Colorectal screening in Canada, 2023-24

Colonoscopy after abnormal fecal test

Recall recommendations after an individual receives an abnormal fecal test but a normal colonoscopy vary across Canadian jurisdictions. Individuals are recalled for FIT in three, five, or ten years, depending on if they are considered to have low or high-risk adenomas (benign tumours).

Screening recall after an abnormal fecal test

P/T Recall after negative (normal) colonoscopy result Recall for those with low or high-risk adenomas
YT
  • Recalled for FIT screening in 10 years or as recommended by an endoscopist
  • Participants with hyperplastic polyp(s) are recommended to return to screening with FIT in 10 years.
  • Participants with low-risk polyp(s) are recommended to return to screening with colonoscopy in five years.
  • Participants with high-risk polyp(s) are recommended to return to screening with colonoscopy in three years.
NT
  • If colonoscopy results are normal, guidelines recommend repeat colonoscopy in 5–10 years
NU
  • Recalled for FIT screening in 10 years
BC
  • Recalled for FIT screening in 10 years
  • Recommendations for those with a personal history of pre-cancerous lesions are described in the Guidelines and Protocols Advisory Committee (GPAC) guidelines.
  • Those with a strong family or personal history of adenomas but have no adenomas identified would be recalled for colonoscopy in five years.
AB*
  • Recalled for FIT screening in 10 years
  • Those with hyperplastic polyps <10mm are recommended for FIT screening in 10 years.
  • Those with 1–2 tubular adenomas <10mm are recommended for FIT screening in five years.
  • Those with 3–4 tubular adenomas <10mm are recommended for colonoscopy in five years.
  • Those with 1–2 sessile serrated lesions <10mm are recommended for colonoscopy in five years.
  • Those with 5–10 tubular adenomas <10mm, or any tubular adenoma ≥10mm in size, or with villous or high-grade dysplasia, are recommended for colonoscopy in three years.
  • Those with 3–10 sessile serrated lesions <10mm, or any sessile serrated lesion ≥10mm in size, or with dysplasia or traditional serrated adenoma, are recommended for colonoscopy in three years.
  • Those with more than 10 tubular adenomas are recommend for colonoscopy in one year and should consider genetic counselling.
SK
  • Recalled for FIT screening in five years
  • The colonoscopy report should make a recommendation for rescreening.
MB
  • Average-risk participants recalled for FIT in 10 years or as recommended by endoscopist
  • Increased risk, due to family history of colon cancer diagnosed at age 60 or greater (and appropriate for FIT), recalled for FIT in five years or as recommended by endoscopist
  • Those with low-risk adenoma(s) identified are recalled in five years for FIT.
  • Those with high-risk adenoma(s) identified are recalled in three years for colonoscopy.
  • Those with a significant family history of CRC diagnosed <60 years are recalled for colonoscopy in 5–10 years.
  • Surveillance of those with significant personal history is managed as per endoscopist’s recommendation.
ON
  • Recalled for FIT screening in 10 years
  • Those with hyperplastic polyp(s) in rectum or sigmoid should return to screening with FIT in 10 years.
  • Those with one or two low risk adenoma(s) are recommended to return to screening with FIT in five years.
  • Those with high-risk adenoma(s) are recommended to have a surveillance colonoscopy three years after the initial colonoscopy.
  • Those with >10 adenomas should undergo genetic assessment for familial adenomatous polyposis syndromes. The subsequent surveillance interval will depend on the results of the genetic assessment and whether the colon is cleared of polyps
QC
  • Recalled for FIT screening in 10 years
NB
  • Recalled for FIT screening in 10 years as per NB clinical practice guidelines
  • Follow up by endoscopist as per existing guidelines
NS
  • Recalled for FIT screening in five years
  • Participants with low-risk adenomas will resume FIT screening after approximately five years (skip two FIT cycles).
  • Participants with high-risk adenomas removed from FIT screening, recommended for surveillance colonoscopy in three years.
PE
  • Recalled for FIT screening in five years
  • No recall activities by program initiated for colonoscopies. PCP/participant coordinate to determine next procedures following Canadian Association of Gastroenterology (CAG) guidelines or recommendation in last colonoscopy report.
NL
  • Recalled for FIT screening in five years
  • Participants with low-risk adenoma(s) are recommended to return to screening with FIT in five years.

*AB: Updated guidelines for follow-up colonoscopy and post-polypectomy surveillance as of January 2023.

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