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Colorectal Cancer Screening Follow-Up Methodology

Colorectal Cancer Screening Colonoscopy Abnormal Fecal Occult Blood Test (FOBT)
Short description of Indicator Percentage of Ontario screen-eligible individuals with an abnormal FOBT result who did not undergo colonoscopy within 6 months of the abnormal FOBT date
Rationale for measurement 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 do not receive colonoscopy within 6 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]
Evidence/references for rationale
  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.
Calculations for the indicator (Total number of Ontario screen-eligible individuals, 50–74 years old, with an abnormal ColonCancerCheck program FOBT result, who did not undergo colonoscopy within 6 months of the abnormal FOBT result / Total number of Ontario screen-eligible individuals, 50-74 years old, with an abnormal ColonCancerCheck program FOBT result in a given year) X 100
Standardized Rate Calculation N/A
Unit Percentage (%)
Data sources
  • LRT (Laboratory Reporting Tool) – ColonCancerCheck FOBTs
  • OHIP CHDB (Claims History Database) – Colonoscopy claims
  • CIRT (Colonoscopy Interim Reporting Tool) – ColonCancerCheck program colonoscopy records
  • GI Endoscopy DSP (Gastrointestinal Endoscopy Data Submission Portal) – hospital colonoscopy records
  • OCR (Ontario Cancer Registry) - Resolved invasive colorectal cancers
  • RPDB (Registered Persons Database) – Demographics
  • PCCF+, version 6D - Residence and socio-demographic info
Time Frame 2014 - 2017
Geographic Scale Provincial (Ontario)
Denominator description Total number of Ontario screen-eligible individuals, 50 to 74 years old, with an abnormal ColonCancerCheck program FOBT result in a given year
  • Individuals, ages 50 to 74 at the index date, who had an abnormal program FOBT result in LRT
  • Index date was defined as the first abnormal FOBT date per person by kit receipt date in LRT in each calendar year
  • FOBTs were identified by ColonCancerCheck program FOBT records in LRT
  • Abnormal FOBT results were defined as at least 1 positive flap out of 3 flaps
  • Each individual was counted once regardless of the number of tests performed
  • LHIN assignment was determined using PCCF+, version 6D; residential postal code was used to identify LHIN

Exclusions:

  • Individuals with a missing or invalid HIN, date of birth, sex, postal code or LHIN
  • 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
Numerator description Total number of Ontario screen-eligible individuals, 50 to 74 years old, with an abnormal program FOBT result in a given calendar year, who did not undergo colonoscopy within 6 months of the abnormal FOBT result
  • Individuals with an abnormal program FOBT result who did not have a colonoscopy within 6 months of the abnormal FOBT result
  • Colonoscopy was defined as a record in CIRT, GI Endo DSP or in OHIP by the fee codes Z555A, Z491A- Z499A
  • If an individual had multiple abnormal FOBT results in a given calendar year, the 6-month follow-up period started from the first abnormal FOBT result date
Considerations  Only ColonCancerCheck program FOBT data are included in the calculation​
Data availability & limitations
  • 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
CSQI Year 2019