In Ontario, the method of finding colon cancer early is testing the stool for occult (hidden) blood. The fecal occult blood test (FOBT) is recommended every two years for people ages 50 and over. The FOBT is non-invasive and can be done at home.

What is the FOBT?

The Fecal Occult Blood Test (FOBT) is the recommended screening test for colon cancer for adults age 50 and over at average risk. It’s safe, non-invasive and recommended every two years. You use the FOBT at home to test your stool (bowel movements).

The FOBT checks for occult, or hidden, blood in the stool. Polyps and/or tumours in the colon have blood vessels that can release a small amount of blood onto the stool. Although this blood isn’t often visible, the FOBT can detect it. By finding occult blood, the FOBT helps identify polyps often before they become cancerous.

If the FOBT finds blood, it doesn’t necessarily mean that you have cancer. If the test finds blood, you’ll need more testing to find out its cause.

How does the FOBT work?

The FOBT checks for traces of blood in the stool from polyps or tumours. Traces of blood can be present in the stool for a variety of reasons, not just cancer.

The FOBT comes in a paper kit with simple instructions. The test involves taking three small, separate stool samples over three different days, at home. Each sample is smeared onto a paper card. You then mail the kit to a lab for analysis. If there’s blood in the stool, a chemical reaction on the paper card will alert lab technicians.

It’s natural to be uncomfortable doing a test that involves handling your own stool. It can help to remember that this simple test can help save your life.

How do I get the FOBT?

FOBT kits are free of charge. You can get an FOBT kit in the following ways:

1. Talk to your healthcare provider. He or she can provide you with an FOBT kit.
2. If you don’t have a healthcare provider call Telehealth Ontario at 1-866-797-0000 or TTY: 1-866-797-0007. A nurse will take down your information, conduct a risk assessment and, if you are eligible, will mail you a kit.

How do I prepare for the FOBT?

Taking a stool test for colon cancer is simple. But make sure to take a few minutes to read all of the instructions provided in the instructional kit before you take the test. You can also download a PDF copy of the instructions.

You’ll be asked to collect stool samples on three separate days. However, you should avoid collecting samples if blood is visible in your stool or urine. For instance, it’s not a good time to do a stool test if hemorrhoids are bleeding.

Be sure to avoid citrus three days before the test as well as during the test. This includes vitamin C supplements, citrus juices and fruit, such as oranges and grapefruit. Except for citrus, you can eat your regular meals and take your prescribed medications.

How do I complete the FOBT?

Once you have the free kit, the test is pretty easy.

You will collect stool samples on three different days from three different bowel movements within a 10-day period. This means that, once you begin the test, you have to finish it within 10 days of starting. The kit comes with applicator sticks, a test card, a foil envelope, a requisition form, and a pre-paid postage envelope.

The test card has three different flaps, one for each day. Under each flap, there are two separate areas on which to smear your samples.

To collect the stool you can use a disposable container, plastic wrap or several layers of toilet paper in the toilet bowl to support the stool. You then use the applicator stick to collect a small sample of the stool. You apply a very thin smear to area 1 of the flap. You then smear a second sample from a different part of the stool in area 2 of the flap. Wait until the samples are dry before you close the flap.

Collect your next samples during your next bowel movements for two more days. Place the test card in the unsealed foil envelope between bowel movements. Be sure to keep the test card in a place away from heat, light, water and chemicals.

When you’ve collected all of your samples, you can seal the envelope. The envelope is pre-addressed and the postage is paid. When you’re done, all you have to do is mail it back or drop it off at a local community laboratory collection centre.

Some helpful tips:

• Be sure to the check the expiry date on the back of the envelope before you start the test. Don’t use an expired kit or a kit that is about to expire.
• Make sure that your toilet bowl is clean and free of toilet bowl cleaning agents.
• Keep the FOBT kit at room temperature, not in the fridge.
• Complete the test within ten days of beginning it.
• Write the date of each sample where indicated on the flap before smearing the sample.

Check out this video to learn how to complete the FOBT in the comfort of your own home.

You can also find detailed instructions on how to complete the FOBT kit in English, French and 26 other languages at ColonCancerCheck (PDF).

