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Screening for Colorectal Cancer

The fecal immunochemical test (FIT) is a screening test for people at average risk of getting colorectal cancer. FIT is now used instead of the guaiac fecal occult blood test (gFOBT), which used to be Ontario’s colorectal cancer screening test. As of December 24, 2019, labs in Ontario will no longer test ColonCancerCheck gFOBT kits.

See Where to Get Screened to learn more.

Cancer screening is testing done on people who are at risk of getting cancer, but who have no symptoms and generally feel fine.

Colorectal cancer screening increases the chance of finding cancer early when it is easier to treat. When colorectal cancer is caught early, 9 out of 10 people can be cured. If you have colorectal cancer and do not get screened, you may miss the chance for early and more effective treatment.

The kind of screening test you get depends on whether you are at average risk of getting colorectal cancer or at increased risk of getting colorectal cancer.

Someone is at average risk if they are 50 to 74 years old with no first-degree relative (parent, brother, sister or child) who has been diagnosed with colorectal cancer.

Someone is at increased risk if they have a family history of colorectal cancer that includes 1 or more first-degree relatives (parent, brother, sister or child) with the disease.

When to Get Screened

Cancer screening is testing done on people who are at risk of getting cancer, but who have no symptoms and generally feel fine.

Your age and family history help your doctor or nurse practitioner figure out when you should get screened for colorectal cancer and what screening test is 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, brother, sister or child diagnosed with colorectal cancer at any age (average risk) Age 50 Fecal immunochemical test (FIT)* Every 2 years
Any Parent, brother, sister or child diagnosed with colorectal cancer before age 60 (increased risk) Age 50, or 10 years earlier than the age your relative was diagnosed with colorectal cancer, whichever comes first Colonoscopy Every 5 years
Any Parent, brother, sister or child diagnosed with colorectal cancer after age 60 (increased risk) Age 50, or 10 years earlier than the age your relative was diagnosed with colorectal cancer, whichever comes first Colonoscopy Every 10 years

*Flexible sigmoidoscopy may be an option for some people at average risk. People who choose to be screened with flexible sigmoidoscopy should be screened every 10 years.

Types of Screening

Screening is the best way of finding colorectal cancer early. Most people ages 50 to 74 are at average risk of getting colorectal cancer, meaning they do not have a first-degree relative (parent, brother, sister or child) who has been diagnosed with colorectal cancer. It is recommended that people at average risk get screened with the fecal immunochemical test (FIT) every 2 years.

Fecal Immunochemical Test  

A fecal immunochemical test (the recommended colorectal cancer screening test for most people, also called FIT) is a safe and painless at-home cancer screening test. FIT checks someone’s stool (poop) for tiny drops of blood, which could be caused by colorectal cancer or some pre-cancerous polyps (growths in the colon or rectum that can turn into cancer over time).

The fecal immunochemical test
The fecal immunochemical test, also called FIT. This illustration is not to scale.

 

Here is what you need to know about FIT:

  • The test only takes a few minutes to do.
  • You only need to collect 1 sample.
  • You can eat and take your medications (including vitamin C and blood thinners) as usual.
  • Once you collect your sample, mail it to LifeLabs using the postage-paid envelope included in your FIT package or drop it off to a LifeLabs Patient Service Centre within 2 days so that it can be tested at the lab within 14 days. See the Location Finder to find a LifeLabs Patient Service Centre near you.
  • Cancer Care Ontario will mail you a letter with your test result. Your family doctor or nurse practitioner will also get a copy of your test result from LifeLabs. Download a test result letter.
  • If your test result is abnormal, it does not necessarily mean that you have colorectal cancer or polyps that could become cancer, but it does mean that additional testing is needed. ColonCancerCheck recommends that people with an abnormal result have a colonoscopy within 8 weeks. For more information on abnormal test results and colonoscopy see the Abnormal FIT Result Frequently Asked Questions  page.
  • If your test result is normal, you should get screened in 2 years using FIT. It is important to keep getting screened with FIT every 2 years until age 74.  
  • If LifeLabs cannot get a result from your test, you will need to repeat it.

For information on how to do a FIT, see the FIT Instructions page.

Flexible Sigmoidoscopy

Flexible sigmoidoscopy is a colorectal cancer screening test. During the test, a doctor or registered nurse endoscopist uses a small, flexible tube to look inside the rectum and sigmoid colon (lower part of the colon). They can also take biopsies (tissue samples) or remove polyps (small growths that form on the lining of the colon or rectum). You do not need sedation (medication that helps you relax or sleep) or to change your diet for a flexible sigmoidoscopy.

