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Colon Screening

Provider and patient speaking

About the Program

The Colon Screening Program started in BC in November 2013. Colon cancer screening in BC is organized under a partnership framework with regional health authorities, laboratory service providers, primary care providers, and specialists. BC Cancer provides oversight for organized cancer screening in BC and supports:

  • development of provincial policies, guidelines, and standards
  • development of strategies to increase public and health care provider awareness, including both benefits and limitations of screening
  • correspondence to eligible British Columbians about results, follow-up, and rescreening
  • quality assurance and quality improvement of the program
  • reporting and monitoring of system performance and screening outcomes. 

Screening Guidelines

Should my patient get colon screening? Generally, anyone between the ages of 50 to 74 with no symptoms should get screened with a Fecal Immunochemical Test (FIT) every 2 years.

Asymptomatic - Average Risk 

 
No history
  • Routine FIT screening is not recommended
Personal history of low-risk precancerous lesion(s)


 
Personal history of low-risk precancerous lesion(s)
  • FIT or colonoscopy is recommended. Refer to the Colonoscopy Follow-up Algorithm for the recommended pathway and screening interval.
  • If patient is younger than age 74, depending on the recommendation, either refer for colonoscopy using the Colonoscopy Referral Form or refer for FIT using the Standard Lab Requisition.
Never screened or screening interval elapsed and No personal or family history of colorectal cancer
  • Routine FIT screening every 2 years.
  • Use Standard Lab Requisition: Select ‘FIT (Age 50-74 asymptomatic q2y) Copy to Colon Screening Program.
Normal FIT within 2 years
  • Routine FIT screening is not recommended. Patient is up to date with colon screening.
Normal colonoscopy within 10 years
  • Routine FIT screening is not recommended. Patient is up to date with colon screening.
Normal CT colonography within 5 years
  • Routine FIT screening is not recommended. Patient is up to date with colon screening.

 
Assess patient’s risk of colorectal cancer and risk of colonoscopy. Harm can outweigh benefit; use clinical judgement.

If proceeding with screening, use Standard Lab Requisition and select ‘FIT No copy to Colon Screening Program’. Patient will not be registered in the program. Refer directly to a specialist for follow-up when indicated.

 

Routine FIT screening is not recommended.

 

High Risk

 
FIT or colonoscopy is recommended. Refer to the Colonoscopy Follow-up Algorithm for the recommended pathway and screening interval.

If patient is younger than age 74, depending on the recommendation, either refer for colonoscopy using the Colonoscopy Referral Form or refer for FIT using the Standard Lab Requisition.

 
Routine FIT screening is not recommended. Refer for ongoing follow-up with a specialist.

 

Routine FIT screening is not recommended. Refer for ongoing follow-up with a specialist.

 

 
One first degree relative (parent, child, full sibling) with colorectal cancer diagnosed under age 60; or Two or more first degree relatives with colorectal cancer diagnosed at any age. 
*If one first degree relative diagnosed with colorectal cancer over age 60, screen as average risk.

  • Routine FIT screening is not recommended. Colonoscopy is recommended every 5 years. Refer for colonoscopy at age 40 or 10 years younger than the age of diagnosis of the patient’s youngest 1st degree relative — whichever is first.
  • If patient is younger than age 74, refer for colonoscopy using the Colonoscopy Referral Form.

Symptomatic

 
Do not screen. Refer for diagnostic testing.

Symptomatic, includes: 
  • Anemia 
  • Abdominal pain 
  • Rectal bleeding 
  • Change in bowel habits

Management of FIT Results 

 
Re-screen with a FIT in 2 years. 

The patient can access their results through MyCareCompass or by contacting your clinic. The patient will not be notified by mail if their FIT result is normal. The patient will receive a reminder letter in the mail when it is time for them to screen again.

 

‎The patient will receive their results in the mail within 5 to 10 business days after their sample is returned to the lab.


BC Cancer will facilitate a referral for a colonoscopy to the patient’s Health Authority. The Health Authority will contact the patient, assess their condition, and book a colonoscopy procedure if appropriate, or if other monitoring and/or treatment is advised.

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