What is the ColonCancerCheck program?

ColonCancerCheck was launched in the spring of 2008 as the first population-based, organized colon screening program of its kind in Canada. The program is a partnership between the Ontario Ministry of Health and Long-Term Care and Cancer Care Ontario (CCO). CCO is a provincial government agency responsible for improving cancer services.

The goals of ColonCancerCheck are to reduce deaths from colon cancer through an organized screening program, and to support healthcare providers in providing the best possible colon cancer screening for their patients.

For more information about ColonCancerCheck:

• call the Service Ontario INFOline at 1-866-410-5853 or TTY 1-800-387-5559.
• email the program at ColonCancerCheck.moh@ontario.ca
• visit the ColonCancerCheck website

How will I get the FOBT results?

Once the lab has processed your sample, there are several different ways you may get your results:

• You will receive a letter with your results from ColonCancerCheck. Your healthcare provider will also receive your test results.
• If you don’t have a healthcare provider and received your kit from Telehealth Ontario, and you have a positive test result, ColonCancerCheck will notify you of your test result and will work with you to find a healthcare provider to arrange for follow-up care.

You can expect your test results within a month. If you haven’t received them by this time, contact your healthcare provider. If you don't have a healthcare provider, call ColonCancerCheck at 1-866-410-5853 to find out about the status of your results.

If your test results are negative, that means that the test was not able to detect blood in your stool.

If your test results are positive, this means that you have blood in your stool. Most people who have blood found in their stool do not have colon cancer. Blood can be found in the stool for many reasons including ulcers, hemorrhoids, inflammatory bowel disease, diverticulosis, or as a result of taking anti-inflammatory medications.

If you tested positive, get follow up care to determine why you have blood in your stool. Follow up care usually means having a colonoscopy within two months of the FOBT finding blood in your stool. If you don’t have a primary healthcare provider, ColonCancerCheck will refer you to a doctor or nurse practitioner for follow up care.

If your test is negative, you will be sent a reminder letter by ColonCancerCheck to repeat the test in two years.

What is a colonoscopy?

A colonoscopy is a procedure that lets the doctor look at the lining of the entire rectum and colon. The procedure uses a small flexible camera that is inserted into the anus.

On the down side, colonoscopies are more invasive than FOBTs. On the up side, they can provide treatment as well as screening. If polyps are found during the test, they can usually be removed during the procedure. Biopsies are taken of growths that are too large to be removed and/or that appear to be cancer. These are tested for cancer and are removed surgically at a later date.

A colonoscopy is the usual follow-up test for people who have a positive FOBT result. Colonoscopies are also used as the initial screening test for people who have a higher than average risk for developing colon cancer.

What happens during a colonoscopy?

A colonoscopy is done in a hospital or clinic on an outpatient basis. The procedure usually takes about 30 to 40 minutes.

• You will be asked to take off your clothes during the test, and you will wear a paper or cloth gown.
• You will be asked to lie on one side of your body.
• An intravenous line will be placed in your arm so that medications, including sedation, pain medication and antibiotics, can be given to you during the procedure.
• The doctor will then put the endoscope (the camera) into the anus and then into the rectum and colon.
• The colon is inflated with air to stretch out the lining so that the doctor can inspect the entire surface.
• If polyps are detected or biopsies are needed, instruments can be passed through the endoscope to perform these procedures.
• It’s normal to have some mild abdominal cramping and to pass gas, both during and after the test.
• You will be monitored for 1-2 hours after the colonoscopy.
• Check with your doctor about when you can go back to your regular activities and diet.

How do I prepare for a colonoscopy?

To get a colonoscopy, you need a referral from your doctor. Your doctor will also give you instructions on how to prepare for your colonoscopy to make sure the procedure is safe and effective. Preparations usually include:

• emptying your colon before you get a colonoscopy. This means that you have to follow a special diet for one or two days before the test, including no solid foods. You will then have to take a laxative and/or have an enema the day before the test, to make sure the bowel is empty.
• making a list of all of the medications and dosages that you’re taking to bring to the appointment.
• finding someone to go with you to the appointment, if you can. You will likely be given sedatives before the test, so it’s important to have someone help you get home and stay with you while the sedatives are in your system. You won’t be able to drive for 12 hours after the test, so it’s important to figure out in advance how you’re going to get home.

