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Screening for Colorectal Cancer

Colorectal cancer screening increases the chance of finding cancer early and can improve treatment results. When colorectal cancer is caught early, 9 out of 10 people will be cured. If you have colorectal cancer and don’t get tested, you may miss the chance for early and more effective treatment.

Screening means testing someone who is not experiencing any symptoms. The best screening method for you depends on whether you are at average risk or increased risk of getting colorectal cancer.

When to Get Screened

Colorectal cancer can be impossible to see or feel. Screening is for people who don’t have any symptoms.

Your age and family medical history help determine when you get screened, and what screening options are best for you.

Screening Options
Your age  Your family history of colorectal cancer When to start screening Type of Screening How often to screen
50 to 74 No parent, sibling or child diagnosed at any age Age 50 Fecal occult blood test* Every 2 years
Any Parent, sibling or child diagnosed before age 60 Age 50, or 10 years earlier than the age at which your relative was diagnosed, whichever occurs first Colonoscopy Every 5 years
Any Parent, sibling or child diagnosed after age 60 Age 50, or 10 years earlier than the age at which your relative was diagnosed, whichever occurs first Colonoscopy Every 10 years

*Flexible sigmoidoscopy may be an option for some people. People ages 50 to 74 without a family history of colorectal cancer who choose to be screened with flexible sigmoidoscopy should be screened every 10 years.

You may hear about other colorectal cancer screening tests, but Ontario’s colorectal cancer screening program, ColonCancerCheck, does not recommend using them. There is not enough research showing that they are a good way to screen for colorectal cancer. These tests include:

  • metabolomic (blood or urine) tests
  • DNA (blood or poop) tests
  • computed tomography colonography
  • capsule colonography
  • double contrast barium enema

Types of Screening

Screening is the most reliable way of detecting colorectal cancer early. Most people ages 50 to 74 are at average risk of colorectal cancer, meaning they don’t have a first-degree relative (parent, sibling or child) with a history of colorectal cancer. It is recommended that people at average risk get screened with the fecal occult blood test every 2 years.

Fecal Occult Blood Test

A fecal occult blood test (the recommended colorectal cancer screening test for most people, also called an FOBT) is a safe and painless cancer screening test that checks a person’s stool (poop) for tiny drops of blood, which can be caused by colorectal cancer:

  • The test only takes a few minutes a day on 3 separate days to complete.
  • Once the samples are collected, they are sent to a lab for testing (using the postage-paid envelope provided in the kit or by returning the kit to a specimen collection centre).
  • At the lab, a technician uses special equipment to test the stool samples for blood.
  • If blood is found, the test result is abnormal and follow-up is needed. Although most people who have blood in their stool don’t have colorectal cancer, a follow-up test called a colonoscopy is required to find out if cancer is present.
  • If no blood is found in the stool, the test result is normal. People with a normal test should re-screen using the fecal occult blood test every 2 years.

If you completed a ColonCancerCheck fecal occult blood test, Cancer Care Ontario will send you a letter with your test result. Your family doctor or nurse practitioner will also receive a copy of your test result. Download a test result letter sample.

Flexible Sigmoidoscopy

Flexible sigmoidoscopy is a colorectal cancer screening procedure that looks at the lining of the rectum and sigmoid colon (lower third of the colon). During the procedure, a doctor or a registered nurse endoscopist can also take biopsies (samples of tissue) or remove polyps. You do not need sedation (medication that helps you relax or sleep) for a flexible sigmoidoscopy.

In Ontario, a doctor can do the procedure or, in some regions, a specially-trained registered nurse can do the procedure under the medical direction of a doctor as part of the Registered Nurse Flexible Sigmoidoscopy Program.

Who is eligible for flexible sigmoidoscopy?

