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Colorectal Cancer Screening Follow-up

Key findings

  • In 2017, over 22,000 Ontarians ages 50 to 74 had an abnormal fecal occult blood test (FOBT) result that required follow-up with colonoscopy. Of these people, 20% (or 4,440 Ontarians) did not have a colonoscopy within 6 months of their abnormal FOBT result.
  • This indicator has remained steady since 2014, when 23% had no follow-up within 6 months of their abnormal FOBT result.

Why is this important to Ontarians?

  • People with abnormal FOBT results are more likely to have colorectal cancer than average risk people who are referred directly to colonoscopy, or even people with certain gastrointestinal symptoms.
  • Timely follow-up with a colonoscopy after an abnormal FOBT result is important because it leads to faster diagnosis and treatment, as well as finding cancer when it is less advanced. 
  • Also, timely follow-up is important because people with abnormal FOBT results may be worried about a possible cancer diagnosis.

See Colorectal Cancer Screening Follow-up Methodology for technical information.


Report date: December 2018
Data source: Ontario Health Insurance Plan (OHIP) Claims History Database (CHDB), Lab Reporting Tool (LRT), Colonoscopy Interim Reporting Tool (CIRT), GI Endo Data Submission Portal (DSP), Ontario Cancer Registry (OCR), Ontario Registered Persons Database (RPDB), Postal Code Conversion File Plus (PCCF+ version 6D)
Prepared by: Analytics, Cancer Screening, Prevention and Cancer Control, Cancer Care Ontario

Data Table 1: Percentage of screen-eligible Ontarians with an abnormal fecal occult blood test (FOBT) result, ages 50 to 74, who did not undergo colonoscopy within 6 months, 2014 to 2017
Year Percentage (%)
2014 22.9
2015 21.7
2016 20.2
2017 19.7


Report date: December 2018
Data source: Ontario Health Insurance Plan (OHIP) Claims History Database (CHDB), Lab Reporting Tool (LRT), Colonoscopy Interim Reporting Tool (CIRT), GI Endo Data Submission Portal (DSP), Ontario Cancer Registry (OCR), Ontario Registered Persons Database (RPDB), Postal Code Conversion File Plus (PCCF+ version 6D)
Prepared by: Analytics, Cancer Screening, Prevention and Cancer Control, Cancer Care Ontario

Results

  • The percentage of abnormal fecal occult blood tests (FOBT) with no follow-up colonoscopy within 6 months has improved.
  • The percentage of Ontarians who had an abnormal FOBT with no follow-up improved, decreasing from 23% (n=4,594) in 2014 to 20% (n=4,440) in 2017.
  • Improvements in abnormal FOBT with no follow-up colonoscopy within 6 months vary by demographic factors.
  • Similar to previous years, in 2017 there was variation by age group in the percentage of people with an abnormal FOBT and no follow-up. This percentage was lowest (18%) in people ages 50 to 54 (the youngest age group) and highest (23%) in people ages 70 to 74 (the oldest age group).

Opportunities

  • With support from the Ontario Institute for Cancer Research, Cancer Care Ontario completed a pilot project to inform future strategies for improving follow-up of abnormal results.
    • Phase 1 was a qualitative study that evaluated the reasons why physicians and patients do not follow up.
    • Phase 2 was a study that explored the use of centralized navigation to improve overall follow-up and the timeliness of follow-up with colonoscopy in people with abnormal fecal occult blood testing (FOBT) results.
    • The learnings from a knowledge transfer and exchange session will support planning for the intake of results from this study.
  • Cancer Care Ontario continues to help primary care physicians identify people who require follow-up of abnormal FOBT results through the Screening Activity Report.
  • Cancer Care Ontario works closely with Regional Cancer Programs to monitor and improve colonoscopy wait times for people with an abnormal FOBT, and to make sure people with an abnormal test result have priority access to colonoscopy over people with non-urgent indications.