The Program is addressed to women and men between 50 and 69 years old and consists of being, every two years, a test (immune test) to detect the presence of small amounts of blood in the stool that cannot be seen with the naked eye. This test is free, simple, convenient and can be done at home.

 How can you participate?

The invitations are not sent to the entire population at once, but are followed in an order according to primary care center (CAP of the neighborhood or municipality) according to the Calendar established

When the program arrives in a municipality or neighbourhood, all people aged between 50 and 69 who live there will receive a letter at their address, together with an informative leaflet and a list of collaborating pharmacies in their area.

You may not receive the invitation until the age of 50, as the entire territory is invited over a two-year period. But you must always receive it before you turn 52.

It is important that you have your address updated in CAP or La Meva Salut. If you do not receive the letter within the period established in the calendar, check that your details are correct in La Meva Salut, modify them if necessary, and contact theVallès Occidental Cancer Screening Technical Office.

Once you have the letter, you need to take it to any of the pharmacies  collaborators of the program in the attached list to give you the test and the instructions to take it.

 ⚠ Before going to the pharmacy, contact theTechnical Office of Cancer Screening Technical Office of Cancer Screening if you present:

• Personal history of colon or rectal cancer.
• Personal history of colorectal pathology that requires specific follow-up, especially ulcerative colitis, Crohn's disease and other diseases.
• Total colectomy (removal of the colon).
• Family history of familial adenomatous polyposis or other polyposis syndromes, or Lynch syndrome.
• A first-degree relative (father, mother, brother, sister, son, daughter) diagnosed with colorectal cancer.
• Digestive symptoms (blood in stool, changes in bowel habits, abdominal pain, weight loss) not studied. A doctor must study the symptoms and determine the most appropriate diagnostic tests in each situation.

  Fecal occult blood test 

It is a very simple, free test that can be done at home and does not require any prior preparation. It consists of collecting a small sample of stool that will later be analyzed in the laboratory of the Parc Taulí Health Corporation to detect the presence of blood not visible to the naked eye. Once the test is done, you must return it to the pharmacy as soon as possible. If not, you will need to keep it in the fridge until you can take it. See them instructions for collecting the sample.

⚠ Important information for taking the test

• Do not test if you have bleeding hemorrhoids or menstruation until 3 days have passed without bleeding.
• Avoid contaminating stool with urine.
• You do not need to be fasting or following or following any diet to take the test.
• You can take your medication as usual.
• Do not swallow the liquid in the tube. If the liquid comes into contact with the eyes, mouth or skin, rinse with plenty of water and, if necessary, consult a doctor or pharmacist.

If you lose the test, accidentally exchange it with someone in the family or if there is any problem during the test, tell the pharmacist, who will tell you what to do, or call theCancer Screening Technical Office.

The results of the fecal occult blood test

After a few weeks of returning the sample to the pharmacy, you will be notified of the test result by post or by phone and you can also check it in La Meva Salut.

Most likely in the test no signs of blood. This is the result in 96 out of every 100 people who participate in the Program. It means that you are unlikely to have colon and/or rectal cancer. After two years, we will offer you to take the test again whenever you are 69 or older. If you are over 69, this test can be offered by your primary care doctor.

The fecal occult blood test, like any medical test, is not perfect and does not detect all cancers. If the cancer or polyp does not bleed at the time of the test, it may not be detected. That is why, even if the test has come out negative, if you have discomfort (visible blood in the stool, change in bowel rhythm, pain), you must consult your doctor.

In a small percentage of cases, they are detected signs of blood in the stool sample and we say that the test has been positive. In this case, you will be scheduled for a first visit with the screening nurse at your reference hospital (Parc Taulí Hospital, Consorci Sanitari de Terrassa, Hospital Mútua de Terrassa) who will review your case and propose a colonoscopy with sedation to find out what is the cause of the bleeding.

 ⚠It is important that you inform the screening nurse of all the medication that you are taking, especially if it is anticoagulants (such as Sintron, Dabigatran, Apixaban, Rivaroxaban, Edoxaban) and antiplatelet agents (clopidogrel, prasugrel, ticlopidine, acetylsalicylic acid).

 Colonoscopy, the diagnostic test

Colonoscopy is a test that allows you to visualize the inside of the large intestine. It is done with sedation, on an outpatient basis and has a low risk of complications. To have a colonoscopy, you need to have one prior preparation (diet and laxatives) so that the bowel is clean and can be explored properly and in detail. The screening nurse will explain to you in a previous visit how to perform this preparation and will review the medication you take.

The colonoscopy will be performed in the Endoscopy Unit of your referring hospital (Parc Taulí Hospital, Consorci Sanitari de Terrassa or Hospital Mútua de Terrassa). Before starting the test, sedation is usually administered. Then, a flexible tube with a light and a small camera is inserted through the anus to visualize the inside of the bowel. During the colonoscopy, biopsies can be taken of the lesions that are detected. If polyps are found, they are usually removed and sent to the pathology lab for analysis.

⚠It is imperative that come accompanied for the colonoscopy. At the end of the test, you need to wait a while for the effects of sedation to wear off and you will not be able to drive or use dangerous machinery for a few hours. You may feel a little bloated because of the air that has been pushed into the bowel so you can see the walls better.

 Like any medical procedure, colonoscopy has risks, although the frequency of serious complications is very low (between 1 and 3 per 1000 people who have a colonoscopy). Although the frequency is low, reactions to sedation, bleeding, or perforation of the bowel may occur during the scan.

The result of the colonoscopy

After 3 to 4 weeks of the colonoscopy, you will be scheduled for a second visit with the screening nurse who will tell you the results of the scan and the analysis of the biopsies and give you a follow-up recommendation.

In general, the possible results of colonoscopy can be grouped into:

• No no polyps or cancer detected (colonoscopy normal/no lesions requiring surveillance).  The risk of having a bowel injury in the next 10 years is very low. Therefore, the recommendation is to re-enter the screening program with the faecal occult blood test, whenever and wherever you are of screening age. If you are outside the screening age, then your primary care doctor will test you. In any case, if during this time you had intestinal symptoms (blood in the stool, change in bowel rhythm, abdominal pain), you should consult your doctor.
• A polyp has been detected. This is the most common result in screening colonoscopies. The polyps are removed and analyzed in the pathology laboratory for their characteristics. Depending on the number, size and type of polyps, it may be recommended to: 1) return to the screening program after 10 years if you are of screening age. If you were outside the screening age, it will be the primary care doctor who will perform the follow-up, 2) do a surveillance colonoscopy after 3 years or 3) do a surveillance colonoscopy after 1 year
• Colon and/or rectal cancer has been detected:  In this case, attention is guaranteed as soon as possible by a team specialized in colon and rectal cancer from the public health system, which will decide the most appropriate therapeutic strategy according to each case. It should be remembered that of every 100 people who undergo a screening colonoscopy, cancer is detected in 3-5 of them. In 70% of cases of cancer diagnosed by screening, the disease is in a localized stage, and in about 20% of cancers detected by screening, the colonoscopy itself allows the lesion to be completely removed and only follow-up is necessary. 

Diagram of the Colon and Rectal Cancer Early Detection Program