Access to tests

Colorectal screening tests can be accessed through different methods. Eight provinces and two territories mail the test kits to participants. Some jurisdictions mail the test kits automatically, while others mail only upon participant request. Some jurisdictions allow participants to access test kits through community hospitals and health centers, walk-in clinics, and/or labs.

Access to colorectal screening tests
Access to colorectal screening tests without a primary care provider
Returning the colorectal screening tests

Access to colorectal screening tests

P/T	Access to test	Kit is mailed: Automatically	Kit is mailed: Upon request	If kit is not mailed: Kit pick-up location	Requisition required
YT*	Kits are available at all community hospitals, community health centres, and programs.		✓ Phone, fax, or online		✓
NT	Kits can only be obtained from PCP (physician, nurse, or community health nurse).	FIT is mailed directly to residents where program is active.	✓^		✓
NU				From PCP	✓
BC	Kits are available at any lab in BC.			At lab	✓
AB	Requisition can be obtained at a walk-in clinic.		✓	At lab	✓
SK	Requisition can be obtained through health-care provider.	✓ FIT is mailed to all clients aged 50–74 with an active Saskatchewan health card.		At lab if requisitioned by a physician
MB	FIT distribution is centralized under CancerCare Manitoba, ColonCheck program. All Fit kits are accessed from the program, and available to eligible persons with or without a healthcare provider. Program automatically mails FIT kits to eligible individuals and can be requested by contacting ColonCheck.	✓ Program actively mails FIT kits to eligible persons starting at 50 years of age.Reminder letters are sent if not completed within 56 days. Eligible participants are automatically mailed FIT when they are due to return to screening.	✓ PCP and eligible persons can request a kit be mailed to a home address.	At the ColonCheck program
ON	Participants can access a FIT kit through their PCP (family physician or nurse practitioner). Individuals who do not have a PCP can call Health811 or visit a mobile screening coach (in some areas), and if the participant is eligible for screening, a requisition for FIT will be submitted to the lab and the lab will mail a FIT kit to the participant.		✓ If eligible for screening, a PCP, a mobile screening coach or Health811 will submit requisition for FIT to the lab and the lab will mail a FIT kit to the participant.	✓ In Sioux Lookout and area, participants who are eligible for CRC screening can pick up a FIT kit at nursing stations and health centres.	✓
QC				Auprès du centre de collecte des échantillons	✓
NB	Following the receipt of a completed screening questionnaire, the program will mail a FIT kit to all eligible participants.		✓ Invited participants will complete a screening questionnaire and the program will mail a FIT kit to the participant if eligible.~
NS		✓ Initial FIT kit is mailed to participant three weeks after invitation letter. Kits mailed after even birthday.
PE	Program will send FIT by mail or make available for pick up at health centres, walk-in –clinics, or from healthcare providers, family physicians, or nurse practitioners’ offices. Handed out by family physicians or nurse practitioners who encourage screening.	✓ Kit mailed on request to new clients. Kit mailed to participants when due, following routine screening interval.	✓ Phone, fax, email, or online order	At local health centres (12 locations across province), individual practices, healthcare provider offices, family physicians, nurse practitioners, and walk-in clinics.	Self-referral form required, filled out by participant to request processing of testing kit within the screening program.
NL	Medical Director acts as referring physician for FIT.		✓ Self-referral by phone (toll-free) or email PCP referrals also accepted by phone, fax, or email

_{*YT: Program automatically mails FIT kits to individuals whose tests were not processed.}
_{^NT: In regions where the organized screening program has been rolled out.

~NB: Participant must complete and mail back eligibility questionnaire (postage-paid envelope provided).}

Three provinces and one territory require participants to have a primary care provider (PCP) in order to access a fecal test. Most programs which do not require participants to have a PCP to access tests will assist participants in connecting with a PCP if the participant requires follow-up.

