Screening for colon cancer

Regular screening is important because colon cancer can often develop without any warning signs or symptoms. The goal is to find and remove pre-cancerous growths (polyps) early before cancer develops or before it spreads. When found early, colon cancer is often preventable and treatable.

Polyps (growths) in the colon can leak small amounts of blood into the stool. A Fecal Immunochemical Test (FIT) can find these small traces of blood. The FIT is a simple test that can be done in the privacy of your home with an at-home test.

Almost every test or procedure has benefits and risks. It’s important to be aware of them so that you can make an informed decision that’s right for you. No screening test is 100% accurate, but the scientific evidence tells us that having regular FIT leads to a decrease in death rates from colon cancer.

Benefits

• Easy to do in the privacy of your own home
• It can help find polyps or early-stage colon cancer when treatment is most effective. In most cases, the earlier a cancer is detected, the better your chance of survival
• Early detection may also mean less treatment and less time spent recovering
• No dietary restrictions
• Only one sample is required
• FIT has an automated processer giving fewer false positives in test results

Risks

• FIT alone has no risk of harm. An abnormal test can lead to other follow-up tests, like a colonoscopy, that have more risks
• False-positive results can happen when test results suggest there is blood in the stool when there really is none. False positives can cause anxiety, stress and possibly painful and unnecessary tests to rule out pre-cancer or cancer
• False-negative results can happen when the FIT may miss blood in the stool that is not detected by the test even though it is present. False-negative results can cause you or your doctor to be unaware of colon abnormalities that could lead to cancer or to ignore symptoms that suggest the presence of cancer, causing a delay in diagnosis and treatment
• Some polyps and colon cancers do not bleed so the FIT will not detect all polyps or cancer

New Brunswickers aged 50 to 74 are invited by mail to participate in the program. To request the simple at-home test, individuals must answer and return the questionnaire to the program. This will help to determine whether the at-home test is the right screening test for them. The questionnaire can also be completed over the phone by calling 1-844-777-3443.

This program is managed by the New Brunswick Cancer Network at the Department of Health, in partnership with health-care providers and the regional health authorities.

The program is an active member of the Pan-Canadian Colon Cancer Screening Network, facilitated by the Canadian Partnership Against Cancer .

Research shows that people aged 50 to 74 benefit the most from screening for colon cancer.

You can expect to receive your invitation by mail to participate in the program if you are 50 to 74 years old with a valid New Brunswick health care number. 

To request a test, you will need to answer some questions included in the invitation letter to determine whether the at-home test is the right screening test for you. You can also call 1-844-777-3443 to complete the questionnaire over the phone or if you have questions.

Average risk individuals will be sent an at-home test from the program. 

The NB Colon Cancer Screening Program will keep track of who has been mailed a screening test and will invite most people to repeat their screening test every two years.

The New Brunswick Cancer Screening Programs collect, use and disclose participants’ name, address, birth date and Health Care Number, along with the necessary clinical screening information, to monitor screening activity, determine eligibility and invite New Brunswickers to participate in cancer screening programs and services. If you want more information about your privacy rights, please send an email to: [email protected].

The NB Colon Cancer Screening Program screens people who are at average risk and aged 50 to 74 every two years with a Fecal Immunochemical Test (FIT).

An average risk person is someone:

• over 50 years of age
• without symptoms
• without personal history of colorectal polyps, colon cancer (CRC) or inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• without one first degree relative (parent, child or sibling) diagnosed with CRC at age 60 or younger
• without two or more first degree relatives (parent, child or sibling) diagnosed with CRC at any age

People with affected relatives, who are more distant than first degree, can be considered to be at average risk. 

People who are at higher risk of developing colon cancer need to have a different screening approach than what the colon program offers. The at-home test (FIT) is not the best screening test for them.

An higher risk person is someone with:

• one first degree relative diagnosed with CRC at age of 60 or younger or two or more first degree relatives with CRC at any age
• a personal history of colorectal polyps or CRC
• a strong family history of CRC with multiple people affected but no genetic syndrome identified
• a family history of HNPCC (hereditary non-polyposis colon cancer) or FAP (familial adenomatous polyposis)
• a personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)

If you fall in this higher risk category, make an appointment to speak with a primary health-care provider to determine your risk and to develop an appropriate screening plan.

By choosing to not participate, this means:

• you will not be invited by the program
• you will not be sent the colon cancer screening test in the mail
• you will not be reminded to do the test every two years
• you and your primary health-care provider will be responsible for all colon cancer screening

To learn more about the NB Colon Cancer Screening Program, to opt out of the program or to return to the program, call 1-844-777-3443.

The at-home test or Fecal Immunochemical Test (FIT) is a screening test that checks for very small amounts of blood in your stool that you cannot see.

Although the Guaiac (gFecal Occult Blood Test) and Fecal Immunochemical Test (FIT) are both tests used to help find small amounts of blood in stool, the biggest differences between the two tests is that the FIT:

• is more ‘sensitive’ to detecting blood in stool than the Guaiac test
• is more specific in finding potential cancer
• requires no special diet and no restrictions on medication
• takes less time to do (requires only one sample)
• is currently only available to eligible participants of the NB Colon Cancer Screening program

The specimen is collected by you in the privacy of your own home.

