Colorectal screening in Canada, 2023-24

Follow-up for people with abnormal screening results

On this page:

Timely follow-up after an abnormal fecal test is optimized with an efficient referral process, which can be facilitated by a navigation system or screening program.

Colorectal screening programs will follow-up with an individual after they receive an abnormal (positive) fecal test result. Nine provinces send result letters, either to both primary care providers (PCP) and participants or just to the participant. Other jurisdictions contact PCP or participants through phone calls. PCPs are often responsible for coordinating follow up. Some jurisdictions have coordinated systems in which a program administrator, nurse navigator or patient coordinator contacts the participant to schedule a colonoscopy.

Receiving results for abnormal colorectal screening tests

P/T PCP responsible for contacting participants to provide results Participant receives phone call from health authority or program Participant receives phone call from a healthcare provider Participants advised to contact PCP for follow-up Results mailed to participants directly PCP receives results directly (e.g., via fax or online system) PCP receives a results letter
YT ✓ ✓ ✓
NT ✓
(opportunistic)		 ✓ ✓
NU ✓
BC ✓ ✓ ✓
AB ✓ ✓ ✓* ✓
SK ✓ ✓
(dependent on navigated services offered in the participant’s area)		 ✓
(excluding non-navigated abnormal opportunistic results)		 ✓ ✓
MB ✓ ✓ ✓
ON ✓ ✓
Participants without a PCP are asked to call Ontario Health (Cancer Care Ontario’s) Contact Centre. If the participant does not call the Contact Centre within 24 hours of receiving the result notification, they will follow-up with the participant through a phone call.		 ✓~ ✓** ✓ ✓
QC ✓
(opportunistic)		 ✓
(opportunistic)		 ✓
(program)‡		 ✓
NB ✓   ✓***
NS ✓ ✓ ✓ ✓
PE ✓ ✓
(when contact by navigation program is faster than mailing process, the positive result is delivered by phone)		 ✓ ✓
NL ✓ ✓
(patient sent registered letter if unable to reach after two weeks)		 ✓^^

*AB: Participants part of the FIT mail-out receive their abnormal results by registered mail.
~ON: The PCP who submitted the requisition contacts the participant. The physician overseeing the Hamilton Niagara Haldimand Brant Mobile Coach provides results directly to participant and manages follow up.
**ON: This recommendation is contained within the abnormal results letter.
‡QC: Once program is established.
***NB: Results are accessible through the provincial electronic health record (EHR).
^^NL: The NL colon screening program will contact clients with an abnormal screening result and arrange for necessary follow up.

Follow-up for people with abnormal colorectal screening test results

Provinces and territories have different follow-up methods after an abnormal colorectal screening test result. In five provinces and three territories, physicians coordinate referrals to colonoscopy. In some jurisdictions, physicians also coordinate informing patients of their appointments, or the screening program may coordinate follow-up with the participant directly.

Follow-up for abnormal colorectal screening test results

P/T Physician coordinates referral to colonoscopy Physician coordinates informing patient of appointment Pre-colonoscopy assessment completed Appointment mailed to participant Colonoscopy location contacts participant with appoint-ment time Program initiates referral to colono-scopy Program coordinates follow-up
YT ✓
(colonoscopy referrals can only be made by physician or NPs)		 ✓ ✓
NT ✓ (opportunistic) ✓ ✓*
NU ✓
(referrals can be made by physicians, NPs or CHNs)		 ✓
BC ✓
(health authority contacts participant)		 ✓ ✓
AB ✓ ✓ ✓ ✓^
SK ✓
(non-navigated)		 ✓
(non-navigated)		 ✓ ✓ ✓ (navigated) ✓ (navigated)
MB ✓ ✓ ✓ (depending on health region) ✓ ✓
ON ✓~ ✓** ✓** ✓**
QC ✓ (opportunistic) ✓ (opportunistic and program) ‡ ✓ ✓
(program)‡
NB ✓
(assessment completed by program)		 ✓ ✓ ✓
NS ✓ ✓ ✓
PE ✓
(Colorectal Diagnostic Navigation nurse directs suitable and agreeable participants to direct colonoscopy. Besides that, physicians coordinate their patients)		 ✓
(Colorectal Diagnostic Navigation nurse coordinates participants’ appointments)		 ✓
(Colorectal Diagnostic Navigation nurse initiates participants’ pre-colonoscopy assessments)		 ✓ ✓
(Colorectal Diagnostic Navigation for participating clients)		 ✓
(Colorectal Diagnostic Navigation for participating clients)
NL ✓ ✓ ✓ ✓ ✓

*NT: In regions where the organized screening program has been rolled out.
^AB: The follow-up care of the unattached FIT mail-out patient with an abnormal result is tracked by screening programs. The abnormal result letter clearly outlines next steps and provides a list of resources to help find a family doctor. If the client is unable to find a doctor the program will assist in follow-up care and refer to endoscopy if required.
~ON: Primary care provider (can include family doctors and nurse practitioners).
**ON: Individual endoscopists or endoscopy service will be responsible for informing patient of appointment, pre-colonoscopy assessment, or communication to patient on appointment details.
‡QC: Once program is established.

