Colorectal screening in Canada, 2023-24
About this section
Colorectal screening is available in all jurisdictions to individuals who are asymptomatic (no signs or symptoms of colorectal cancer present) and at average risk for colorectal cancer. This section describes colorectal screening programs, guidelines, and recruitment methods in provinces and territories across Canada. More information about programs who manage increased and high-risk participants can be found here.
All jurisdictions offer colorectal screening. There is variability in how each jurisdiction provides screening services, with some jurisdictions offering fully organized programs, while others screen opportunistically. Screening parameters, referral strategies, and promotional strategies, as well as integrated IT systems, are all elements of organized screening programs (WHO, IARC).
Colorectal screening programs in Canada
In the table below, screening programs defined themselves as “full programs” if they are organized programs, are available jurisdiction-wide and embed a culturally safe approach to care. A full organized program would also include elements such as eligibility criteria, quality assurance mechanisms, patient navigation, participant recall, diagnostic follow up, etc. Programs defined themselves as “partial” if they are organized programs that have rolled out in certain sites or for certain populations across the jurisdiction, are being phased-in over time by gradually increasing the capacity of screening sites, or are otherwise still working towards being a full program. Programs without confirmed sustainable funding that are in early planning phases are defined as “under development.”
| P/T | Program start date | Program status | Program name | Agency responsible for program administration |
|---|---|---|---|---|
| YT | 2017 | Full program, territory-wide | ColonCheck Yukon | Government of Yukon Health and Social Services |
| NT | 2020 | Full program, territory-wide | Colorectal Cancer Screening Program | Northwest Territories Health and Social Services Authority |
| NU | Under development | |||
| BC | 2013 | Full program, implemented in 4 out of the 5 BC Health Authorities* | Colon Screening Program | BC Cancer |
| AB | 2007 | Full program, province wide | Alberta Colorectal Cancer Screening Program (ACRCSP) | Alberta Health Services |
| SK | 2009 | Full program, province wide | Screening Program for Colorectal Cancer (SPCRC) | Saskatchewan Cancer Agency |
| MB | 2007 | Full program, province wide | ColonCheck | CancerCare Manitoba |
| ON | 2008 | Full program, province wide | ColonCancerCheck | Ontario Health (Cancer Care Ontario) |
| QC | N/A | Opportunistic CRC screening program started in 2013 for all eligible individuals with PCPs. Access will be increased to all individuals (with and without access to PCPs). Systematic and organized Program with invitations will be available in the following years (IT solution being developed). | Programme québécois de dépistage du cancer colorectal (Québec Colorectal Cancer Screening Program) | Ministère de la Santé et des Services sociaux (Ministry of Health and Social Services) |
| NB | 2014 | Full program, province wide | New Brunswick Colon Cancer Screening Program | New Brunswick Cancer Network (NB Department of Health) |
| NS | 2009 | Full program, province wide | Colon Cancer Prevention Program | Nova Scotia Health Cancer Care Program |
| PE | 2011 | Full program, province wide | Colorectal Cancer Screening Program | Health PEI |
| NL | 2012 | Full program, province wide | Newfoundland and Labrador Colon Screening Program | Cancer Care Program, Newfoundland and Labrador Health Services |
*BC: The colorectal screening program in BC is offered province-wide with the exception of The Northern Health Authority, which does not participate in the program.
Six jurisdictions are considering making changes or are in the process of making changes to their colorectal screening programs.
Saskatchewan
Saskatchewan is currently expanding navigation services. This project will extend navigation services provincially, allowing the program to navigate abnormal results from a programmatic FIT to colonoscopy (based on eligibility), regardless of geographic location across the province.
Concomitantly, a standardized framework is in development to guide all operational and quality improvement pieces of navigation. This includes metrics, equity considerations, and nursing best practice.
Manitoba
Manitoba has transitioned to FIT, centralizing all CRC screening activities including FIT distribution, communicating participant results, and management of follow-up investigation (referral for colonoscopy) in participants with an abnormal result, under the CancerCare Manitoba, ColonCheck program.
Ontario
Ontario’s ColonCancerCheck program is in the process of updating screening recommendations for people in Ontario at increased risk of developing colorectal cancer. The program convened an expert panel to review the available evidence and provide input on updating the program’s screening recommendations.
Quebec
Quebec is implementing a synoptic colonoscopy report that is standardized for the whole province. This will allow for better quality assurance, evaluation, and improvement of the program. Access to CRC screening was increased for all of Quebec’s eligible population. L’Institut national d’excellence en santé et en services sociaux (INESSS) published a national medical protocol with a model of collective prescription, allowing all nurses to initiate screening measures, thus extending access to people without PCP. Quebec is currently developing an IT solution with strong interoperability that is powerful enough to support all aspects of an organized screening program (in progress). Upon completion of the IT solution, all eligible individuals will receive their invitation to participate in the Colorectal Cancer Screening Program through invitation communications (lettermail or electronic).
New Brunswick
New Brunswick is in the process of reviewing clinical practice guidelines.
Nova Scotia
The Nova Scotia Colon Cancer Prevention Program (CCPP) has established a proven logistics, data management, and QA infrastructure. Nova Scotia will leverage the existing CCPP infrastructure to expand the coordination of CRC screening. In addition to automatically mailing the FIT kit to participants at age 50, Nova Scotia will be establishing a central clearinghouse and single referral pathway for patients who may be at increased risk and require colonoscopy screening. Individualized risk profiles based on age, family history, and prior colonic neoplasia will ensure the appropriate screening modality at appropriate intervals. Once a patient is engaged with the CCPP, no further referrals will be required. Nova Scotia’s vision is to provide all residents with colon cancer screening using the right test at the right time through individualized, risk-based patient pathways.
Prince Edward Island
Prince Edward Island is providing sample FIT kits to eligible residents starting in April 2023. Direct-mail kits include the option to mail the at-home sample kit back to the lab for testing. The Colorectal Diagnostic Navigation Pilot Program coordinates follow-up colonoscopies by facilitating referrals and providing individuals with education and support.