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Registered Nurse Flexible Sigmoidoscopy

Evidence for screening with flexible sigmoidoscopy

Several large international trials have shown that screening with flexible sigmoidoscopy provides a significant reduction in colorectal cancer incidence (new cases) 1,2 and mortality (deaths) 1,2,3 (see references at the bottom of this page).

Evaluations of a 2007 Cancer Care Ontario pilot study demonstrated the success and sustainability of this method. See the 2013 report: Registered Nurse-Performed Flexible Sigmoidoscopy – Implementation and Outcomes of the Ontario Pilot Project

Flexible sigmoidoscopy is a procedure to examine the lining of the rectum and sigmoid colon (lower third of the colon) that can be used for colorectal cancer screening. It allows for the detection, biopsy and removal of small polyps (pre-cancerous lesions). Flexible sigmoidoscopy does not require sedation and the preparation is simple.

In Ontario, the procedure can be performed by a physician, or by a specially-trained registered nurse under the medical directive of a physician as part of the Registered Nurse Flexible Sigmoidoscopy (RNFS) program, which began as a pilot program in 2007.

Within the ColonCancerCheck program, the fecal occult blood test (FOBT) is the recommended test for asymptomatic people ages 50 to 74 without a family history of colorectal cancer (i.e. average risk).

Individuals ages 50 to 74 years at average risk for colorectal cancer can be screened with flexible sigmoidoscopy every 10 years. These individuals can be referred to a registered nurse flexible sigmoidoscopy site for colorectal cancer screening.

For people at increased risk of developing colorectal cancer (defined as a family history of colorectal cancer in one or more first-degree relatives), colonoscopy is the recommended screening test beginning at age 50, or 10 years earlier than the age the relative was diagnosed, whichever comes first. Primary care providers should have a discussion with their patients to decide which screening test is right for them.

ColonCancerCheck RNFS Eligibility Criteria

People are eligible for colorectal cancer screening with registered nurse flexible sigmoidoscopy if they meet the criteria below. Referral from a primary care provider is required.

  • Men and women ages 50 to 74
  • Average risk of colorectal cancer
    • No first degree relative who has been diagnosed with the disease
    • No personal history of previous polyps (with the exception of previous rectal hyperplastic polyps), colorectal cancer, or inflammatory bowel disease (i.e., Crohn’s Disease or ulcerative colitis)
  • Asymptomatic
  • Due for colorectal cancer screening
    • No FOBT in the past two years, flexible sigmoidoscopy in the past 10 years or colonoscopy in the past 10 years

How to Refer Patients for Registered Nurse Flexible Sigmoidoscopy

Primary Care Providers: In regions with a Registered Nurse Flexible Sigmoidoscopy site, you have the option to refer eligible individuals for colorectal cancer screening with this method. Discuss with your patients which screening test is right for them.

No RNFS site in your region? Refer your patients to the closest site for registered nurse flexible sigmoidoscopy, to any endoscopist for flexible sigmoidoscopy, or discuss other screening tests.

To refer someone, request a referral form from the coordinator at one of the sites listed below.

Contact for Referral Forms

Grand River Hospital
519-749-6578 x4046
St. Mary’s General Hospital 519-749-6578 x4046
Kingston Hotel Dieu Hospital 613-544-3400 x2409
The Ottawa Hospital Civic Campus 613-798-5555 x10402
Timmins & District Hospital
705-267-2131 x2306

Want More Information?

To find out more about Registered Nurse Flexible Sigmoidoscopy, email or call 1-866-662-9233.

For more information about the ColonCancerCheck program, visit the Screen for Life section.

  1. Atkin WS, Edwards R, Kralj-Hans I, Wooldrage K, Hart AR, Northover JM, et al. Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial. Lancet. 2010;6736(10):1-10.
  2. Segnan N, Armaroli P, Bonelli L, Risio M, Sciallero S, Zappa M, et al. Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian randomized controlled trial–SCORE. J Natl Cancer Inst. 2011;103:1-13.
  3. Schoen RE, Pinsky PF, Weissfeld JL, Yokochi LA, Church T, Laiyemo AO, et al. Colorectal-cancer incidence and mortality with screening flexible sigmoidoscopy. NEJM 2012; 366 (25):2345-57.

Last modified: Mon, Oct 02, 2017
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