Access to tests

Colorectal screening tests can be accessed through different methods. Seven 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

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 program.		✓ Phone, fax or online		✓
NT	Inclusion in organized screening program is based on EMR records.*	FIT is mailed directly to residents in large centres where program is active.		PCP nurses/community health reps distribute kits from the program in smaller communities.*	✓*
NU				From PCP	✓
BC				At lab	✓
AB	Requisition can be obtained at a walk-in clinic.			At lab	✓
SK		✓ FIT is mailed to all clients aged 50-74 with an active Saskatchewan health card.		At lab	✓
MB	Program automatically mails test kits to eligible individuals. Individuals can also request a test kit by contacting ColonCheck.	✓ Program actively mails FOBT kits to eligible persons and sends reminder letters if not completed within 56 days.	✓ PCP and eligible persons can request a kit be mailed to a home address.	Kits can be picked up at the ColonCheck program.
ON	Individuals who do not have a PCP can call Telehealth Ontario 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, PCP (or Telehealth Ontario) will submit requisition for FIT to the lab and the lab will mail a FIT kit to the participant.		✓
QC				At specimen collection centre Program: Bring invitation letter to pick up kit.	✓
NB	Following the receipt of a completed screening questionnaire, the Program mails 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 2 weeks after invitation letter. Kits mailed after even birthday.
PE	Send by mail by program or pick-up by participant at health centres, walk-in-clinics or PCP providers’ offices.	✓ Kit mailed to participant or can be picked up.	✓ Phone, fax or online	Can pick up at a health centre (12 locations across province). Can also be picked up from many PCPs and walk-in-clinics.
NL	Medical Director acts as referring physician for FIT test.		✓ Self referral by phone (toll-free) or email

_{NT: *In larger communities, participants may need to see their PCP first for a referral/requisition, and then visit a lab to obtain a kit

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 the 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.

Screening process for participants with no PCP

P/T	Role of PCP in access to test	PCP required to access test	Receiving results	Identification of a PCP if follow-up required
YT	· PCP provides kits. · PCP can contact program to request a kit to be sent to their patient. Kit will be accompanied by a letter indicating that PCP has requested one be sent. · Program mails subsequent rounds of requisitions.			· If participant does not have a PCP, the program will refer to a physician who will follow the client throughout screening pathway.
NT	· Kits can only be obtained from PCP (physician, nurse or community health nurse).		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).	✓		· PCP required for access to screening test.
BC	· PCP provides initial requisition. · Program mails subsequent rounds of requisitions.	✓		· PCP required for access to screening test.
AB	· PCP provides requisition.	✓		· PCP required for access to screening test.
SK	· PCP referral not required. · PCP can order a test for pick up by participant.			· Individuals are asked to identify their PCP on the form when they return their kit. · If no PCP is identified, participant is sent a list of PCPs taking new patients in their area and encouraged to see them for follow up. · Program also partners with some walk-in clinics to help connect to primary care if needed.
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 be sent.		ColonCheck manages test result including mailing results and making colonoscopy referral for positive 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 Telehealth Ontario/ mobile screening coach (for participants without a PCP) submits requisition.		· Ontario Health (Cancer Care Ontario) sends the result to all participants, including those who access FIT through the mobile coach. · For participants who access FIT through the Hamilton Niagara Haldimand Brant Mobile Coach, the PCP also provides result directly to participant and manages follow-up.	· Program contacts those without a PCP by mail and phone and attaches participant to PCP for follow up. · Program maintains list of PCPs who have agreed to assist those without a PCP and will engage our Regional Cancer Programs and Regional Primary Care Leads as required.
QC	· Opportunistic: PCP provides requisition for kit.* · Program: PCP involvement not required.	✓
NB	· PCP referral not required.^ · PCPs are encouraged to promote participation in screening program.		All participants are notified of results by the 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.			· PCP not required; program coordinates all follow up for individuals regardless of whether or not they have a PCP.
PE	· PCP referral not required.		Yes, by letter	· If a participant has no PCP, program will connect them with a provider who can manage the follow-up process. · Contact information for this provider sent to the patient in the same letter as results.
NL	· PCP referral not required. · PCP can submit referral by fax to program and kit will be mailed to participant.			· Follow up coordinated by the program, PCP not required (program Medical Director acts as physician of referral).

_{QC: *Currently working on an expanded access strategy in opportunistic mode for people who do not have easy access to a PCP.}

In many jurisdictions, colonoscopy capacity is limited, and wait times to colonoscopy after an abnormal screen are longer than the national target of 60 days. Six provinces and two territories limit the use of colonoscopy as a primary test for screening individuals at average risk.

Limits on colonoscopy as a primary test for screening individuals at average risk

P/T	Access is limited	Considering or planning to limit	No current plans to limit access	Guidelines on use of FIT and colonoscopy for screening individuals at average risk
YT			✓	Current guidelines indicate that average risk individuals should be screened by FIT test, but guidelines are not enforced.
NT	✓ Referral required
NU	✓ Referral required			Current guidelines indicate average risk individuals are screened by FIT Scopes are performed out of territory for many communities in Nunavut.
BC			✓	The Guidelines and Protocols Advisory Committee (GPAC) guidelines in BC outline the screening recommendations.
AB	✓ Referral required		✓	Strongly recommend the use of FIT for average risk.
SK				Current guidelines indicate that average risk individuals should be screened by FIT test, but guidelines are not enforced.
MB			✓	No current plans, but strongly recommend the use of FOBT for average risk screening.
ON	✓ *	✓ Continue to consider additional strategies		The program continues to recommend against colonoscopy for screening people at average risk. We have reinforced this message to providers and facilities performing colonoscopy to help the system manage during the pandemic.
QC	✓
NB			✓	FIT is only available through the NB Colon Cancer Screening Program. Current guidelines do not recommend colonoscopy as a primary screening test for average risk.
NS	✓ FIT is strongly encouraged	✓		Strongly recommend the use of FIT for average risk. Colonoscopy screening for average risk individuals is strongly discouraged.
PE	✓ FIT is strongly encouraged			Current guidelines indicate that average risk individuals should be screened by FIT test.
NL	✓ FIT is strongly encouraged

_{ON: *With the transition to FIT, Ontario Health (Cancer Care Ontario) adjusted colonoscopy funding models to ensure endoscopists are being appropriately funded for high-yield procedures (FIT positive colonoscopies)}

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