Colorectal Cancer Screening and FIT Testing

Algorithm:

1. During patient encounter recommend FIT testing to:
   • Patients age 45-75 years old at average risk
   • No personal or family history of polyps or colorectal cancer – these individuals should be referred to a colonoscopy directly!
   • No colonoscopy in the last 5 years
   • For people at average risk, FIT testing should be done every year
   • FIT testing is not appropriate for those with current gastrointestinal symptoms like rectal bleeding, change in bowel habits, or abdominal pain. These people will require colonoscopy – please fill out the Imaging Referral Request form on the stvhopeclinics.org website and possibly refer to County Indigent Care
2. Complete Lab Requisition Form
   • Fill out LabCorp Lab Requisition form and give original to patient. Ask patient to fill out the specimen collection date and time on their own prior to mailing the sample + Lab Requisition form together
3. Log patient information
   • Order FIT Test on Epic and mark as External lab order, use Z12.11 Screening for colorectal cancer as the diagnostic code
   • Write date of visit and medical record number on the CRC screening tracker spreadsheet when you pick up the FIT test from the lab as this helps us monitor the process and ensure follow up
4. Provide FIT test to patient
   • FIT test kits already include instructions for home administration in English and Spanish – please go over these instructions with the patient
   • Explain that the test checks for occult blood in stool, which can indicate cancer/polyps
   • Ask patients to mail FIT test + Lab Requisition form (with the collection date and time noted) together using the pre-addressed envelope. Patients can also drop off all materials to clinic, and clinic can mail the sample and form on their behalf
   • Inform patient that they will be notified if the test is positive and will need a follow-up colonoscopy paid for through MD Anderson. Please give patients the MD Anderson Project 80% Program flyer for more information!
5. Follow up on result
   • FIT tests will be processed by LabCorp (must have Lab Requisition form included for processing) and result on the LabCorp portal
   • Staff and student leadership will check portal and notify patient and ordering provider about results
   • Results and follow up are documented in Epic EHR
6. If FIT is negative, test is repeated yearly until age 75
7. If FIT is positive
   • Inform patient and provider
   • Complete online colonoscopy referral form on the stvhopeclinics.org website or fax a paper referral to MD Anderson
   • MD Anderson will provide a prior authorization for a GI specialist, ensure patient is informed about their appointment and assist with bowel prep pick-up (available in clinic) and any transportation needs

Patient Education Materials:

Resources