Excellence in Quality – Staying Healthy Winner
Penticton Regional Hospital Colon Check Program Team
Colorectal cancer is the second leading cause of cancer death in British Columbia; three people die from it every day. Fortunately, if detected at its earliest stage, the chance of survival is over 90%.
Currently, only 37% of eligible British Columbians get screened for colorectal cancer. Screening is usually done “opportunistically:” where there is cause for concern, where a patient requests it, or if individual doctors recommend screening when they see eligible patients for other reasons. There is often considerable variation in the application of screens and there can be long waiting periods for access to a screening colonoscopy.
Colon Check is a pilot program that is offered systematically to all individuals in a target group. It is a population-based screening program that first started in Penticton in January 2009 and then expanded to include Powell River and the downtown core of Vancouver.
The Penticton Regional Hospital Colon Check team serves Penticton as well as several other communities throughout the Okanagan. Men and women between the ages of 50 and 74 can be referred to the program by their doctor or can contact Colon Check directly to request a fecal immunochemical test – a FIT. The FIT is a relatively new, highly sensitive, simple test that is mailed to participants so that they can complete it in their homes. The FIT looks for blood in the stool that may be an early sign of colorectal cancer and requires two stool samples, as opposed to the traditional guaiac method that uses cards and requires the collection of 3 stool samples over 3 days. Since the FIT has a higher sensitivity and higher specificity than the guaiac method, it decreases the risk of false positives and false negatives. It also offers the advantages of no diet restrictions or medication requirements in preparation for the test.
Once the test kit has been completed, the participant delivers it to one of a number of drop-off locations. The sample is then analyzed and results are sent to a participant’s family physician and the Colon Check program. Patients whose results are normal, and who have a negative family history, receive a letter from Colon Check advising them of the result and recommending that re-screening with a FIT occur in two years’ time. Patients whose results are abnormal receive a letter that informs them of the results and advises them that further testing is recommended. Their letter will also state that they will be contacted by a nurse navigator who will schedule a consultation appointment.
In Penticton, 1014 screening colonoscopies have been completed. In 60% of these cases, specimens requiring pathological analysis were obtained – clearly supporting the FIT as a reliable indicator of the need for a colonoscopy. It has also been shown to be more predictive of colorectal cancer and precancerous polyps than the traditional guaiac testing. In total, 94% of participants with an abnormal FIT result proceeded to a screening colonoscopy and received the colonoscopy well within the recommended time limit. 95% of the patients were highly satisfied with the Colon Check program and would personally participate again as well as recommend the program to others. 82% of respondents felt comfortable using the FIT kit.
On November 5, 2012, the BC Ministry of Health announced that it would be launching a co-ordinated province wide colorectal screening program in April 2013 that “will build on the experiences of the pilot Colon Check colorectal screening program.”
Interior Health’s Purple Dot/Aggressive Alert Program