Dear Healthcare Providers,
As a reminder, the Guaiac Fecal Occult Blood Test (gFOBT) can no longer be ordered on our requisitions as the manufacturer who produces the cards for the test has discontinued them. If you have any existing cards in your office, you may continue with the test and the samples may be dropped off by patients at any LifeLabs patient service center until October 1, 2024. After October 1, we will no longer be able to accept any cards for gFOBT testing.
Leveraging FIT over gFOBT for CRC screening
Ontario Health recommends utilizing the fecal immunochemical test (FIT) through their ColonCancerCheck program once every two years as an option for colorectal cancer screening for patients between the ages of 50 to 74. The test is offered by LifeLabs and covered under the ColonCancerCheck program. For details on eligibility and/or to order, please visit www.lifelabs.com/test/cco-fit-patient/.
Patients who do not have access to the ColonCancerCheck program and are looking to be proactive about their health may want to consider LifeLabs’ private-pay Colorectal Health (FIT) Kit if they are between the ages of 50-74 and are due for screening. Visit /fit-testing/ for more information.
Note: The ColonCancerCheck program does not recommend regular screening for people older than age 74. Considerations for deciding when to screen people ages 75 to 85 for colorectal cancer include how long someone is expected to live, their screening history, and whether they are willing and able to have a follow-up colonoscopy. Please review the guideline provided by Ontario Health below on options for fecal-based screening tests. This guideline covers screening recommendations for individuals at average risk and those at increased risk of developing colon cancer. It also addresses different age groups and appropriate testing options based on symptoms presented by the patient.
For any questions, please contact LifeLabs Customer Care Center 1-877-849-3637. Thank you.
Ontario Health Guideline on fecal-based screening tests
ColonCancerCheck’s screening recommendations
ColonCancerCheck recommends screening in two different groups of people: people at average risk of colorectal cancer and people at increased risk. People at average risk are those ages 50 to 74 with no family history of colorectal cancer in a first-degree relative (parent, sibling, or child). People at average risk are recommended to get screened with FIT every two years. Since implementing FIT as the recommended screening test in 2019, ColonCancerCheck does not recommend the use of gFOBT for colorectal cancer screening. People who have a first-degree relative diagnosed with colorectal cancer are at increased risk for colorectal cancer and are recommended to screen with colonoscopy as the primary test starting at age 50, or 10 years earlier than the age their first-degree relative was diagnosed, whichever comes first.
People who are under age 50 or over age 85
ColonCancerCheck does not recommend regular colorectal cancer screening with FIT for people younger than age 50 with no first-degree relatives who have been diagnosed with colorectal cancer. Even though the number of colorectal cancers being diagnosed in younger adults is increasing in Canada, it is still very low in adults younger than age 50. ColonCancerCheck is actively monitoring colorectal cancer trends and research on screening in younger age groups. ColonCancerCheck also strongly recommends against colorectal cancer screening in people older than age 85. Scientific evidence shows that people over 85 are less likely to benefit from colorectal cancer screening and more likely to be harmed than people under age 85. While a benefit of getting checked may be finding cancer early, the harms are possible problems from having a colonoscopy, which is an exam done after an abnormal FIT result. A colonoscopy may result in bleeding caused by removing polyps, perforation of the bowel from the removal of a polyp or insertion of the colonoscope, a reaction to the medication used during the exam, heart problems, low blood pressure from the bowel preparation before the exam, and, in very rare cases, death (1, 2).
People who have symptoms
It is important that people of any age who have symptoms or problems that could be caused by colorectal cancer (e.g., iron deficiency anemia, rectal bleeding) are referred to endoscopy for appropriate investigation. ColonCancerCheck does not recommend using any fecal-based test (i.e., FIT or gFOBT) for indications other than colorectal cancer screening (e.g., for diagnostic use, point-of-care testing). This is because stool-based testing has low sensitivity for the diagnosis of colorectal cancer or other significant pathology in people with symptoms (3, 4), and using stool-based testing as a diagnostic tool has been shown to lead to diagnostic delays and inefficiencies (5, 6, 7). A case study that provides a clinical example illustrating the impact of inappropriate fecal occult blood testing (including diagnostic delay and patient care) can be found here: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2706178. For patients who are interested in colorectal cancer screening but are not eligible to screen with FIT, primary care providers should talk to them about their risk factors for getting colorectal cancer, as well as the harms and benefits of screening. Patients can learn more about their risk of getting colorectal cancer at mycanceriq.ca.
Additional questions from primary care providers that are not covered by the above messages can be directed to Ontario Health (Cancer Care Ontario)’s contact centre at 1-866-662-9233, Monday to Friday from 8:30 a.m. to 5 p.m., or by email at cancerinfo@ontariohealth.ca.
References:
- Rabeneck L, Paszat L, Hilsden R, Saskin R, Leddin D, Grunfeld E, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology. 2008;135(6):1899-1906.e1.
- Hilsden RJ, Dubé C, Heitman SJ, Bridges R, McGregor SE, Rostom A. The association of colonoscopy quality indicators with the detection of screen-relevant lesions, adverse events, and postcolonoscopy cancers in an asymptomatic Canadian colorectal cancer screening population. Gastrointest Endosc. 2015 Nov; 82(5):887-94.
- Farag A, Barkun AN, Martel M. The utility of fecal occult blood testing for clinical indications of suspected gastrointestinal blood loss outside a setting of colorectal cancer screening: A systematic review. Poster session presented at: Digestive Disease Week; 2016 May 22 – 24; San Diego, CA.
- Pochapin MB, Fine SN, Eisorfer RM, Rigas B. Fecal occult blood testing in hospitalized patients. J Clin Gastroenterol. 1994; 19(4):274-277.
- Narula N, Ulic D, Al-Dabbagh R, Ibrahim A, Mansour M, Balion C, et al. Fecal occult blood testing as a diagnostic test in symptomatic patients is not useful: A retrospective chart review. Can J Gastroenterol Hepatol. 2014; 28(8): 421–26.
- van Rijn AF, Stroobants AK, Deutekom M, Lauppe C, Sturk A, Bossuyt PMM, et al. Inappropriate use of the faecal occult blood test in a university hospital in the Netherlands. Euro J of Gastroenterol and Hepatol. 2012; 24(11):1266-69.
- Ip S, Sokoro AA, Kaita L, Ruiz C, McIntyre E, Singh H. Use of fecal occult blood testing in hospitalized patients: results of an audit. Can J Gastroenterol Hepatol. 2014; 28(9): 489-94.