Access to colorectal screening for participants without a primary care provider

P/T	Role of PCP in access to test	Is a PCP required to access test?	Receiving results without a PCP	Identification of a PCP if follow-up required
YT	PCP provides kits and can contact program to request a kit be sent to their patient. Kit will be accompanied by a letter indicating PCP has requested one. Program mails subsequent rounds of requisitions.	No	Yes	If participant does not have a PCP, the program will refer to a physician who has volunteered to follow the client throughout screening pathway.
NT	Inclusion in organized screening program is based on EMR records.*	No	Directly from screening program	Patients with positive FIT are referred to endoscopy program and cancer navigation team.
NU	Kits can only be obtained from PCP (physician, nurse practitioner, or community health nurse).	Yes		PCP required for access to screening test.
BC	PCP provides initial requisition. Program mails subsequent rounds of requisitions.	Yes		PCP required for access to screening test.
AB	PCP provides requisition and is not required for access to FIT mail-out	No	Directly from screening program	PCP required for access to screening test.
SK	PCP referral not required. PCP can requisition a FIT for the participant.	No	Directly from screening program via mailed letter	Program will send a letter to the client via registered mail with resources to locate a PCP. Nurse navigators will attempt to contact client by phone for additional support.
MB	PCP referral not required. PCP can contact program to request a kit be sent to their patient. Kit will be accompanied by a letter indicating that PCP has requested one.	No	ColonCheck manages test results including mailing results and making colonoscopy referral for abnormal results. A PCP is preferred, but not required.	Program will assist with connecting participants to the Doctor Finder service if they do not have a PCP.
ON	PCP (family physician or nurse practitioner) or Health811/mobile screening coach (for participants without a PCP) submits requisition.	No	Ontario Health (Cancer Care Ontario) sends result letters to all participants, including those who access FIT through a mobile coach or Health811. For participants who access FIT through the Hamilton Niagara Haldimand Brant Mobile Coach, the PCP also provides results directly to participant and manages follow-up.	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: PCP provides requisition for kit.^ Program: PCP referral not required.	Yes
NB	PCP referral not required. PCPs are encouraged to promote participation in screening program.	No	Directly from screening program.	Colonoscopy is arranged by the program for all participants with a positive FIT result. Following a colonoscopy, any abnormalities are managed by the endoscopist. Participants without a PCP are encouraged to register with the provincial registry for unattached patients.
NS	PCP referral not required. PCP encourages patient participation. FIT available only through organized program.	No	Directly from screening program.	PCP not required. Program coordinates all follow ups for individuals regardless of whether they have a PCP.
PE	PCP referral not required.	No	Directly from screening program	Follow up is arranged by the Colorectal Diagnostic Navigation team for all participants with a positive FIT result.
NL	Open access province wide. Medical Director acts as the physician of record for all FIT tests. PCP referral not required. PCP can submit referral by fax to program and kit will be mailed to participant.	No		Follow up coordinated by the program. PCP not required (program Medical Director acts as physician of referral for follow up).

_{*NT: In the regions where the organized screening program has been rolled out.}_^QC:_{Currently working on expanding access to opportunistic screening for people who cannot easily see a PCP.}

Returning the screening test

There are many ways for participants to return their colorectal screening test. Most jurisdictions allow participants to drop off their tests at a community hospital, community health center, or at the lab, or mail the tests using pre-paid postage that was provided with the testing kit. Only Northwest Territories, Quebec, and Nova Scotia allow tests to be dropped off at pick-up locations.

Most jurisdictions recommend returning the screening test within 7 days of sample collection, as samples need to be analyzed within 14 to 15 days of sample collection.

Returning the colorectal screening test

P/T	Drop off at community hospital/ health centre	Drop off at pick up location	Drop off at lab	Mail using postage-paid envelope provided with kit
YT	✓
NT	✓	✓	✓
NU	✓
BC			✓
AB			✓
SK			✓	✓
MB			✓	✓
ON	✓*		✓^	✓
QC		✓
NB				✓
NS				✓
PE	✓ ~	✓	✓	✓
NL				✓

_{*ON: People who live in a First Nations community can contact their health centre or nursing station to discuss drop-off options.}
^_{ON: Participants can drop off their FIT at any LifeLabs Patient Service Centre.}
~_{PE: Kits can also be dropped off at PCP offices with a lab run.}

Recommended timeframe for returning the colorectal screening test

P/T	Guidelines for date of return	Guidelines for date of sample analysis
YT	✓ (within 48 hours of sample collection)
NT	✓ (within 7 days of sample collection)
NU
BC	✓ (within 7 days of sample collection)	✓ (within 15 days of sample collection)
AB	✓ (within 7 days of sample collection)
SK	✓ (within 3 days of sample collection)	✓ (within 30 days of sample collection)
MB	✓ (within 48 hours of sample collection)	✓ (within 14 days of sample collection)
ON	✓ (within 48 hours of sample collection)	✓ (within 14 days of sample collection)
QC	✓ (within 48 hours of sample collection)
NB~	✓ (within 7 days of sample collection)	✓ (within 14 days of sample collection)
NS		✓ (within 15 days of sample collection)
PE	✓ (within 48 hours of unrefrigerated sample collection, within 7 days of refrigerated sample collection)^	✓ (within 14 days of sample collection)
NL		✓ (within 15 days of sample collection)

_{^PE: Within 7 days of sample collection is acceptable for refrigerated samples.}
~_{NB: Participants are encouraged to avoid mailing the completed kit on Thursdays and Fridays and before holidays.}

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