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Colorectal Cancer Screening Participation

Key findings

  • Of the more than 4 million eligible Ontarians ages 50 to 74, approximately 38% (1.6 million) were overdue for colorectal (bowel) cancer screening (i.e., they needed to get screened) in 2017. These people had not completed a recent fecal occult blood test (FOBT), nor had they had a flexible sigmoidoscopy or colonoscopy for either screening or diagnostic reasons.
  • The percentage of Ontarians overdue for screening has decreased (i.e., improved) annually since 2008, when the ColonCancerCheck program began. At that time, 50% of the screen-eligible population was overdue for screening.

Why is this important for Ontarians?

  • Getting screened for colorectal cancer reduces the chance of dying from colorectal cancer and may prevent colorectal cancer.

See Colorectal Cancer Screening Participation 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
Notes:

  • Individuals are considered “overdue” if they have not had an FOBT in 2 years, colonoscopy in 10 years, or flexible sigmoidoscopy in 10 years.
  • Rates are adjusted for age.
Data Table 1: Age-adjusted percentage of Ontarians, ages 50 to 74, who were overdue for colorectal cancer screening, 2014 to 2017
Year Percentage (%)
2014 39.9
2015 38.7
2016 38.1
2017 37.5

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
Notes:

  • Individuals are considered “overdue” if they have not had an FOBT in 2 years, colonoscopy in 10 years, or flexible sigmoidoscopy in 10 years.
  • Rates are adjusted for age.

Results

  • The percentage of people overdue for colorectal cancer screening (fecal occult blood testing, flexible sigmoidoscopy or colonoscopy) has improved.
  • The percentage of people overdue for colorectal cancer screening is the percentage of eligible Ontarians who have not been screened by the end of the calendar year. This measure takes into account all colorectal tests that were available at the time for colorectal cancer screening, including fecal occult blood testing (FOBT), flexible sigmoidoscopy and colonoscopy. It excludes people who have completed an FOBT within the past 2 years, or have had a flexible sigmoidoscopy or colonoscopy within the past 10 years (for screening or other reasons).
  • In 2017, approximately 38%, or 1.6 million Ontarians were overdue for colorectal cancer screening (i.e., they needed to get screened).
  • From 2014 through 2017, the percentage of Ontarians overdue for colorectal cancer screening decreased from 40% (n= 1,596,221) to 38% (n= 1,613,306). This trend has been observed since 2008, when the ColonCancerCheck program began. At that time, 50% of Ontarians were overdue for screening (data not shown).
  • The percentage of people overdue for colorectal cancer screening (FOBT, flexible sigmoidoscopy or colonoscopy) varies by demographic factors.
  • Similar to previous years, in 2017, the percentage of people overdue for colorectal cancer screening in Ontario decreased (improved) with increasing age. The percentage was lowest in the older age groups (ages 65 to 74) at 29%, and highest in the youngest age group (ages 50 to 54) at 48%.
  • More men were overdue for colorectal cancer screening than women. In 2017, 40% of screen-eligible men were overdue for colorectal cancer screening compared with 35% of screen-eligible women.

Comparisons

Getting comparable data and measures from other jurisdictions is a challenge. Be aware of the different data definitions, methodologies and years used in indicators measured outside of Ontario. Jurisdictional comparison may still be useful to provide a rough indication of how well Ontario is doing relative to other provinces and countries.

Manitoba

In 2017, 38% of screen-eligible Ontarians were overdue for colorectal cancer screening. In Manitoba, 50% of screen-eligible adults were overdue for colorectal cancer screening for the 24-month period of 2011 to 2012. Manitoba has seen improvement in participation since 2010, when 55% were overdue for colorectal cancer screening. Based on previous trends, it is expected that Manitoba has improved further since the 2011 to 2012 report.[1]

Be careful when comparing Manitoba’s participation with Ontario’s because of these reporting differences:

  • Reporting periods: 2017 in Ontario versus 2011 to 2012 in Manitoba.
  • Screening recommendations: Manitoba’s measure includes colonoscopy and flexible sigmoidoscopy within the last 5 years (and FOBT in the last 2 years), while Ontario’s includes colonoscopy and flexible sigmoidoscopy in the last 10 years (and FOBT in the last 2 years). Ontario uses this screening interval for flexible sigmoidoscopy to align with the recommendations of the Canadian Task Force on Preventive Health Care.