You simply place a small amount of your stool in the test container. Instructions are provided with the mailed test.

You can watch a video on collecting a colon screening test .

Try securing the tissue paper provided in the kit in between the toilet bowl and the seat to collect stool. Plastic wrap can also be used instead of the tissue paper to support the stool.

You can also collect your stool on a clean, disposable container, for example, a paper plate.

The collection/tissue paper is biodegradable and will not harm septic systems.

The liquid in the tube is a buffer solution and is to remain in the tube. This is required for transport and analyzing your sample. 

If you have any questions, call 1-844-777-8443.

If you have symptoms of colon cancer, including blood in your stool, you should not use the test kit. See a primary health-care provider to discuss your symptoms.

If you are bleeding from hemorrhoids, are currently menstruating or have blood in your urine, you should wait to do the test until you have stopped bleeding for three days.

Visit the Canadian Cancer Society  for more information about the signs and symptoms of colon cancer.

It is okay to collect the sample from very loose or hard stools. 

If the loose stools are related to a virus, like food poisoning, wait to take the test until you feel better.

For hard stool, using a clean, disposable container may make it easier to collect your sample.

The kit can be mailed in any Canada Post mail box or outlet. You do not need any stamps, the postage is pre-paid. The address of the laboratory is printed on the envelope.

Your collection tube will have an expiry date on it. Be sure to complete the test prior to the kit's expiry. Once the kit is used, it must be analyzed within 7 days. Please avoid mailing the test on a Friday afternoon or during the weekend. If you cannot mail the same day, please keep in the fridge until you can mail it.

Sometimes the lab is unable to process your test. This could be because:

• the collection date was not on the test tube or on the form
• the test was damaged in the mail
• the collection date was more than 14 days ago
• the analyzer malfunctioned
• the test had expired
• there was a recall on your test
• the specimen was not put in the envelope prior to mailing
• the information on the tube did not match the information on the form

Please read and follow the instructions carefully when mailing your specimen.

A normal or negative result means that no blood was found in your stool. You will be invited to repeat the screening test in two years.

An abnormal or positive FIT result means that blood was found in your stool and more testing needs to be done to see where the blood is coming from. It could be coming from a polyp or cancer or even from hemorrhoids. Some polyps could develop into colon cancer if they are not removed.

The screening program nurse will call you to arrange for a follow-up test called a colonoscopy.

For every 1000 people who complete the FIT, about 60 people will have an abnormal result and will be referred for a colonoscopy. It is estimated that six of those people will have colon cancer or pre-cancerous lesions found by a colonoscopy. 

Several people with positive FIT will have polyps that could have led to colon cancer if they had not been removed during their colonoscopy.

A long, flexible tube (scope) is slowly guided into your colon through your rectum. You are given medication to keep you from feeling much discomfort. The scope sends a picture of the inside of your colon to a video screen.

A specialist examines the lining of the colon and can remove polyps using tiny tools passed through the scope. For most people, a colonoscopy is a straightforward procedure. However, on rare occasions (1/1000), some people may have bleeding or other complications such as a perforation (tear) that may require a hospital stay.

Sometimes a colonoscopy has to be repeated. This will be arranged for you. The specialist will follow up with you for anything abnormal in your colon. If everything is normal, the program will send you a letter and then re-invite you in 10 years.

Learn more about how a colonoscopy works 

The program nurse will make arrangements for a colonoscopy in a hospital closest to your home. The procedure is done in an outpatient clinic by a specialist qualified to perform it. Instructions will be sent to you as to how to prepare for a colonoscopy.

In order for the specialist to see the lining of your colon clearly, your colon must be empty. You will need to take a powerful laxative to clean the colon the day before and the day of the procedure. You will have to buy the laxative at a pharmacy and the program nurse will explain to you how to take it. Also, you won’t be able to eat solid food the day before the procedure but you will be able to drink clear liquids.

Expect to be at the hospital for two to three hours. The actual procedure usually lasts 20 to 45 minutes. Bring a list of your current medications.

You will be closely monitored before, during and after the procedure. The specialist will give you the results of the procedure and tell you if you need to be seen again.

If the colonoscopy was normal or negative, you will be re-invited to the screening program in 10 years with a FIT if you are still between 50 to 74 years old.

If the specialist removed polyps, they will give you the results of the pathology when they are available (usually within three to four weeks) and discuss whether you should return to the screening program or need to be followed-up with different tests.

Have an adult accompany you home. You cannot drive until 24 hours after the colonoscopy. You may be sleepy after you arrive home from the procedure. It is recommended that you do not operate equipment, sign legal papers or drink alcohol until the following day. A responsible adult must stay with you 24 hours after the colonoscopy.

You will be able to resume your regular diet and medications after your colonoscopy, unless otherwise directed by your specialist.

The air inside your colon may cause you to feel bloated or have cramping during and after the procedure. It is important to relax and pass the air as soon as possible. If this discomfort increases or is unrelieved, you are experiencing rectal bleeding, or develop a fever or chills, go to the emergency department and advise them that you had a colonoscopy.