What is the FOBT?

An at home stool test, also known as the Fecal Occult Blood Test (FOBT) is the recommended screening test for colon cancer for people at average risk who are 50 or over. It’s safe, not invasive and recommended every two years.

This test finds blood in the stool that is not visible to the naked eye. Polyps and/or tumours in the colon have blood vessels that can release a trace amount of blood onto the stool when it passes by. Stool tests check for occult (hidden) blood. The stool test helps identify polyps before they become cancerous.

The presence of blood does not necessarily mean cancer. If blood is found, more testing is necessary to find out if it was caused by cancer.

How does the FOBT work?

The FOBT uses a chemical reaction on a paper card to find 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 separate stool samples over three different days, at home, and then mailing the kit to a lab for analysis.

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

How do I get the FOBT?

You can get an FOBT kit in the following ways:

1. Talk to your health care provider. Your health care provider can provide you with an FOBT kit.
2. If you don’t have a health care provider, call Telehealth Ontario’s Colorectal Screening Line at 1-866-828-9213. This is a 24 hour line. The staff person who answers the phone will ask you for your health card information, and will ask you if you’re experiencing any symptoms of colon cancer. If you are, you will be redirected to a Telehealth Ontario nurse. If you don’t have any symptoms, the staff person will conduct a risk assessment to ensure that you’re eligible for an FOBT. The representative will ask to relay information that is on your health card, will ask you questions about your colon cancer family history, and will mail you a kit if you are eligible. They will not ask you detailed questions about your gender or sexual identity, but they will ask you about what the gender on your health card is.

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 copy (PDF).

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, if you still get monthly bleeding cycles, bleeding hemorrhoids, or a urinary tract infection, it’s not a good time to do a stool test. As an aside, if there’s blood in your stool or urine, it would be a good idea to have that checked out by your health care provider.

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, the width of a piece of paper, 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 movement, for two additional days, and 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 put the kit in the mail.

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.

The envelope is pre-addressed and the postage is pre-paid, so all you have to do is put it in the mail when you’re done or drop it off at a local community laboratory collection centre.

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 to the public in the spring of 2008 as the first population-based, organized colorectal screening program of its kind in Canada. This means that there is now a structured program in place in Ontario that is working to get every eligible Ontario resident regularly checked for colon cancer before they develop symptoms. They are doing this by promoting the test and ensuring that there are easy and efficient methods to obtaining it. As well, the ColonCancerCheck program ensures that there is a process in place to respond to the increased number of tests being carried out and that there are follow-up procedures in place.

The goals of ColonCancerCheck are to reduce deaths from colon cancer and to support health care providers in providing the best possible colon cancer screening for their patients.

For more information about ColonCancerCheck:

• call the ServiceOntario 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 doctor will also receive your test results.
• If you don’t have a health care provider and received your kit from ColonCancerCheck, and you have a positive test result, ColonCancerCheck will notify you of your test result and will work with you to find a health care 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 health care provider. If you do not have a health care 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 health care 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 using a camera that is inserted into the anus. On the down side, they are more invasive than FOBTs. On the upside, they can provide treatment as well as screening. If polyps are found during the test, they can usually be removed during the procedure. Growths that are too large to be removed and/or appear to be cancer are removed surgically at a later date and a biopsy is taken during the colonoscopy to get a sample of cells for testing.

A colonoscopy is the usual follow up test for people who have a positive FOBT result.

It is also the initial screening test used for people who have been identified as being at higher risk for developing colon cancer.

What happens during the colonoscopy?

A colonoscopy is done in a hospital or clinic on an outpatient basis. The procedure usually takes about 30 45 minutes.

• You will be asked to take off your clothes during the test, and you will wear a paper gown. As a trans person, it can be uncomfortable and even terrifying to have to get naked at your doctor’s office. Click here for more information on how to be more comfortable while getting a colonoscopy
• 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 both to have some mild abdominal cramping and to pass gas, both during and after the test.
• The sedation given to you for the procedure may mean you have little memory for events during the procedure. This is normal.
• 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 the colonoscopy?

To get a colonoscopy, you need a referral from your doctor. If you don’t have a doctor, you can call Telehealth Ontario’s Colorectal Screening Line at 1-866-828-9213 and they will conduct a risk assessment with you. If you are high risk and qualify for a colonoscopy, they will connect you with a 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 and emotionally?

• Ask the doctor who is referring you, to book a colonoscopy at a clinic that is known to be trans positive, if that’s possible.
• It may help to have a supportive friend attend the appointment with you.
• It may help to call ahead to the screening centre to speak to a booking clerk, receptionist or technician to discuss what practices are in place to make the reception, changing room, waiting area and test procedure as stress-free as possible for you. You can ask in advance what intake questions they will have for you, so that you can be prepared. You can call, or get a friend to call, and ask if they will ask about gender, and in what ways, during the intake process. You can also ask about how they will accommodate any of your other access needs at this time, for example, wheelchair accessibility.
• A colonoscopy is not a health procedure that depends on your sex or gender. If a health care provider is asking you questions about your gender identity, feel free to ask (or have a friend ask) if those questions are necessary for the medical procedure and to stop the conversation if at any time you feel uncomfortable.
• Talk to your doctor ahead of time to find out what sedative options are available for you.
• Getting a colonoscopy can be a bit intimidating, and for trans folks there may be another layer of worry about transphobia to tackle. For some of us, being out isn’t an option, especially once you’re in a paper gown. If you want to or have to come out, it’s often best to do so when you have your clothes on (so before you put on the paper gown) so that you feel more empowered. You can also call the clinic in advance, and let them know that you’re trans or gender non-conforming before you get to the appointment. Another strategy that you can use is to ask your referring health care provider to disclose your gender identity for you. They can do so in the requisition form. This can be helpful if the gender on your health card doesn’t match your gender identity or expression, and can also be a good place to let the colonoscopy doctor know what pronouns and name you prefer.
• Since a colonoscopy requires access to your colon, this means that you will be naked from the waist down. Your genitals will be covered with a paper gown, but there is a good chance that your health care provider will be able to see them. While this can be scary and vulnerable-making, you do have the power to figure out what you want to do in advance of the procedure. Some of us may want to come out about our gender identity in the hopes of being treated with respect and dignity, and getting the health care we deserve. Some of us might not want to disclose for fear of experiencing transphobia. This means that we will likely be misgendered, which we know can be painful. Some of us may have to come out because of where we are at in our transition, or because our health card or other medical documentation doesn’t match who we are. It’s a good idea to think through the pros and cons of your decision in advance. If you want to or have to come out, think about the ways that work best for you. For example, would you feel comfortable telling your doctor face-to-face? Would you prefer it if your referring doctor wrote a letter or wrote your needs in the requisition form? What if you wrote a letter and handed it to the doctor in person? An email in advance? Having your accompanying friend tell the doctor? Would it be helpful to call the clinic in advance to let the doctor and accompanying staff know that you’re trans? Do you want all staff to know or just the doctor you’re working with? Thinking through the possibilities before you get to the clinic can be helpful. Consider asking a friend to brainstorm with you.
• You may want to ask your health care provider to walk you through the process of getting a colonoscopy before it starts. They can tell you step by step what they will be doing.
• Prior to the test, you can let the health care provider know what you will need to make your test more comfortable.

How will I get the 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.