If you have questions about the procedure, be sure to ask them before you take the sedatives, as they can impair your ability to think clearly. Some questions you may want to ask include:

• when will I get the test results back?
• how should I take care of myself for the next day or two after the procedure?
• when can I start drinking alcohol after the procedure?
• if polyps are found, who will give me the results of the lab analysis, and who will tell me about further testing? When?

How can I make the colonoscopy more comfortable physically?

It’s true: a colonoscopy is an intimate procedure. It also requires some careful preparation, which can be uncomfortable. Here are some tips to make the prep and the procedure as comfortable as possible:

• Remember that you will be given sedation and pain medication before and during the colonoscopy. Hopefully, these should help you relax and stay pain-free. If you’re in pain during or after the test, tell your doctor.
• Make sure that you receive your colonoscopy prep instructions well before the test, and read them over as soon as you get them. You may need to stop certain foods and medications up to a week ahead of time.
• You will experience diarrhea as part of the process to clear out your bowel. Make sure that you have cleared your schedule the evening before your test so that you can be home and near a bathroom during the process.
• Pick up some medicated wipes and a skin-soothing cream to help keep your skin comfortable while you have diarrhea.
• If you’re prone to constipation, talk to your healthcare provider about taking an extra laxative to ensure that your bowel is fully cleared out. You may need to temporarily stop taking any supplements (like calcium, iron and multivitamins) that can cause constipation. Drinking lots of fluids and getting exercise can help.
• The day before the test, when you can’t eat solid food, keep a variety of clear liquids on hand. You can have water, popsicles, Jell-O, clear broth, coffee or tea without milk or cream, soft drinks or Gatorade.

How can I make a colonoscopy more comfortable emotionally?

Let’s be frank: many of us aren’t thrilled about the idea of having a scope inserted into the anus. Having a colonoscopy is an intimate procedure, and the test or its preparation may have you feeling embarrassed, anxious or vulnerable. Those of us who have had negative experiences with the healthcare system or who are survivors of abuse may find the test upsetting or traumatic. Still, a colonoscopy can save your life. Here are some tips to make the process more emotionally comfortable:

• Remember that you will be sedated during the test. In fact, most people are asleep or in a comfortable, drowsy “twilight” state during the test and aren’t even aware that it’s happening.
• If you’re worried about the discomfort of the test prep, it can help to know that many new products make the process easier and more comfortable. You may not even need to take the day off work the day before.
• Talk to your healthcare provider ahead of time to find out what sedative options are available for you.
• It may help to have a supportive friend attend the appointment with you.
• Coming out to your healthcare provider is a personal decision. For some gay and bisexual men, being out to our providers is important to getting the healthcare that we need. For others, coming out can make getting adequate healthcare more difficult because of fears about experiencing homophobia and/or provider misinformation. It can help to think in advance about whether you’re comfortable being out, and how you might answer any questions related to your partner(s) or sexuality.
• You can call the hospital or clinic ahead of time to speak to a booking clerk, receptionist or technician about what practices are in place to make the reception area, changing room, waiting area and procedure as welcoming and stress-free as possible for you. Is the clinic gay-friendly? Have they undergone and sensitivity training for LBGTQ+ communities? You can also ask about how they will accommodate any of your access needs.
• Ask your friends and family members about their experiences with getting a colonoscopy. Hearing about it from somebody else can increase your confidence.
• Before the test, you can let the healthcare provider know what you will need to make your test more comfortable.

How will I get my colonoscopy results?

If your colonoscopy finds no cancer, polyps or any other problem, you do not have to get another colonoscopy for ten years. At that point, you will go back to getting an FOBT every two years.

If your colonoscopy results are abnormal, that could be for a variety of reasons. Some include diverticulosis (abnormal pouches in the lining of the colon), inflammatory bowel disease, bleeding, polyps or cancer.

If your colonoscopy showed polyps, they were likely removed during the test. Talk to your health care provider about when you have to get screened again. If polyps can’t be removed, then further treatment will likely be required.