Ontario's ColonCancerCheck: Results from Canada's First Province-Wide Colorectal Cancer Screening Program

Abstract

Background: ColonCancerCheck (CCC), Canada's first province-wide colorectal cancer screening program, was publicly launched in Ontario in April 2008. The objective of this article is to report on key indicators of CCC Program performance since its inception.Methods: The CCC Program recommends biennial guaiac-based fecal occult blood test (gFOBT) for persons 50 to 74 years of age at average risk for colorectal cancer and colonoscopy for those at increased risk (having one or more first-degree relatives with a diagnosis of colorectal cancer). Opportunistic screening with colonoscopy is available in Ontario. Five data sources were used to compute indicators of program performance during 2008 to 2011. The indicators computed were FOBT participation, overdue for screening, FOBT positivity, positive predictive value (PPV) of FOBT for colorectal cancer, diagnostic follow-up, and colorectal cancer detection rate.Results: In 2011, FOBT participation was 29.8% and 46.8% of the target population was overdue for screening. FOBT positivity was higher among men (5.1%) than women (3.5%), and the PPV of FOBT for cancer was 4.3% in 2011. Follow-up colonoscopy within 6 months of a positive FOBT was completed by 74.6% of Program participants in 2011. The cancer detection rates for FOBT and for colonoscopy in those with a family history were 1.3 per 1,000 and 4.0 per 1,000, respectively, in 2011.Conclusion: These results provide an early indication of Program performance and provide findings relevant to other organized colorectal cancer screening programs.Impact: The greater cancer detection rate in those at increased risk due to family history who undergo colonoscopy screening suggests that a strategy of risk stratification will enhance the impact of FOBT-based screening programs. Cancer Epidemiol Biomarkers Prev; 23(3); 508-15. Ó2014 AACR.

Colorectal cancer screening: a global overview of existing programmes

“…Most provinces are currently using FIT to screen persons aged 50–74 years at average risk for CRC (figure 1B) 101. Ontario's ColonCancerCheck, Canada's first organised CRC screening programme, launched province-wide in 2008 102. Participation in the gFOBT aspect of the programme was 29.8% in 2010–2011 102.…”

“…Ontario's ColonCancerCheck, Canada's first organised CRC screening programme, launched province-wide in 2008 102. Participation in the gFOBT aspect of the programme was 29.8% in 2010–2011 102. In Ontario in 2013, 58% of the target population were up-to-date with CRC screening, taking all screening modalities into account.…”

Implementation of colorectal cancer screening in Spain: main results 2006–2011

“…The positivity rate was higher in the last 3 years (except in 2006, when the data correspond exclusively to first-time invitations, although 71% were guaiac tests, when the pioneer programmes switched from the guaiac to the immunochemical test and the new programmes began directly with these tests). A recent meta-analysis reported a sensitivity for CRC of 79% (confidence interval 69-86%) and a specificity of 94% (confidence interval 92-95%), and the variation was related to the cut-off point (Halloran et al, 2012;Lee et al, 2014;Rabeneck et al, 2014;Young et al, 2015). In 2010 and 2011, 91 and 78% of tests, respectively, were performed in individuals who were invited for the first time, 90% with FIT.…”

Harms, benefits and costs of fecal immunochemical testing versus guaiac fecal occult blood testing for colorectal cancer screening

“…[7] Fecal immunochemical testing (FIT) offers several advantages over gFOBT, including greater sensitivity, no need for dietary restrictions and automated processing of test kits. [8] However, depending on the cut-off level used FIT also has a lower specificity, which is associated with increased colonoscopy demand.…”