| Short description of Indicator |
Percentage of Ontario screen-eligible individuals, 50 to 74 years old, who were overdue for colorectal screening |
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| Rationale for measurement |
Regular screening using fecal occult blood tests (FOBT) can reduce colorectal cancer mortality by detecting cancer earlier when treatment is more likely to be successful.[1] [2] [3] [4]. Screening can also lower the incidence of colorectal cancer (through the detection of polyps that can be removed before they become cancerous).[5]
The European Guidelines for Quality Assurance in Colorectal Cancer Screening recommend overdue for screening as a more appropriate measure of screening participation than FOBT participation when there has been opportunistic screening with colonoscopy prior to the introduction of an organized colorectal cancer screening program.[6] |
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| Evidence/references for rationale |
- Hewitson P, Glasziou P, Watson E, Towler B, Irwig l. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult): an update. Am J Gastroenterol. 2008;103(6):1541–9.
- Mandel JS, Church TR, Ederer F, Bond JH. Colorectal cancer mortality: Effectiveness of biennial screening for fecal occult blood. J National Cancer Inst. 1999 Mar 3;91(5):434–7.
- Ontario Health Technology Advisory Committee. OHTAC recommendation: screening methods for early detection of colorectal cancers and polyps [Internet]. Toronto: The Committee; 2009 [cited 2015 Dec 1]. Available from: http://www.hqontario.ca/Evidence/Publications-and-OHTAC-Recommendations/Ontario-Health-Technology-Assessment-Series/Screening-Methods-for-Early-Detection-of-Colorectal-Cancers-and-Polyps
- Jorgensen OD, Kronborg O, Fenger C. A randomised study of screening for colorectal cancer using faecal occult blood testing: Results after 13 years and seven biennial screening rounds. Gut. 2002 Jan;50(1):29–32.
- Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med. 2000;343(22):1603-7.
- Moss S, Ancelle-Park, R, Brenner H. Evaluation and interpretation of screening outcomes. In: Segnan N, Patnick J and von Karsa L, editors. European Guidelines for quality assurance in colorectal cancer screening and diagnosis: First edition. Luxembourg: Publications Office of the European Union; 2010. p. 72–102.
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| Calculations for the indicator |
(Total number of Ontario screen-eligible individuals, 50–74 years old, who were overdue for colorectal screening by the end of the calendar year / Total number of Ontario screen-eligible individuals, 50–74 years old) X 100 |
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| Standardized Rate Calculation |
The 2011 Canadian population |
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| Unit |
Percentage (%) |
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| Data sources |
- OHIP CHDB (Claims History Database) – Colectomy claims, non-CCC and CCC FOBT, colonoscopy, flexible sigmoidoscopy
- CIRT (Colonoscopy Interim Reporting Tool) – CCC program colonoscopy records
- GI Endo DSP (Gastrointestinal Endoscopy Data Submission Portal) – hospital colonoscopy records
- LRT (Laboratory Reporting Tool) – CCC FOBTs
- OCR (Ontario Cancer Registry) - Resolved invasive colorectal cancers
- RPDB (Registered Persons Database) – Demographics
- PCCF+, version 6D - Residence and socio-demographic info
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| Time Frame |
2014 - 2017 |
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| Geographic Scale |
Provincial (Ontario)
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| Denominator description |
Total number of Ontario screen-eligible individuals, 50 to 74 years old in each calendar year
- Ontario residents ages 50 to 74 at the index date
- Index date was defined as January 1 of a given year
Exclusions:
- Individuals with a missing or invalid HIN, date of birth, sex, postal code or LHIN
- Individuals with an invasive colorectal cancer prior to January 1 of the calendar year of interest; 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 prior to January 1 of the calendar year
- Total colectomy was defined in OHIP by fee codes S169A, S170A, S172A
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| Numerator description |
Total number of Ontario screen-eligible individuals, 50 to 74 years old, who were overdue for colorectal screening by the end of the calendar year
- Individuals were considered overdue for colorectal screening if they:
- did not have an FOBT within the last 2 years (January 1 of the previous year to December 31 of the calendar year of interest) AND
- did not have a colonoscopy in the last 10 years (January 1, 9 years prior to the calendar year of interest to December 31 of the calendar year of interest) AND
- did not have a flexible sigmoidoscopy in the last 10 years (January 1, 9 years prior to the calendar year of interest to December 31 of the calendar year of interest)
For example: at the end of 2014, an individual would be considered overdue for colorectal screening if he or she did not have an FOBT test in 2013-2014, or flexible sigmoidoscopy in 2005-2014, or a colonoscopy in 2005-2014
- Identifying FOBTs:
Program CCC FOBT was identified in LRT or OHIP:
- L179A ColonCancerCheck Fecal Occult Blood Testing
Non-program FOBT was identified using fee codes in OHIP:
- L181A Lab Med - Biochem - Occult Blood
- Colonoscopies were identified using fee code Z555A, Z491A- Z499A in OHIP, in CIRT or in GI Endo DSP
- Flexible sigmoidoscopies were identified using fee code Z580A in OHIP
- Multiple claims with the same Health Insurance Number (HIN) and service date were assumed for a single procedure
- Each individual was counted once regardless of the number of tests performed
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| Considerations |
N/A |
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| Data availability & limitations |
- Historical RPDB address information is incomplete; therefore, the most recent primary address was selected for reporting, even for historical study periods
- FOBTs in hospital labs could not be captured
- A small proportion of FOBTs performed as diagnostic tests could not be excluded from the analysis
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