• 2,500 women
    were determined to be at high risk for breast cancer by the High Risk Screening Program in Ontario in 2014
  • 84%
    of cancer patients saw a registered dietitian at a regional cancer centre within 14 days of referral in 2015
  • 72%
    of stage III colon cancer patients received chemotherapy within 60 days after surgery
  • 84%
    of all cancer surgery patients received their consult within the recommended wait time in 2015, and 88% received their surgery within the recommend wait time
  • 29%
    of patients with oropharynx cancer and 20% with cervical cancer visited the emergency department while undergoing a course of curative radiation therapy between 2012 and 2015
  • 44%
    of breast cancer patients, 48% of colon cancer patients and 62% of lymphoma patients visited the emergency department or were admitted to hospital at least once while receiving chemotherapy
  • About 25%
    of patients who undergo lung, prostate and colorectal surgery have an unplanned hospital visit following cancer surgery
  • 64%
    of cancer patients had a first consult with an outpatient palliative care team within 14 days of referral in 2015
  • 40%
    of cancer patients visited the emergency department in the last 2 weeks of life in 2012
  • 361,991
    unique patients were screened for symptom severity using ESAS in 2015, representing 60% of patients
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Colorectal Cancer Screening Quality and Efficiency

 
Measure Desired DirectionAs of this Report
Number of outpatient colonoscopies followed by hospital admissions for perforation within 7 days of colonoscopy per 1,000 colonoscopies Black Arrow DownGreen Arrow Down
Percentage of Ontario men and women, age 53 and over, who had a colonoscopy within 36 months of a normal and complete outpatient colonoscopyBlack Arrow DownGrey Arrow Level
See Methodology and Approach to find out how the ratings are calculated.

Key findings

The rate of perforation within 7 days of an outpatient diagnostic or therapeutic colonoscopy has declined annually since 2011. In 2014, the rate was 0.36 per 1,000 colonoscopies, compared to a rate of 0.43 per 1,000 colonoscopies in 2011. These rates are well below Cancer Care Ontario’s target of less than 1 perforation per 1,000 colonoscopies1.

In 2014, over 11,000 Ontarians 53 years of age and older had a colonoscopy within 36 months of an earlier outpatient colonoscopy that was normal and complete. These 11,000 colonoscopies represent 4% of the 265,000 outpatient colonoscopies performed in 2014.

What is a colonoscopy?

  • A colonoscopy is a procedure that allows a doctor to look at the lining of the rectum and colon using a long, flexible tube with a tiny camera on the end.
  • During a colonoscopy, any polyps (pre-cancerous lesions) will be removed and sent to pathology for analysis.
  • ColonCancerCheck (Ontario’s colorectal cancer screening program) recommends screening with colonoscopy for people who have a family history of colorectal cancer (i.e. a parent, sibling or child diagnosed with the disease), beginning at age 50, or 10 years earlier than the age at which their relative was diagnosed, whichever occurs first2. Colonoscopy also is used as a diagnostic test for people who have had an abnormal fecal occult blood test (FOBT) or symptoms of colorectal cancer, as well as for a number of other indications.
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What do the results show?

The number of colonoscopy-related bowel perforations in Ontario has declined (Figure 1).

  • The rate of patients admitted to hospital with perforation within 7 days of outpatient colonoscopy has declined annually since 2011, from 0.43 per 1,000 colonoscopies to 0.36 per 1,000 colonoscopies in 2014.
  • Ontario’s perforation rate is well under the target of less than 1 perforation per 1,000 colonoscopies.

A minority of Ontarians had a second colonoscopy within 36 months of a normal and complete outpatient colonoscopy, although there was notable regional variation (Figure 2).

  • In 2014, 4.3% of Ontarians had a second colonoscopy within 36 months of a normal and complete outpatient colonoscopy, compared to 4.4% in 2013.
  • There was some regional variation for this indicator. The Local Health Integration Networks (LHINs) with the highest percentages of colonoscopies within 36 months of a normal and complete outpatient colonoscopy in 2014 were Erie St. Clair, South East and North East (5.0% each).
  • The 2014 percentages for Erie St. Clair and North East were lower (indicating improvement) than their 2013 percentages (6.0% and 5.4%, respectively); however, the 2014 percentage for South East (5.0%) was higher than its 2013 percentage (4.5%).
  • The LHIN with the lowest percentage of colonoscopies within 36 months of a normal and complete outpatient colonoscopy was Waterloo Wellington (2.6%).

Colonoscopy within 36 months of a normal and complete outpatient colonoscopy varies by socio-demographic factor‡.

  • In 2014, the percentage of people having a colonoscopy within 36 months of a normal and complete outpatient colonoscopy varied by age group (Figure 3). Percentages were lowest in the youngest age groups (3.8% for ages 53 to 54, 55 to 59 and 60 to 64) and highest in the oldest age groups (4.5% for ages 65 to 69, 4.8% for ages 70 to 74, and 5.6% for ages 75 and older).
  • A greater percentage of women had a colonoscopy within 36 months of a normal and complete outpatient colonoscopy in 2014, compared to men (4.4% vs. 4.2%).
  • In 2014, a greater percentage of people living in the lowest income urban neighbourhoods had a colonoscopy within 36 months of a normal and complete outpatient colonoscopy (4.8%), compared to 3.8% of people living in the highest income urban neighbourhoods.
  • In 2014, a greater percentage of people living in neighbourhoods with the highest concentration of self-reported immigrant residents had a colonoscopy within 36 months of a normal and complete outpatient colonoscopy (4.8%), compared to people living in neighbourhoods with the lowest concentration of self-reported immigrant residents (4.2%).

‡Some data are not shown. Percentages by socio-demographic factor are available in the data tables (select the desired file type and click “Download”) and presented in the figures by age group.

Why is this important to Ontarians?

  • Ontario is performing well with respect to perforations (target of less than 1 perforation for 1,000 colonoscopies)1. Close monitoring is warranted, however, given the potentially serious risks associated with colonoscopy (perforations can lead to death in rare cases)3.
  • The proportion of colonoscopies within 3 years of a normal and complete outpatient colonoscopy is a new indicator that measures the appropriateness of colonoscopies and potential overuse. One potential reason for the overuse of colonoscopies is poor continuity of care.
  • It would be expected that a minority of people would have a repeat colonoscopy within 3 years of a normal and complete colonoscopy4.

Next steps

  • Minimizing harms to patients is an essential component of an organized screening program. Cancer Care Ontario will continue to monitor colonoscopy indicators, including perforation rates and repeat colonoscopies.

View Notes

  1. Tinmouth J, Kennedy E, Baron D, Burke M, Feinberg S, Gould M, et al. Guideline for colonoscopy quality assurance in Ontario. Toronto: Cancer Care Ontario; 2013.
  2. Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. How Ontarians participate in the program; 2015 July 16 [cited 2016 Mar 7]. Available from: https://cancercare.on.ca/pcs/screening/coloscreening/cccworks/cccparticipation
  3. Rabeneck L, Paszat LF, Hilsden RJ, Saskin R, Leddin D, Grunfeld E, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 2008; 135:1899–1906.
  4. Lieberman DA, Rex DK, Winawer SJ, Giardiello FM, Johnson DA, Levin TR. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology [Internet]. 2012 Sep [cited 2016 Mar 6]; 143(3):844–857. Available from: http://www.sciencedirect.com/science/article/pii/S0016508512008128.