Patients with an Abnormal Fecal Immunochemical Test (FIT) Result Without Follow-up Colonoscopy

What is the current situation?

  • The COVID-19 pandemic and resulting ramp down of health services has led to increased cancellations and deferrals by both patients and providers for cancer screening and diagnostic services. This has resulted in a significant backlog of individuals in our region who are overdue for both cancer screening and follow-up of abnormal tests.
  • The Ontario Health (Cancer Care Ontario) (OH-CCO) COVID Monitoring database shows that there are 549 people in the Hamilton Niagara Haldimand Brant (HNHB) region who had an abnormal FIT result who have not received a follow-up colonoscopy as of March 31, 2021 and that this number has increased in recent months.

Why is timely follow-up colonoscopy for abnormal FIT results important?

  • OH-CCO recommends that anyone with a positive FIT be followed up by colonoscopy within 8 weeks of the abnormal test result.
  • This is because FIT is very good at detecting clinically significant lesions, with positive predictive values (PPV) ranging from 2.9% to 7.8% for colorectal cancer and 33.9% to 54% for advanced adenoma across a variety of populations1.
  • Timely follow-up colonoscopy is associated with decreased late stage colorectal cancer diagnoses, decreased colorectal cancer-related deaths, maximized cost-effectiveness of screening, and reduced inequities in colorectal cancer screening and outcomes2.

What can primary care providers do?

  1. Continue to provide and promote cancer screening. Practice opportunistic screening and consider strategies to address backlogs. Eligibility for FIT can be assessed over the phone. Colonoscopy is reserved for patients with a first-degree family history of colorectal cancer or a previous history of colonic polyps or cancer (i.e.
    surveillance) and is not recommended for individuals without these risk factors.
  2. Identify patients in need of follow-up colonoscopy. If you belong to a Patient Enrolment Model, you (or a delegate) can access a list of your patients with an abnormal FIT who require follow-up through your Screening Activity Report. Information on how to access this can be found here:
  3. Refer patients for follow-up colonoscopy. Referrals for follow-up colonoscopy after an abnormal FIT result can be made to any site in the HNHB region using the centralized referral form available here:
  4. Stay connected. Reach out to your Regional Primary Care Lead, Dr. Meghan Davis if you have questions ( Updates and provider resources are posted on the regional website: Follow us on Facebook or Twitter at @HNHB_Cancer.

1 Robertson DJ, Lee JK, Boland RC, et al. Recommendations on fecal immunochemical testing to screen for colorectal neoplasia: A consensus statement by the US Multi-Society Task Force on Colorectal Cancer. American Journal of Gastroenterology. 2017;112(1):37-53.
2 Cusumano VT, Corona E, Partida D, et al. Patients without colonoscopic follow-up after abnormal fecal immunochemical tests are often unaware of the abnormal result and report several barriers to colonoscopy. BMC Gastroenterology. 2020;20(1).

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