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

Who qualifies for flexible sigmoidoscopy?

You qualify for colorectal cancer screening at a registered nurse flexible sigmoidoscopy site if:

  • you are ages 50 to 74.
  • you are at average risk of getting colorectal cancer:
    • You do not have a first-degree relative (parent, brother, sister or child) diagnosed with the disease.
    • You do not have a personal history of polyps that could become cancer (called pre-cancerous polyps) which requires future follow-up.
    • You do not have inflammatory bowel disease involving the colon (i.e., Crohn’s disease involving the colon or ulcerative colitis).
  • if you do not have any symptoms that could be linked to colorectal cancer.
  • if you are due for colorectal cancer screening, which means you have not had a FIT in the past 2 years, flexible sigmoidoscopy in the past 10 years or colonoscopy in the past 10 years.

Your family doctor or nurse practitioner has to order a flexible sigmoidoscopy for you. You cannot arrange to get the test on your own.

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

Colonoscopy

A colonoscopy is a test that allows a doctor to look at the entire 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 polyps that can become cancer over time (called pre-cancerous polyps).

A colonoscopy is not recommended to screen people who are at average risk of getting colorectal cancer. However, colonoscopy is recommended to screen people who are at increased risk of getting the disease. Colonoscopy can also be used to test people who have symptoms such as rectal bleeding or diarrhea.

It is very important that people with an abnormal FIT result have a colonoscopy within 8 weeks.

To learn more about what happens during a colonoscopy or what to do after getting an abnormal FIT result, see the Abnormal FIT Result Frequently Asked Questions page.

Tests not recommended for screening

ColonCancerCheck no longer recommends screening with the guaiac fecal occult blood test (gFOBT), which is now replaced by FIT. FIT is a better test and is easier to use.

The following tests are not recommended for average risk and increased risk screening because there is not enough research showing that they are a good way to check for colorectal cancer:

  • Metabolomic (blood or urine) tests
  • DNA (blood or poop) tests
  • Computed tomography colonography (a test that takes images of the inside of the colon by X-ray)
  • Double contrast barium enema (an older test that takes images of the inside of the colon by X-ray)
  • Capsule colonography (a small disposable capsule that takes pictures of the colon after being swallowed)

 

Where to Get Screened

Fecal Immunochemical Test

The fecal immunochemical test (FIT) is an at-home screening test. To get your free FIT, talk with your family doctor or nurse practitioner. If you do not have a family doctor or nurse practitioner, you can get a FIT by calling Telehealth Ontario at 1-866-828-9213. Men and women in the North West region or the Hamilton, Niagara, Haldimand Brant regions, may be able to get a FIT through one of our mobile screening coaches. If you live on a First Nation reserve, contact your health centre or nursing station for more information.

Once a FIT has been ordered for you, LifeLabs will mail a FIT package to your Ontario mailing address of choice. For more information on how to do your FIT, see the FIT Instructions page.

If you have any problems with your FIT package, call LifeLabs at 1-833-676-1426.

Flexible Sigmoidoscopy

A flexible sigmoidoscopy is a test done by a specialist or, in some regions across Ontario, a registered nurse endoscopist.  

If you live in or close to a region that offers registered nurse flexible sigmoidoscopy (RNFS) and qualify for the test, your family doctor or nurse practitioner can send you for flexible sigmoidoscopy. Your doctor or nurse practitioner can also send you to a specialist (called an “endoscopist”) for flexible sigmoidoscopy.

Colonoscopy

A colonoscopy is a test done by a specialist at a hospital or clinic. Your family doctor or nurse practitioner will send you for the test. If you think you may be at increased risk of getting colorectal cancer, be sure to speak with your family doctor or nurse practitioner.

ColonCancerCheck Program

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

  • Invites people to get screened
  • Reminds program participants when it is time for their next screening test
  • Lets participants know of their screening results
  • Tells participants to talk to their family doctor or nurse practitioner if they have an abnormal test result
  • Tracks program participants as they get screened
  • Tracks 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. These letters invite them to talk to their family doctor or nurse practitioner about colorectal cancer screening.

Letters You May Get

  • Invitation letter
  • Invitation reminder letter
  • Normal result letter
  • Abnormal result letter
  • Abnormal result reminder letter
  • Unsatisfactory result letter
  • Unsatisfactory result reminder letter
  • Recall letter
  • Recall reminder letter

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

Resources for the Public