ColonCheck (FIT) for Healthcare Providers

Effective April 19, 2022: Implementation of colonoscopy waitlist reduction project and new fecal occult blood test (FOBT) requisition form.

Reducing Colonoscopy Waitlist Project

In support of reducing the endoscopy waitlist, ColonCheck CancerCare Manitoba will be distributing fecal immunochemical tests (FIT) to consenting eligible patients currently on the elective colonoscopy waitlist. This includes patients at average risk and selected patients at increased risk due to family history or surveillance of prior low-risk adenomas. This project provides an interim option for FIT until the transition from gFOBT to full FIT implementation has occurred.

Fecal Occult Blood Test Requisition

Healthcare Providers can access FOBTs for their patients using the FOBT requisition form. ColonCheck CancerCare Manitoba will supply the appropriate test kit based on the following criteria:

  • Guaiac FOBT (gFOBT) for average risk colorectal cancer screening for patients age 50 years and older
  • FIT for selected low increased risk colorectal cancer screening as an alternative to colonoscopy
  • FIT for low risk adenoma surveillance as an alternative to colonoscopy

The following information is intended for healthcare providers whose patients are eligible for a fecal immunochemical test (FIT) for colorectal cancer (CRC) screening or surveillance:

Criteria

Provided to Endoscopy Waitlist Clients

Provided from Fecal Test Requisition Order Form

Average risk screening

  • Asymptomatic with no additional risk factors for CRC including personal or family history.
  • Includes individuals with one or more second degree relatives with CRC.
FIT gFOBT*

Low-increased risk screening

  • One or more first degree relatives diagnosed with advanced adenomas at any age, or
  • One first degree relative diagnosed with CRC at age 60 or greater.
FIT FIT

Surveillance of low risk adenomas

  • Previous finding 1-2 tubular adenomas, each less than 1 centimetre and with no high-grade dysplasia.
FIT FIT

*This is an interim recommendation until full FIT implementation. Once full implementation occurs, it will be recommended that a FIT test be used for average risk screening.

If your patient does not meet the criteria for FIT, they will continue to receive gFOBT for average risk screening. FIT is being released earlier for select individuals to support the current endoscopy waitlist for appropriate individuals (link project announcement).

Related Documents

The FIT is an accurate screening test with increased sensitivity for CRC and advanced adenoma (cancer precursor) detection compared to the guaiac FOBT. The FIT is a quantitative test that is specific for human hemoglobin in the stool, and generally detects blood loss from colonic sources only. Unlike the guaiac FOBT, a FIT result is not affected by dietary factors or vitamin C. 

A positive FIT result indicates that the measured hemoglobin in the sample is at or above a pre-determined threshold for positivity. Its use for average risk and some low increased risk screening, in addition to low risk adenoma surveillance, is supported by Canadian and international guidelines published by professional societies and CRC screening programs.

Potential Benefits

  • Routine FIT screening can reduce CRC mortality and CRC incidence in the population.
  • FIT can find CRC at an earlier stage, when patients have more treatment options.
  • FIT is easy to use, requires only one stool sample, and has no dietary or medication restrictions. These factors have resulted in increased patient compliance with routine screening compared to gFOBT.
  • FIT is the recommended test for average risk screening and can replace colonoscopy in circumstances where the risk of CRC is only slightly increased.
  • FIT may be preferable to colonoscopy because
    • Patients are more likely to participate in routine colorectal cancer screening due to ease of use, and non-invasive approach.
    • Patients are able to be screened for colorectal cancer in a timely fashion.
    • Patients can avoid the risks of colonoscopy in most cases.
    • FIT can replace low-yield colonoscopy for some indications.
    • FIT testing will reduce the demand for colonoscopy and allow colonoscopy resources to be prioritized to those who can benefit most.

Potential Harms

  • False positive or false negative FIT results, can lead to unnecessary colonoscopy or missed cancers respectively.
  • False reassurance with a negative test.
  • Interval cancers (cancers occurring between FIT tests).
  • Patient distress.
  • Complications due to follow-up colonoscopy required if the FIT is positive. This includes adverse reaction to sedative, bleeding from the biopsy site, and perforation of the colon or rectum.

You can expect one of three results from a FIT kit:

Negative (measured blood was below the threshold for positivity):

ColonCheck will:

  • Send you and your patient a letter with the result.
  • Remind the patient to be screened again in two years if they are still eligible.

Positive (measured blood was at or above the threshold for positivity):

ColonCheck will:

  • Contact the patient by phone to discuss their result.
  • Do a pre-procedure assessment and refer the patient for a colonoscopy.
  • Send you and your patient a letter with their result.

Indeterminate (the lab was unable to produce a result):

ColonCheck will:

  • send the patient another FIT kit in the mail.

It is not recommended that another FIT test be performed after a positive result. Colonic bleeding may be intermittent and a repeat test with a negative result does not rule out significant colonic pathology. A positive result requires further investigation with colonoscopy.

People who have an abnormal FIT result will be referred to colonoscopy for follow-up.

Bowel Prep (PDF)

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Colonoscopy (PDF)

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French

 

Encourage your patients to talk to you if they have these signs and symptoms, even if their recent FIT result was negative:

  • Blood in stool,
  • Abdominal discomfort that lasts more than a few weeks,
  • Change in bowel habits (e.g. diarrhea or constipation that last more than a few weeks,
  • Exhaustion or weight loss that they cannot explain.

If your patient has CRC symptoms, refer them for semi-urgent colonoscopy.

Contact

ColonCheck@cancercare.mb.ca

P: 1-855-95-CHECK (1-855-952-4325)

F: 204-774-0341