Colorectal cancer screening in Canada 2021/2022

Follow-up for abnormal colorectal screening test results

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. Additionally, monitoring colonoscopy quality maximizes the benefits of screening.

Colorectal cancer 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
NT ✓ (opportunistic)
ON* ✓^ ✓~

NB   ✓‡
Patient sent registered letter if unable to reach after 2 weeks

ON: * Participants may call the Ontario Health (Cancer Care Ontario) contact centre to obtain their FIT result.
ON: ^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 established.
NB: ‡Results are accessible through the provincial electronic health record (EHR)

Provinces and territories have different follow-up methods after an abnormal colorectal screening test result. In six 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 appoint-ment Pre-colono-scopy assessment completed Appoint-ment mailed to participant Colono-scopy location contacts participant with appoint-ment time Program initiates referral to colono-scopy Program coordinates follow-up
(colonoscopy referrals can only be made by physician or NPs)
NT ✓ (opportunistic) ✓*
(referrals can be made by physicians, NP’s or CHN’s)
(health authority contacts participant)
(physician or endoscopy navigator)
(if preferred by PCP)

(with PCP permission)

(with PCP permission)
ON ✓* ✓^ ✓^ ✓^
QC ✓ (opportunistic) ✓ (opportunistic and program)~

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 established

Follow-up for abnormal colorectal screening test results (Description of follow-up process)

P/T  Description of follow-up process 
YT  · Health care providers and program receive FIT results directly from Whitehorse General Hospital (WGH) lab through IS systems. Program follows up all positive FIT results. PCP notifies the client of the results and refers for f/u colonoscopy (a standardized colonoscopy referral form is available and is to be copied to program). Follow-up referral is monitored. Reminders to PCP to f/u positive FIT results if copy of colonoscopy referral not received by program.
NT  · The primary care provider receives the 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 referred to an endoscopy program.
NU  · Abnormal result reviewed by primary care provider. Referral for coloscopy depended on nearest referral center (in our out of territory). Requires out of community transportation with exception of Iqaluit.
BC  · Primary care provider receives the abnormal lab result report, the patient is sent a letter indicating that follow-up is required. The patient is referred to their health authority. The patient is contacted by their health authority to complete pre-colonoscopy assessment and book the patient for colonoscopy or advise the primary care provider that the patient is not proceeding.
AB  · Letter to patient from provincial program advising 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  · Primary care provider and participant notified of abnormal result by direct correspondence. Primary care providers sign medical directives which authorizes client navigators to refer client for a colonoscopy. Client navigator phones participant to discuss test results, refer participant to colonoscopy and complete a standardized assessment. Not all units have consented to client navigation. Approximately 50% of participants are assessed and booked by client navigators.
MB  · ColonCheck’s follow-up clerk contacts participant by phone (followed by letter to participant and PCP) regarding the abnormal result and follow up referral process (colonoscopy brochure included in letter).
· Referral process depends on agreements with each of the 5 Regional Health Authorities, and on permissions granted from primary care provider (ColonCheck has received permission from a majority of PCP to directly refer clients).
· A pre-colonoscopy assessment is completed by ColonCheck’s nurse practitioner for all patients receiving their colonoscopy in Winnipeg.
ON  1. Attached participants (those with a PCP):
· 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.
2. Unattached participant (those without PCP or received FIT through mobile coach):
· Ontario Health (Cancer Care Ontario) mails abnormal result letter to participant which directs the person to call Ontario Health (Cancer Care Ontario)’s Contact Centre for assistance.
· Contact Centre identifies a physician who is within 1 hour drive of the participant and has availability for an appointment within 10 days and connects the participants to a PCP for follow up.
· If there are no physicians available, the case is escalated to Ontario Health (Cancer Care Ontario)’s provincial and regional leads.
QC  · Opportunistic: Colonoscopist and PCP responsible for contacting participants to provide results.
· Program: Colonoscopist responsible for contacting participants to provide results and manage diagnostic clinical follow up if required. Screening program will manage diagnostic follow up regarding future screening.~
NB  · The lab sends a letter to primary care providers as notification of all FIT results. All participants with positive FIT 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 (CCSP) sends letter of abnormal results to clients instructing them to follow-up with a primary care provider. The primary care provider determines follow-up. A standardized colonoscopy referral form is available. Follow-up activity/referral (e.g. colonoscopy) is monitored. Primary care provider is contacted if there is no activity/referral in the client’s chart.
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 proceed to 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 also provide information on bowel prep.