer Care Ontario. ColonCancerCheck 2010 program report. Toronto (ON): Cancer Care Ontario; 2012.
2. Canadian Partnership Against Cancer. Colorectal Cancer Screening in Canada: Program Performance Results Report, January 2009– December 2011. Toronto (ON): Canadian Partnership Against Cancer; 2013.

(Total number of Ontario screen-eligible individuals, 50-74 years old, with an abnormal CCC program FOBT result, who underwent colonoscopy within six months of the abnormal FOBT result/ Total number of Ontario screen-eligible individuals, 50-74 years old, with an abnormal CCC program FOBT result in a given year) x100= Abnormal follow-up rate

N/A

Percentage (%)

• LRT (Laboratory Reporting Tool) – CCC FOBTs
• OHIP’s CHDB (Claims History Database) – colonoscopy claims
• CIRT (Colonoscopy Interim Reporting Tool) – CCC program colonoscopy records
• OCR (Ontario Cancer Registry) - resolved invasive colorectal cancers
• RPDB (Registered Persons Database) – demographics
• PCCF+, version 6C - residence and socio-demographic info

2012-2015

• Provincial (Ontario)
• LHIN of residence

Total number of Ontario screen-eligible individuals, 50-74 years old, with an abnormal CCC program FOBT result in a given year

• Individuals, aged 50–74 at the index date, who had an abnormal program FOBT result in LRT
• Index date was defined as the first abnormal screen date per person by kit receipt date in LRT in each calendar year
• FOBTs were identified by CCC program FOBT records in LRT
• Abnormal FOBT results were defined as at least one abnormal flap out of three flaps
• Each individual was counted once regardless of the number of tests performed
• LHIN assignment was determined using PCCF+, version 6C; residential postal code was used to identify LHIN and individuals with unknown/missing LHINs were excluded from the analysis

Exclusions:

• Individuals with a missing or invalid HIN, date of birth, sex or postal code
• Individuals with an invasive colorectal cancer before the index date; prior diagnosis of colorectal cancer was defined as: ICD-O-3 codes C18.0, C18.2-C18.9, C19.9, C20.9, a morphology indicative of colorectal cancer, microscopically confirmed with a path report

Individuals with a total colectomy before the index date; total colectomy was defined in OHIP by fee codes S169A, S170A, and S172A

Total number of Ontario screen-eligible individuals, 50–74 years old, with an abnormal program FOBT result in a given calendar year, who underwent colonoscopy within six months of the abnormal FOBT result

• Individuals with an abnormal program FOBT result who had a colonoscopy within six months of the abnormal FOBT result; colonoscopy was defined as a record in CIRT or in OHIP by the fee codes Z555A, Z491A- Z499A

If an individual had multiple abnormal FOBT results in a given calendar year, the six-month follow-up period started from the first abnormal FOBT result date

​Only CCC program FOBT data are included in the calculation

• Historical RPDB address information is incomplete; therefore, the most recent primary address was selected for reporting, even for historical study periods
• Number of persons who completed a CCC program FOBT kit is available in LRT as of April 1, 2008

Percentage of Ontario screen-eligible individuals with an abnormal FOBT result, 50-74 years old, who underwent colonoscopy within eight weeks of the abnormal screen date

Figures 3 and 4

In order to realize the mortality reduction expected from colorectal cancer screening, participants with abnormal screening results must receive timely and appropriate follow-up. (1) Cancer Care Ontario recommends timely colonoscopy after an abnormal FOBT to assess whether or not cancer is present.¹

The proportion of individuals who receive a colonoscopy within eight weeks of an abnormal FOBT is a measure of timeliness. Wait times for colonoscopies are influenced by system-level, patient and provider factors.² Cancer Care Ontario has adopted an eight-week benchmark based on the Canadian Association of Gastroenterology (CAG) consensus, which recommends that a follow-up colonoscopy should be completed within two months of an abnormal FOBT.³

1. Cancer Care Ontario. ColonCancerCheck 2010 program report. Toronto, Ontario: Cancer Care Ontario; 2012.
2. Canadian Partnership Against Cancer. Colorectal Cancer Screening in Canada: Program Performance Results Report, January 2009– December 2011. Toronto (ON): Canadian Partnership Against Cancer; 2013.
3. Paterson GP, Depew WT, Paré P, Petrunia D, Switzer C, Veldhuyzen van Zanten SJ, et al. Canadian consensus on medically acceptable wait times for digestive health care. Can J Gastroenterol. 2006 Jun;20(6):411–23.

(Number of Ontario screen-eligible individuals, 50–74 years old, with an abnormal CCC program FOBT result, who underwent colonoscopy within eight weeks of the abnormal FOBT result/ Total number of Ontario screen-eligible individuals, 50-74 years old, with an abnormal CCC program FOBT result in a given year) x 100 = Abnormal follow-up

N/A

​Percentage (%)

• LRT (Laboratory Reporting Tool) – CCC FOBTs
• OHIP’s CHDB (Claims History Database) – colonoscopy claims
• CIRT (Colonoscopy Interim Reporting Tool) – CCC program colonoscopy records
• OCR (Ontario Cancer Registry) - resolved invasive colorectal cancers
• RPDB (Registered Persons Database) – demographics
• PCCF+, version 6C - residence

2012-2015

• Provincial (Ontario)
• LHIN of residence​

Total number of Ontario screen-eligible individuals, 50-74 years old, with an abnormal CCC program FOBT result in a given year

• Individuals, aged 50–74 at the index date, who had an abnormal program FOBT result in LRT
• Index date was defined as the first abnormal screen date per person by kit receipt date in LRT in each calendar year
• FOBTs were identified by CCC program FOBT records in LRT
• Abnormal FOBT results were defined as at least one abnormal flap out of three flaps
• Each individual was counted once regardless of the number of tests performed
• LHIN assignment was determined using PCCF+, version 6C; residential postal code was used to identify LHIN and individuals with unknown/missing LHINs were excluded from the analysis

Exclusions:

• Individuals with a missing or invalid HIN, date of birth, sex or postal code
• Individuals with an invasive colorectal cancer before the index date; prior diagnosis of colorectal cancer was defined as: ICD-O-3 codes C18.0, C18.2-C18.9, C19.9, C20.9, a morphology indicative of colorectal cancer, microscopically confirmed with a path report

Individuals with a total colectomy before the index date; total colectomy was defined in OHIP by fee codes S169A, S170A, and S172A

Total number of Ontario screen-eligible individuals, 50–74 years old, with an abnormal program FOBT result in a given calendar year, who underwent colonoscopy within eight weeks of the abnormal FOBT result

• Individuals with an abnormal program FOBT result who had a colonoscopy within eight weeks of the abnormal FOBT result; colonoscopy was defined as a record in CIRT or in OHIP by the fee codes Z555A, Z491A- Z499A

If an individual had multiple abnormal FOBT results in a given calendar year, the eight weeks follow-up period started from the first abnormal FOBT result date

​Only CCC program FOBT data are included in the calculation

• Historical RPDB address information is incomplete; therefore, the most recent primary address was selected for reporting, even for historical study periods
• Number of persons who completed a CCC program FOBT kit is available in LRT as of April 1, 2008