Australia

In Australia, 59% of screen-eligible adults were overdue for colorectal cancer screening for the 24-month period of 2016 to 2017. Australia had seen improvement in participation since 2012 to 2013, when 64% were overdue for colorectal cancer screening.[2]

Be careful when comparing Australia’s participation with Ontario’s because of these reporting differences:

  • Screening recommendations: While Australia’s measure includes FOBT every 2 years, Ontario’s rate includes FOBT every 2 years, and flexible sigmoidoscopy or colonoscopy within the last 10 years. Ontario uses this screening interval for flexible sigmoidoscopy to align with the recommendations of the Canadian Task Force on Preventive Health Care.

For more information on comparisons of colorectal cancer screening participation among jurisdictions, see the screening graphs at Comparisons.

Opportunities

  • In June 2019, Cancer Care Ontario transitioned from the fecal occult blood test (FOBT) to the fecal immunochemical test (FIT) as the recommended screening test for people at average risk of developing colorectal cancer. FIT is more user-friendly, and better at detecting colorectal cancer and some pre-cancerous polyps (growths in the colon or rectum that can turn into cancer over time).[3] [4] It has also been shown to increase colorectal cancer screening participation.[5]
  • To support the launch of FIT, Cancer Care Ontario worked closely with Regional Cancer Programs to educate the primary care and endoscopy medical communities on the benefits and impacts of screening with FIT. Cancer Care Ontario also provided the Regional Cancer Programs with public-facing promotional materials, including a correspondence insert, poster, pull-up banner and postcard to promote screening with FIT. In addition, Cancer Care Ontario developed media materials (e.g., provincial and regional news releases and social media posts) to support provincial and regional campaigns for the FIT launch.
  • As part of the transition to FIT, Cancer Care Ontario helps primary care providers promote screening participation through initiatives such as FIT continuing professional development, continued promotion of physician-linked correspondence, and a web page with supporting resources.
  • In 2019, Cancer Care Ontario implemented invitation letters with targeted messaging for men. The initiative was based on the findings of the organization’s randomized controlled trial showing that male-specific letters resulted in an increase in colorectal cancer screening participation in men.
  • Cancer Care Ontario continues to help primary care providers identify eligible people through the Screening Activity Report. This online tool gives primary care physicians who participate in a patient enrolment model the complete screening status of each of their enrolled age-eligible patients. The report includes those who are overdue or due for screening, and those who require follow-up. Cancer Care Ontario has also partnered with a rural First Nations community to improve its colorectal cancer screening rates by issuing a Screening Activity Report to primary care providers serving the community.

References

  1. CancerCare Manitoba. (n.d.). Colorectal Cancer Screening Report January 2011- December 2012. Winnipeg, MB: ColonCheck CancerCare Manitoba. 
  2. Australian Institute of Health and Welfare. (2019). National Bowel Cancer Screening Program: monitoring report 2019. Canberra: AIHW.
  3. Lee JK, Liles EG, Bent S, Levin TR, Corley DA. Accuracy of Fecal Immunochemical Tests for Colorectal Cancer: Systematic Review and Meta-analysis. Ann Intern Med. 2014; 160(3):171-181.
  4. Canadian Task Force on Preventive Health Care. Screening for Colorectal Cancer [Internet]. Ottawa, Canada: Canadian Task Force on Preventive Health Care; 2014 [cited 2019 June 26]. Available from: http://canadiantaskforce.ca/guidelines/published-guidelines/colorectal-cancer/
  5. Tinmouth J, Vella E, Baxter NN, Dubé C, Gould M, Hey A, et al. Colorectal cancer screening in average risk populations: evidence summary. Toronto: Cancer Care Ontario; 2015.