Colorectal screening in Canada, 2023-24

Innovations in colorectal screening

On this page:

The COVID-19 pandemic required jurisdictions to rethink how cancer screening services can be designed in a way that is responsive and resilient to future interruptions, demonstrates equitable access to screening services, and complies with health and safety measures. The Partnership made funding available in 2021 to support jurisdictions’ response to the pandemic through the Accelerating Innovations to Build Resilience in Cancer Screening during COVID-19 initiative. Four provinces and two territories participated in this initiative. These projects optimized existing programs and facilitated accelerated uptake of evidence-based innovation, thereby increasing resiliency of screening services through removing barriers to screening and improving access to colonoscopy services, particularly among underscreened populations.

Many jurisdictions continue to develop innovative solutions to ongoing challenges.

Results of the Accelerating innovations to build resilience in cancer screening during COVID-19 initiative

Yukon

The project supports purchasing colonoscopy equipment to improve procedure efficiency and quality, including improved infection control measures. Objectives include ensuring Yukon Hospital maximizes use of resources to better position themselves for current and subsequent waves of COVID-19 while improving sustainable CRC screening services and outcomes. The work is focused on ensuring that residents of Yukon, a jurisdiction with a large rural, remote, and First Nations population, have high quality and timely access to colonoscopy services.

Northwest Territories

The Northwest Territories project is focused on creating a proper database to facilitate ongoing Territorial Screening Programs for breast, colorectal, and cervical cancer. A functional database will allow a shift away from opportunistic testing towards inclusion methods that will more reliably serve under-screened populations, and experience less disruptions in local healthcare provision like those that have resulted from COVID-19.

Alberta

The FIT Mail-Out initiative aims to increase access to FIT kits via an alternate distribution process. A grant-funded project through the Canadian Partnership Against Cancer, it gives eligible Albertans the option to order a FIT kit online or over the phone. The kit is then mailed directly to the client’s home, effectively removing two visits to healthcare facilities: a healthcare provider for a requisition, and a lab for the kit itself.

Manitoba

ColonCheck participated in the Accelerating Innovations to Build Resilience in Cancer Screening during the COVID-19 initiative for CRC screening. Manitoba’s project provided a second CRC screening participation opportunity, inviting close to 15,000 residents due for screening. An FOBT was sent to specifically targeted individuals based on geography (low screening participation rates) and screening status (never screened or most overdue for screening), as well as to underserved populations that are unlikely to seek healthcare services during COVID-19 slow-down periods. Individuals who completed an FOBT through this project were incorporated into ColonCheck operations and integrated into the routine screening invitation cycle. Manitoba was pleased to see a participation rate that closely resembled program participation rate achieved during standard program recruitment strategies.

Quebec

This project’s objectives include validating the colonoscopy referral form, since a preliminary assessment no longer reflects current practice, including the current widespread use of FIT screening. It also aims to confirm that the nature and respective proportion of lesions discovered in a colonoscopy have not been affected by a change in patient characteristics during pre- and post-pandemic induced slowdown (e.g., when older patients at higher risk of colorectal cancer are not showing up for their colonoscopy for fear of contracting SARS-CoV-2 in a hospital setting). Quebec is also assessing the clinical benefits of increased yield and better wait time assignments via the colonoscopy referral form by allowing patients to select multiple indications (e.g., change in stool habits and rectal bleeding rather than only one or the other). An additional biological test that measures natural killer cell activity (NKViewTM) is being assessed to help further stratify patients with a positive FIT in assigning an adapted shorter wait-time for colonoscopies.

Prince Edward Island

The reinstatement of CRC screening during COVID-19 involved less in-person contact. This project aims to improve access and increase uptake in CRC screening. The Colorectal Cancer Screening Program implemented a direct-mail FIT kit, updated information materials, enhanced the program database with tracking and monitoring mailed FIT kits, and reviewed current data to include clients overdue for FIT screening since the pandemic. Internal office processes were reviewed and communicated to assemble kits, mail them to clients, and accept them in the centralized lab. This resulted in reduced traffic in health centres by unplanned visitors dropping off or requesting a FIT kit when restrictions were in place. During the pandemic, the supply chain was fragile. Receiving a kit in the mail and self-sampling at home were appreciated by participants.

The COVID-19 pandemic had a profound impact on health services across the country, including reducing or pausing cancer screening. Throughout the COVID-19 pandemic, and as screening programs resumed, many jurisdictions developed innovative tools and updated their processes to better serve the community.

Innovations in colorectal screening programs

Yukon

The biggest change to the program was the addition of telephone consults. This has decreased the abnormal FIT result to colonoscopy timeline.

Northwest Territories

The roll out of the new screening program had to be adjusted to avoid in-person gatherings. Community meal events planned as part of the program launch were replaced with radio ads, newspaper ads, etc.

Manitoba

ColonCheck CancerCare Manitoba partnered with Manitoba Health to expedite the transition to FIT (from gFOBT) to address the growing endoscopy waitlist caused by COVID-19. The initiative intended to decrease the number of patients waiting for a colonoscopy by diverting a specific eligible population (average risk, moderate increased risk, surveillance of low-risk adenomas) to FIT.

Ontario

In spring 2020, Ontario’s Ministry of Health paused all non-essential health services (e.g., cancer screening). This resulted in a pause in FIT kit mailing and some colorectal screening correspondence letters. A gradual approach was taken to resuming healthcare services (kit mailing resumed in summer 2020 and colorectal correspondence campaigns in winter 2020). Ontario Health (Cancer Care Ontario) continues to monitor screening trends and provide support to Regional Cancer Programs (RCPs) as needed.

Multiple tools that were developed include:

A media kit with materials (e.g., key messages, phone call scripts, program fact sheet, etc.) was also developed to support regional public awareness campaigns.

Since then, there have been no major changes to the ColonCancerCheck program in response to COVID-19.

Quebec

Implementing a funding system for endoscopy units improved volume and reduced wait times. This funding now includes an additional amount for colonoscopy overproduction to reduce the waiting lists that have increased during COVID-19. This program established the pairing of health institutions according to their proximity, wait times for colonoscopy, and capacity. When a balance is reached between supply and demand in colonoscopy in health institutions, the pairing and management of colonoscopy cases from partner institutions is mandatory. A call for tenders in endoscopy to promote access to clinics from the private sector helped to administer colonoscopy exams.

Nova Scotia

Nova Scotia Health’s Central Zone, the largest and most populous of the four management zones, has seen a complete change in how endoscopy is scheduled, with considerable effort to determine utilization of endoscopy time. When endoscopy services resumed in late May 2020 after a 12-week suspension, there were 800 people on the Central Zone FIT-positive wait list and estimated wait times of six to eight months. FIT-positive colonoscopy was prioritized. At the time of this report, two thirds of FIT-positive colonoscopies in the Central Zone have been completed within the target time-frame of eight weeks with a median wait time of six weeks.

The change has enabled Nova Scotia to re-envision how the program can be organized to support colon cancer screening more broadly. COVID-19 has provided an opportunity to have conversations about how Nova Scotia can maximize the existing infrastructure to do a better job ensuring all residents have access to appropriate screening.

Prince Edward Island

Before the direct-mail FIT kit project, people could only access drop-off locations at specific healthcare facilities. The pandemic resulted in restricted access to healthcare facilities. Rules were implemented, such as calling ahead before entering, meeting at the door restrictions, and not entering if symptomatic. If the participants were allowed to enter, they had to wear medical masks and undergo COVID-19 screening questions. The pandemic showed that providing service at drop-off locations was a weak point in the system.

The direct-mail initiative made it much easier for participants to receive and return the FIT kit. Participants mailed the kit to the central lab and did not need to go to a healthcare facility to drop the kit off. The direct-mail kit helped the healthcare system manage staff resources and protect staff and patients from potential contamination of COVID-19 infection carried by visitors. It also saved participants from in-person contact and potential COVID-19 contamination at healthcare facilities.

Newfoundland and Labrador

The Newfoundland and Labrador Colon Screening Program was well positioned to continue service through much of the COVID-19 pandemic as the program utilized the postal service to deliver and receive test kits. Additionally, FIT-positive colonoscopies received priority once follow-up service delivery could continue.

Jurisdictions are committed to continuous improvement of CRC screening programs. The priority work in each jurisdiction is presented below.

Priority work in colorectal screening

P/T Priority work in colorectal screening
YT
  • Currently mailing out FIT kits directly to clients in the community.
  • Changing FIT machine to a Polymedco (aligns with BC). Should the machine break down, YT will send samples to BC for processing.
  • Newer technology is supporting screening data collection and capacity planning.
  • In partnership with the Yukon First Nations Cancer Care Project Manager, the community is lobbying for approval from the government to use community-specific data (identify local variations and systemic barriers to screening).
  • Program Manager is on the First Nations Cancer Care committee, which is improving First Nations cancer outcomes in Yukon by jointly developing and meeting the following objectives:
    1. Ensuring equitable access to cancer screening in Yukon
    2. Increasing Yukon First Nations awareness of and participation in cancer screening
    3. Providing access to culturally safe, trauma-informed cancer screening in Yukon
  • Initiating work to update/review program screening standards and performance measures.
NT
  • Increasing demand from both the provider and community.
  • Reducing barriers to accessing CRC screening throughout the territory through various strategies.
  • After engaging key stakeholders and trialing a program that mailed FIT kits to residents in 2020, follow-up interviews were conducted with a selection of residents who chose to participate in a screening, and those who did not. Based on feedback received, the program has:
    1. Adapted promotional materials to be available in appropriate Indigenous languages
    2. Updated kit instructions to be more pictograph-based
    3. Expanded direct mailing of kits to the remainder of the territory
NU –
BC –
AB
  • The AHS Alberta Colorectal Cancer Screening Program’s (ACRCSP) recommendation for follow-up after colonoscopy and post polypectomy has been updated following a review of new evidence. Notably, low-risk polyps do not require aggressive surveillance, a practice that is consistent with other jurisdictions in Canada and internationally.
  • With financial support from Alberta Health, ACRCSP is developing interactive, web-based, pre-procedural education videos for patients who are referred for colonoscopy. This new initiative will help to standardize pre-procedural education and colonoscopy care across Alberta. These new resources were launched in Fall 2023.*
  • Increasing CRC screening participation has been identified as a key priority and collaborative efforts will be directed towards:
    1. Expanding the FIT mail-out program
    2. Scalability of FIT distribution through primary care locations
SK
  • Currently expanding navigation services provincially, allowing the Screening Program for Colorectal Cancer (SPCRC) to navigate abnormal results from a programmatic FIT to colonoscopy, 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.
  • Preparing to align screening and surveillance guidelines with the revisions anticipated from the Canadian Association of Gastroenterology. Additional key priorities include expanding the Direct Observation of Skills Procedural Program and exploring reducing the age of initiation for colorectal cancer screening.
  • Program promotional materials are being revised and updated, including content revision, increased visual representation among equity-deserving populations, and making translated promotional materials accessible on the program website.
  • SPCRC is a partner in the Provincial Endoscopy Committee. Work includes strategic planning for the province’s endoscopy services in the key areas of access, quality, and timeliness.
MB
  • Transitioned to FIT June 2023. All colorectal cancer screening activities (distribution, result management, and referrals) are centralized under CancerCare Manitoba, ColonCheck program. With this practice change, new guidelines, resources, and instructions were developed, and education sessions were offered.*
ON
  • The 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.
  • Ontario Health (Cancer Care Ontario) together with the Sioux Lookout First Nations Health Authority, Indigenous Services Canada, LifeLabs and the Ontario Ministry of Health, launched an initiative in 2023 to deliver a tailored FIT kit distribution model to Sioux Lookout and Area (area in Northwestern Ontario comprised of First Nations communities and the Municipality of Sioux Lookout). The goals of this initiative are to:
    1. improve access to colorectal cancer screening with FIT in 28 Sioux Lookout and Area communities and the Municipality of Sioux Lookout
    2. support improvements in colorectal cancer screening participation in these communities
    3. inform the implementation of similar strategies in other populations
QC
  • Developing an IT solution with strong interoperability that is powerful enough to support all aspects of an organized screening program (in progress).
  • Implementing a synoptic colonoscopy report that is standardized for the whole province, allowing for better quality assurance, evaluation, and improvement of the program (in progress).
  • Access to CRC screening was increased for 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 and thus extending access to people without PCP.
NB
  • Planning a review of the Colon Cancer Screening Program clinical practice guidelines in mid-late 2023. The latest review was completed in summer 2021.
NS
  • The Colon Cancer Prevention Program (CCPP) recently launched a project that builds on the success of the Partnership-funded FIT Plus Program: Better Care, Better Outcomes.
    • Lacking a coordinated approach to referral management, triage, and application of guidelines (only one third of CRC screening in Nova Scotia is done within the CCPP Quality Assurance framework and evaluated for appropriateness).
  • Planning to scale up existing CCPP infrastructure so all CRC screening is administered within a unified quality assurance program.
  • Goals include:
    1. 100% appropriateness of screening modality — FIT or colonoscopy
    2. 80% of FIT positive colonoscopies within the target timeframe
    3. 50% of polyp surveillance colonoscopies within the target timeframe
  • In collaboration with other cancer screening programs, the CCPP is targeting outreach to Mi’kmaq First Nations, Nova Scotians of African Descent, and Nova Scotia’s new immigrant population to ensure equitable access to culturally safe cancer screening.
PE
  • Moved to a one-sample collection FIT kit in April 2023 and updated screening guidelines in March 2023.
  • Health PEI implemented the Colorectal Diagnostic Navigation Pilot Program. The overall objectives are:
    1. FIT+ program participants receive a colonoscopy within the national target of 60 days
    2. A program-coordinated approach to follow-up colonoscopies
    3. Endoscopists support the clinical standards, documentation requirements, and surveillance guidelines
  • Patients are satisfied with the diagnostic navigation program experience
NL
  • The Partnership-funded project helped the NL Colon Screening Program to develop new promotional materials for social media awareness and provided an opportunity to renew and form new communities throughout the province. These new partnerships have helped make access to cancer screening a priority among many primary healthcare and community partners.

*AB, MB: Updated March 2024.
-No information was provided at the time data were collected.

Previous: Summary
Next: Fecal testing