ColonCheck (FIT) for Healthcare Providers

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.

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.