Description of follow-up processes for abnormal colorectal screening test results

P/T  Description of follow-up process 
YT  Healthcare providers and program receive FIT results directly from Whitehorse General Hospital lab through IS systems. Program follows up on all positive FIT results. PCP notifies the client of the results and refers for follow-up colonoscopy (a standardized colonoscopy referral form is available and is to be copied to program). Follow-up referral is monitored. Reminders to PCP to follow up on positive FIT results if copy of colonoscopy referral is not received by program.
NT  PCP receives abnormal lab result if they ordered the test. They are responsible for notifying the patient and completing the referral for colonoscopy.

Positive results for tests ordered by the screening program are reviewed by an RN at the program. The client is notified of the result and, with RN’s consent, is referred to an endoscopy program and the cancer navigation program.
NU  Abnormal result reviewed by PCP. Referral for colonoscopy dependent on nearest referral centre (in or out of territory). Requires out-of-community transportation, with the exception of Iqaluit.
BC  PCP receives abnormal lab result report, then the patient is sent a letter indicating that follow-up is required. The patient is referred to their health authority, who will contact them to complete pre-colonoscopy assessment and book the patient for colonoscopy or advise PCP that the patient is not proceeding.
AB  Letter is sent to patient from provincial program advising them to see MD. MD refers to zone-based screening program or directly to endoscopist. MD has access to FIT test results on Netcare system (lab reporting system).
SK  In navigated areas, PCPs sign medical directives authorizing nurse navigation to colonoscopy. Screening Program for Colorectal Cancer (SPCRC) nurse navigators phone participants to discuss test results, refer participants to colonoscopy, and complete standardized assessments. Client navigation is not yet offered provincially; 43% of participants were assessed and booked by nurse navigators (Mar–Sept 2022). In non-navigated areas, physicians are responsible for providing follow-up care.
MB  ColonCheck’s follow-up clerk contacts participant by phone (followed by result letter) regarding the abnormal result and follow-up referral process (colonoscopy brochure included in letter). A pre-colonoscopy assessment is scheduled and completed by ColonCheck’s nurse practitioner for all patients referred to colonoscopy.

Following the pre-colonoscopy assessment, a referral is processed following the provincial endoscopy referral processes. The healthcare provider is advised of the referral.

Following the procedure, the program receives copies of the colonoscopy and pathology (if applicable) report so that outcomes can be determined. If eligible, the participant will be recalled for a FIT as per the endoscopist recommendation and screening guidelines.
ON  For attached participants (those with a PCP), the PCP responsible for communicating abnormal FIT result to participant and referring for timely follow-up with colonoscopy. Ontario Health (Cancer Care Ontario) also mails FIT result letters to participants.

For unattached participants (those without PCP or received FIT through mobile coach), Ontario Health (Cancer Care Ontario) mails abnormal result letter directing participant to call Ontario Health (Cancer Care Ontario)’s contact centre for assistance. If the participant does not call the Ontario Health (Cancer Care Ontario) Contact Centre within 24 hours of receiving the result notification, they will follow up with the participant through a phone call.

The Ontario Health (Cancer Care Ontario) Contact Centre maintains a list of providers (physician or nurse practitioner) who have agreed to support unattached people who are at increased risk for colorectal cancer or have an abnormal fecal immunochemical test result (i.e., FIT+). Participants are connected to a provider from this list based on their postal code. If a provider cannot be identified from the provider list, then regional leads and/or regional cancer programs are engaged for support.
QC  Opportunistic: The person who performs the colonoscopy and PCP responsible for contacting participants with results.

Program: Colonoscopist responsible for contacting participants with results and managing diagnostic clinical follow-up if required. Screening program will manage diagnostic follow-up regarding future screening.
NB  The lab sends a letter to PCPs as notification of all FIT results. All participants with positive FIT results are called by the program nurse to discuss next steps (pre-colonoscopy assessment, colonoscopy and consult with endoscopist if required). A letter is sent if unable to reach the participant by phone.
NS  Screening nurse will contact the participant with an abnormal result to conduct a pre-colonoscopy assessment. After the assessment is completed, the individual is booked for colonoscopy with a physician credentialed by the screening program.
PE  Colorectal Cancer Screening Program sends letter of abnormal result to the patient, notifying that the Colorectal Diagnostic Navigation nurse will call them. The navigation team supports the patient by providing telephone assessments, bowel prep and procedure information, and scheduling them for their recommended colonoscopy. The navigation team will be responsible for assessing and booking the patient for a colonoscopy. The navigation team will notify PCPs if they schedule a patient for colonoscopy, if the patient declines the navigation service, or if they are not suitable for navigation.
NL  Once an abnormal test result is sent to the screening program, nurse coordinators contact the patient and inform them of the test result. The nurse will conduct a telephone health assessment and refer the patient to the endoscopy unit closest to their home for a colonoscopy. The nurse coordinators will send a package of materials to the patient and provide information and education on bowel preparation.
Previous: Fecal testing
Next: Increased and high risk