You are eligible for colorectal cancer screening at a registered nurse flexible sigmoidoscopy site if you meet the following requirements:

  • You are between the ages of 50 to 74.
  • You are at average risk of colorectal cancer:
    • No first-degree relative diagnosed with the disease (parent, sibling or child)
    • No personal history of pre-cancerous colorectal polyps requiring surveillance or inflammatory bowel disease (i.e., Crohn’s disease or ulcerative colitis)
  • You don’t have any symptoms.
  • You are due for colorectal cancer screening:
    • No FOBT in the past 2 years, flexible sigmoidoscopy in the past 10 years or colonoscopy in the past 10 years

A referral from your family doctor or nurse practitioner is needed to have a flexible sigmoidoscopy.

If you have questions about whether this procedure is right for you, please speak to your family doctor or nurse practitioner for more information.

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, the doctor can also take biopsies (samples of tissue) or remove abnormal growths.

People who have symptoms, abnormal results from a fecal occult blood test or a family history of colorectal cancer may need a colonoscopy. It’s recommended that you have a colonoscopy within 8 weeks of your abnormal fecal occult blood test result.

A colonoscopy usually lasts half an hour, and you can receive medication (a sedative) to make you comfortable. Many people will not require another colonoscopy and will be able to screen again with a fecal occult blood test in 10 years. A few people may need to repeat the colonoscopy every 5 or 10 years, depending on their medical history.

To learn more about what happens during a colonoscopy or what to do after receiving an abnormal fecal occult blood test result, see the Abnormal FOBT Result FAQs.

 

 

Where to Get Screened

Fecal Occult Blood Test

A fecal occult blood test (FOBT) is a test you can do at home. To get your free test kit, talk with your doctor or nurse practitioner. If you don’t have a doctor or nurse practitioner, you can get a kit by contacting Telehealth Ontario at 1-866-797-0000.

Men and women in the North West and Hamilton, Niagara, Haldimand Brant regions may be able to get a test kit from one of our mobile screening coaches.

Flexible Sigmoidoscopy

A flexible sigmoidoscopy is a procedure done by a doctor within a healthcare setting. In some regions across Ontario, a registered nurse endoscopist may also be able to do the screening procedure.

If you live in a region with a registered nurse flexible sigmoidoscopy site and are eligible for screening using a flexible sigmoidoscopy, your doctor can give you a referral for the procedure. If you don't live in a region that offers this screening method, your doctor or nurse practitioner can refer you to the closest registered nurse flexible sigmoidoscopy site or to any endoscopist for flexible sigmoidoscopy, or discuss other screening tests with you.

Colonoscopy

A colonoscopy is a procedure done by a doctor within a healthcare setting. Normally, it’s your family doctor or nurse practitioner who will refer you for the test. If you think you may be at an increased risk for colorectal cancer, be sure to speak with your family doctor or nurse practitioner.

Depending on where you live in Ontario – a city centre or a rural area – your access to healthcare centres that perform colonoscopies will be different. Your family doctor or nurse practitioner will try to make sure your test location is as convenient as possible.

ColonCancerCheck Program

ColonCancerCheck is Ontario’s province-wide, organized screening program designed to encourage screening participation and reduce deaths from colorectal cancer. The program provides many important benefits:

  • Invites people to participate in screening
  • Reminds program participants when it is time for their next screening test
  • Notifies participants of their screening results
  • Tracks program participants throughout the screening process
  • Evaluates program quality and performance

 

Screening Letters Sent to the Public

Cancer Care Ontario sends letters through ColonCancerCheck to men and women ages 50 to 74 who have never been screened before or who are due for screening to invite them to visit their family doctor or nurse practitioner to discuss colorectal cancer screening.

Letters Men and Women May Receive

  • Invitation
  • Invitation reminder
  • Normal result letter
  • Abnormal result letter
  • Abnormal result reminder
  • Indeterminate result letter
  • Indeterminate result reminder
  • Rejected result letter
  • Rejected result reminder
  •  Recall letter
  • Recall reminder

A sample of each letter type is available in the Letters to the Public area.

Resources for the Public

Fact Sheets from ColonCancerCheck

An online version is also available: Abnormal FOBT Result FAQs

Helpful Websites

Resources for Newcomers and Immigrants

When you arrive in a new place, it’s important to keep your health at its best. Part of that may include getting screened for colorectal cancer. Find out if you should be screened and how to make an appointment with a family doctor or nurse practitioner: