Description | Specific Indicators | Ontario Public Health Standards (OPHS) | Corresponding Health Indicator from Statistics Canada and CIHI | Corresponding Indicators from Other Sources | Data Sources | Survey Questions | Alternative Data Sources | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Definitions| Cross-References to Other Indicators | Cited References | Changes Made
Proportion of people aged 50-74 who report having a screening fecal occult blood test (FOBT) in the previous two years.
- Colorectal cancer screening (FOBT) rate
Ontario Public Health Standards
The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.
Outcomes Related to this Indicator
- Board of Health Outcome (Chronic Disease Prevention): The public is aware of the benefits of screening for early detection of cancers and other chronic diseases of public health importance.
Health Promotion and Policy Development Requirements Related to this Indicator
- The board of health shall collaborate with community partners to promote provincially approved screening programs related to the early detection of cancers (Chronic Disease Prevention).
- The board of health shall increase public awareness in the following areas: Benefits of screening for early detection of cancers and other chronic diseases of public health importance (Chronic Disease Prevention).
- The board of health shall provide advice and information to link people to community programs and services on the following topics: Screening for chronic diseases and early detection of cancers (Chronic Disease Prevention).
Corresponding Health Indicator from Statistics Canada and CIHI
Corresponding Indicator from Other Sources
- Ontario's Cancer System Quality Index1: Colorectal Cancer Screening (FOBT) http://www.cancercare.on.ca/english/and search for "Cancer System Quality Index", then for "Access", then for "Colorectal Cancer screening".
Numerator & Denominator: Canadian Community Health Survey (CCHS)
Original source: Statistics Canada
1. Ontario Ministry of Health and Long-Term Care
2. Statistics Canada
Suggested citation (see Data Citation Notes):
1. Canadian Community Health Survey [year], Statistics Canada, Share File, Ontario MOHLTC
2. Canadian Community Health Survey [year], Statistics Canada, Public Use Microdata File, Statistics Canada
This module was optional content in 2003 and selected by some health units in Ontario. It was optional content
and selected by Ontario (all health units) in 2005 and 2007-08. These questions are asked of respondents 35 and over.
Colorectal Cancer Screening
An FOBT is a test to check for blood in your stool, where you have a bowel movement and use a stick to smear a small sample on a special card. Have you ever had this test?
Yes, No, Don't Know, Refused
When was the last time?
Less than 1 year ago, 1 year to less than 2 years ago, 2 years to less than 3 years ago, 3 years to less than 5 years ago, 5 years to less than 10 years ago, 10 or more years ago, Don't Know, Refused
Why did you have it? Interviewer: Mark all that apply.
Family history of colorectal cancer, Part of regular check-up / routine screening, Age, Race, Follow-up of problem, Follow-up of colorectal cancer treatment, Other - specify, Don't Know, Refused
CCSC_83A, CCSC_83B, CCSC_83C, CCSC_83D, CCSC_83E, CCSC_83F, CCSC_83G
CCSE_83A, CCSE_83B, CCSE_83C, CCSE_83D, CCSE_83E, CCSE_83F, CCSE_83G
CCS_83A, CCS_83B, CCS_83C, CCS_83D, CCS_83E, CCS_83F, CCS_83G
Alternative Data Source(s)
The Rapid Risk Factor Surveillance System (RRFSS) contains a module called Colorectal Screening. This module was optional from 2001-2008. These questions are only asked if the respondent is 40 years old and older. Starting in January 2009, these questions are asked of respondents 35 years old and older.
Have you ever had a test for blood in your stool, that is a test where you have a bowel movement and use a stick to smear a small sample of it on a special card. Have you had this test?
Did you have this test in the last two years?
What was the reason for having this test (a test for blood in your stool)? Was it because of a family history of colorectal cancer, your age, a regular check-up or routine visit, ongoing or past bowel problems, concern about a possible problem, or was there some other reason?
Family history of colorectal cancer,
Regular check-up or routine visit,
Ongoing or past bowel problems,
Concern about possible problems,
What was the reason for having this test (a test for blood in your stool)?
ONE: a regular check-up or routine visit,
TWO: was it because of ongoing or past bowel problems, or
THREE: concern about a possible problem?
A regular check-up or routine visit,
Because of ongoing or past bowel problems,
Concern about possible problems,
Analysis Check List
- The numerator is defined as people aged 50-74 who report having had an FOBT in the previous two years for one or more of the following reasons: family history of colorectal cancer, part of regular check-up / routine screening, age, race. These respondents must not have had an FOBT in the previous two years for follow-up of a problem, follow-up of colorectal cancer treatment, or ‘other’ reason.
- If using RRFSS for 2001-2008, the response “regular check-up or routine visit” is the reason that is meant to capture screening FOBT, and should form the numerator.
- Users should refer to the most recent RRFSS Manual of Operations for a complete list of RRFSS analysis guidelines.
- Denominator Data - cell size less than 30 not to be released (based on unweighted data).
- Numerator Data - cell size less than 5 not to be released (based on unweighted data).
- Coefficients of variation (CV) should be calculated for every estimate. The following categories determine the release of the data:
- CV between 0 and 16.5: estimate can be released without qualification.
- CV between 16.6 and 33.3: estimate can be released with qualification: interpret with caution. High variability.
- CV greater than 33.3: estimate should not be released, regardless of the cell size.
- 95% confidence intervals should accompany all released estimates. In general the simple computation of the C.I. for a proportion assuming SEp = sqrt(pq/n) and CI95% = p +/- 1.96*SEp is sufficient. However, if estimates are close to 0 or 100% and the simple computation confidence intervals include values less than zero or greater than 100 then the Fleiss 2nd edition computation for skewed estimates should be employed.
- General household weight will be applied for questions related to the individual.
- Household weight is to be applied for questions about households when we wish to determine the population/number of people affected.
- Household weight is not to be applied for child proxy questions (bicycle helmet use, car seat safety), dog and cat immunization modules, or other questions that relate to the household rather than the respondent.
- Household weights are not required to be recalculated for sub-population based questions; for example mammography in women ages 35+ years and 50-74 years.
- If the weights supplied with the data set (health unit wave specific, health unit cumulative total, all health units combined wave specific, all health units combined cumulative total) are not appropriate for the required analysis, then a time-specific weight must be calculated. For example, a new weight is required for all seasonal modules.
- If the cell size of ‘Don't Know' responses is 5% or greater, ‘Don't Know' responses should be included in the denominator of the analyses and reported separately.
- If the cell size of ‘Refusal' responses is 5% or greater, ‘Refusal' responses should be included in the denominator of the analyses and reported separately.
- When an indicator is being compared between groups (e.g. health units, time periods, gender), if any one group has ‘Don't Know' and/or ‘Refusal' responses that are 5% or greater, ‘Don't Know' and/or ‘Refusal' responses should be included in the denominator of the analyses and reported separately for all groups.
- A provincial sample is not available with the RRFSS.
- Refer to the RRFSS Data Dictionaries at http://www.rrfss.ca/ for more information about module questions and indicators.
Method of Calculation
|Number of people aged 50-74 reporting having had a screening FOBT in past two years |
Total number of people aged 50-74
| X 100|
This is defined as people in the CCHS who report having had an FOBT in the previous two years for one or more of the following reasons:
1 Family history of colorectal cancer (CCS_83A=1)
2 Part of regular check-up / routine screening (CCS_83B=1)
3 Age (CCS_83C=1)
4 Race (CCS_83G=1)
and not for any of the following reasons
5 Follow-up of problem (CCS_83D=2)
6 Follow-up of colorectal cancer treatment (CCS_83E=2)
7 Other - Specify (CCS_83F=2)
- Sex: male, female
- Geographic areas of patient residence: public health unit
FOBT test - A fecal occult blood test (FOBT) tests for blood in the stool. Small samples of stool are placed on special cards and sent to a laboratory for testing. Blood in the stool may be a sign of colorectal cancer. 10% of people with a positive FOBT are found to have cancer during a follow-up colonoscopy.6
Cross-References to Other Indicators
- Cancer Care Ontario: Cancer System Quality Index. Colorectal Cancer Screening (FOBT) Participation, 2008. Available online at: http://www.cancercare.on.ca/english/csqi2008/csqiaccess/csqi-colorectal-screen/ (Accessed January 23, 2009).
- The Provincial Cancer Prevention and Screening Council. Report on Cancer 2020. Canadian Cancer Society, Ontario Division, and Cancer Care Ontario, 2006. Available online at: http://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=13824(Accessed January 23, 2009).
- Canadian Cancer Society/National Cancer Institute of Canada. Canadian Cancer Statistics 2006. April 2008. Special Topic: Progress in Cancer Control: Screening, 71-19. http://www.cancer.ca/canada-wide/about%20cancer/cancer%20statistics/canadian%20cancer%20statistics/special%20topics.aspx?sc_lang=en.
- Public Health Agency of Canada. Reducing Canadian Colorectal Cancer Mortality Through Screening. 2002. Available online at: http://www.phac-aspc.gc.ca/publicat/ncccs-cndcc/ccsrec_e.html (Accessed January 23, 2009).
- 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. American Journal of Gastroenterology 2008;103:1541-49.
- Government of Ontario. Ministry of Health and Long-Term Care. ColonCancerCheck. http://www.coloncancercheck.ca/ (Accessed January 23, 2009).
- Cancer Care Ontario. Insight on Cancer. News and Information on colorectal cancer and screening in Ontario. Toronto: Canadian Cancer Society (Ontario Division), December, 2008. Available online at: http://www.cancer.ca/ontario/publications/od-insight%20on%20cancer/insight%20on%20cancer%20-%20volume%207.aspx?sc_lang=en (Accessed May 22, 2009)
- Sewitch MJ, Fournier C, Ciampi A, Dyachenko A. Colorectal cancer screening in Canada: results of a national survey. Chronic Dis Can 2008;29(1):9-21.
|Date||Formal Review or Ad Hoc?||Changes made by||Changes|
|June 25, 2009||Formal Review ||Cancer, Smoking and Sun Safety subgroup of Core Indicators. ||This is a new indicator. |
|June 29, 2009||Ad hoc||Harleen Sahota on behalf of CIWG||Removed an out-of-date point in the Analysis Check List on how the Health Indicators department at Statistics Canada handles 'Not Stated' respondents when using CCHS data.|