Colorectal Cancer Screening PROGRAMS AND STRATEGIES in Canada Environmental Scan

1. Colorectal Cancer Screening PROGRAMS AND STRATEGIES in Canada Environmental Scan March 2013

2. Background • Quarterly, the Canadian Partnership Against Cancer collects information from the provinces/territories on the status of population-based colorectal cancer screening programs and/or strategies. • The information is collected through provincial and territorial leads represented on the National Colorectal Cancer Screening Network supported by the Canadian Partnership Against Cancer.

3. National Colorectal Cancer Screening Network The Colorectal Cancer Screening Network serves as a national forum to discuss and take action on matters of mutual interest or concern related to the implementation of organized colorectal screening programs.

4. Presentation Outline • Current National Guidelines • Colorectal Cancer Screening Program Status/Availability • Entry Level Tests • Program Recruitment • Colonoscopy • Increased Risk Population Strategies • Promotion/Education/Human Resources • Quality Assurance

5. Canadian Task Force on Preventive Health Care Guidelines • Canadian Task Force in Preventive Health, 2001: • For people at normal risk there is good evidence to support the inclusion of annual or biennial fecal occult blood testing (A recommendation) and fair evidence to include flexible sigmoidoscopy (B recommendation) in the periodic health examinations of asymptomatic individuals over 50 years.

6. Colorectal Cancer Screening Program Status

7. Colorectal Cancer Screening Program Status, cont’d

8. Colorectal Cancer Screening Program Availability

9. Entry Level Test: Fecal Occult Blood Test (FOBT) All programs use, or plan to use, a fecal test as primary screening modality for average-risk individuals

10. Entry Level Test: FOBT Follow-up

11. Summary of Key Program Activities Across Canada As of July 2011 key activities in colorectal cancer screening across Canada include program: • Program Expansion • Evaluation of Entry Level tests • Development of Quality Indicators

12. FOBT: Recruitment Strategy/ Invitation Method *pick-up kit at pharmacy

13. Process Following an Abnormal Result

14. Re-screening Recommendations for +FOBT and Negative* Colonoscopy * No cancer or polyp found

15. FOBT – No physician

16. Colonoscopy • Standard follow-up diagnostic procedure following abnormal fecal test • Standard procedure for increased risk individuals • Performed by gastroenterologists; surgeons; internal medicine-specialists; or, in some cases, general practitioners • In hospitals or external clinics

17. Increased Risk* Population Strategies Increased Risk*: A level of risk that is above that of the general population, where the individual is still eligible for screening (and not diagnostic workup or surveillance) Increased risk population: Planning to advise high risk population to see their Primary Care Provider through invitation letter in NB • Identified by physician in AB, MB and ON • Self-identified by program participant in which case, participant is advised to see primary care provider in NS • Self-identified in BC and SK • Information is documented separately in BC, AB, SK-may change • Are evaluated based on Medical and Nursing Clinical Practice Standards for colonoscopy (algorithms for moderate, slightly or moderately increased risk , with a personal history of polyps and with a personal history of colorectal cancer) in QC. *Is also referred to as: above-average risk, elevated risk, moderate risk, high risk

18. Increased Risk Screening Recommendations* *Not all programs coordinate referrals of increased risk population

19. Increased Risk Screening Recommendations* cont’d *Not all programs coordinate referrals of increased risk population

20. Increased Risk Screening Recommendations* cont’d *Not all programs coordinate referrals of increased risk population

21. Program Education/Promotion: Health Care Community

22. Program Education/Promotion: Health care Community cont’d

23. Program Education/Promotion: Public

24. Human Resources: Navigation/Consultation/Coordination * Tracking patients from abnormal screen to diagnosis/treatment

25. Human Resources: Navigation/Consultation/Coordination Cont’d * Tracking patients from abnormal screen to diagnosis/treatment

26. Current Quality Assurance Activities Planned or Underway

27. Reference Slide • Please use the following reference when citing information from this presentation: Colorectal Cancer Screening in Canada: Programs and Strategies. Cancer View Canada. Available at: [Enter Link], Accessed: [Enter Date Accessed].