Overdue for Colorectal Cancer Screening

Percentage of screen-eligible Ontarians, 50–74 years old, who were overdue for screening for colorectal cancer

Percentage

Numerator divided by the denominator times 100

Number of Ontario screen-eligible individuals, 50-74 years old, who were overdue for colorectal screening by the end of the calendar year as defined by not having any of the following*:

Fecal Occult Blood Test (FOBT) in the last 2 years:

Program CCC FOBT was identified in LRT or OHIP:

• L179A ColonCancerCheck Fecal Occult Blood Testing

Non-program FOBT was identified using fee codes in OHIP

• L181A Lab Med - Biochem - Occult Blood

Colonoscopy in the last 10 years

- Identified using fee codes Z555A, Z491A- Z499A in OHIP or in CIRT or in GI Endo DSP

Flexible sigmoidoscopy in the last 10 years

- Identified using fee code Z580A in OHIPHIN), service date and fee code were assumed to be a single claim 

Each individual was counted once regardless of the number of tests performed

Number of Ontario screen-eligible individuals, 50-74 years old in each calendar year.

Inclusions:

• Ontario residents aged 50–74 at the index date (Index date was defined as Jan 1 of a given year

Exclusions:

• Individuals with a missing or invalid regional data, date of birth, sex or postal code
• Individuals with an invasive colorectal cancer prior to Jan 1 of the calendar year of interest; prior diagnosis of colorectal cancer was defined as: ICD-O-3 codes C18.0, C18.2-C18.9, C19.9, C20.9, a morphology indicative of colorectal cancer, microscopically confirmed with a path report
• Individuals with a total colectomy prior to Jan 1 of the calendar year of interest
• Total colectomy was defined in OHIP by fee codes S169A, S170A, S172A

The 2011 Canadian population was used as the standard population for calculating direct age-standardized rates

Colonoscopy Interim Reporting Tool (CIRT), Laboratory Reporting Tool (LRT), Ontario Cancer Registry (OCR), Ontario Health Insurance Plan (OHIP) Claims History Database, PCCF+ version 5k6A, Registered Persons Database (RPDB)

Cancer Care Ontario (CCO)

Age, Income, Region, Rurality, Sex, Time

Historical RPDB address information is incomplete; therefore, the most recent primary address was selected for reporting, even for historical study periods FOBTs in hospital labs could not be captured A small proportion of FOBTs performed as diagnostic tests could not be excluded from the analysis This indicator does not capture tests performed as part of the Registered Nurse Flexible Sigmoidoscopy Project.

•Multiple claims with the same Health card Number and service date were assumed to be a single claim •Each individual was counted once regardless of the number of tests performed •Some methodology changes are made for 2015 analysis (flexible sigmoidoscopy timeframe is changed form five to ten years) Neighbourhood income quintiles are analyzed for urban residents only. LHIN assignment was determined using PCCF+, version 6D; residential postal code was used to identify LHIN and individuals with unknown/missing LHINs were excluded from the analysis. This was a Quality Improvement Plan (QIP) additional indicator for 2018/19, however retired from 2019/20. Neighborhood percent immigrant was determined using PCCF+; this indicator divides DAs into three categories according to the percentage of immigrants: low immigrant (≤ 27% immigrant population), moderate immigrant (27.1-51.8% immigrant population), and high immigrant (≥ 51.9% immigrant population) • Neighbourhood income quintile was determined using PCCF+; this indicator was based on income quintiles developed by Statistics Canada; income quintiles range from 1 to 5 (low to high) Rural or urban residence was determined using PCCF+. This indicator was based on whether individuals lived within a census metropolitan area (CMA), census agglomeration (CA) or Influenced Zones (MIZ) which takes into account population size, distance and commuting flow between rural and small towns and larger centres. o Urban: CMAs or CAs with a core population of 10,000 or more and 50+% of the population commute to a CMA/CA. o Rural: Areas with a core population of <10,000 and 30-49% of the population commute to an urban area (referred to as strong MIZ in Statistics Canada's classification) o Rural-Remote: Areas with a core population of <10,000 and 5-29% of the population commute to an urban area (referred to as Moderate MIZ in Statistics Canada's classification) o Rural-Very Remote: Areas with a core population of <10,000 and 0-4% of the population commute to an urban area, also includes non-urban parts of Territories (referred to as Weak MIZ, No MIZ, Territories outside CAs in Statistics Canada's classification)

• Hewitson P, Glasziou P, Watson E, Towler B, Irwig l. Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (Hemoccult): an update. Am J Gastroenterol. 2008;103(6):1541–9. • Mandel JS, Church TR, Ederer F, Bond JH. Colorectal cancer mortality: Effectiveness of biennial screening for fecal occult blood. J National Cancer Inst. 1999 Mar 3;91(5):434–7. • Ontario Health Technology Advisory Committee. OHTAC recommendation: screening methods for early detection of colorectal cancers and polyps [Internet]. Toronto: The Committee; 2009 [cited 2015 Dec 1]. Available from: http://www.hqontario.ca/Evidence/Publications-and-OHTAC-Recommendations/Ontario-Health-Technology-Assessment-Series/Screening-Methods-for-Early-Detection-of-Colorectal-Cancers-and-Polyps. • Jorgensen OD, Kronborg O, Fenger C. A randomised study of screening for colorectal cancer using faecal occult blood testing: Results after 13 years and seven biennial screening rounds. Gut. 2002 Jan;50(1):29–32. • Mandel JS, Church TR, Bond JH, Ederer F, Geisser MS, Mongin SJ, et al. The effect of fecal occult-blood screening on the incidence of colorectal cancer. N Engl J Med. 2000;343(22):1603-7. • Moss S, Ancelle-Park, R, Brenner H. Evaluation and interpretation of screening outcomes. In: Segnan N, Patnick J and von Karsa L, editors. European Guidelines for quality assurance in colorectal cancer screening and diagnosis: First edition. Luxembourg: Publications Office of the European Union; 2010. p. 72–102. • Cancer Care Ontario. Incidence & Mortality in Ontario. Available from: https://www.cancercare.on.ca/ocs/csurv/stats/ontario/. • Cancer Care Ontario. Colorectal cancer screening. Available from: https://www.cancercare.on.ca/pcs/screening/coloscreening • Cancer Care Ontario. Screening Guidelines. Available from: https://www.cancercare.on.ca/pcs/screening/coloscreening/cccstandardsguidelines/.

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