Earlier screening aims to catch colorectal cancer before symptoms sideline working Canadians
More Canadians in their 40s are being diagnosed with colorectal cancer, and most are not yet eligible for routine screening.
The Canadian Cancer Society (CCS) is calling on provinces and territories to lower the start age of organized colorectal cancer screening programs to 45 from 50 for people at average risk.
CCS bases its push on mounting evidence that colorectal cancer is increasingly affecting younger adults in Canada, and on new modelling that suggests earlier screening would prevent illness and death.
Over recent decades, incidence of colorectal cancer has significantly increased among people younger than 50 in Canada, with the likelihood of a diagnosis now 2 to 2.5 times higher than previous generations of the same age.
Recent modelling published by Canadian researchers shows that if this trend continues, lowering the start age to 45 would result in more than 15,000 fewer colorectal cancer cases and 6,100 fewer deaths over the next 45 years.
Research also shows that younger adults are more frequently diagnosed with colorectal cancer at later stages, with stage III and IV being most common.
When found early, survival rates for colorectal cancer are about 90 percent, compared to less than 15 percent when found at advanced stages.
Access to screening is therefore critical to help find more cancers early, when treatment can be more effective, or even while disease is still precancerous and preventable.
Brandon Purcell, advocacy manager of Prevention and Early Detection at the Canadian Cancer Society, says “current colorectal cancer screening guidelines are failing to meet the evolving needs of people under 50.”
He says that “when the context changes, our healthcare systems must change with it,” and that provinces and territories should lower the screening age in response to new evidence.
Colorectal cancer is the fourth most commonly diagnosed cancer in Canada and the second leading cause of cancer-related death among Canadians, behind lung cancer.
It is estimated that by 2030, about 15 percent of colorectal cancer cases globally will be diagnosed in adults below the age of 50. Screening for colorectal cancer starts with a fecal immunochemical test (FIT) or stool test that checks stool for blood.
For Wylie Butler, lowering the screening age is personal. He was diagnosed at 48 after brushing off months of occasional bleeding as something minor.
By the time he sought care, the cancer had progressed, leading to three surgeries, a difficult bout of sepsis, and months away from work and activities he loved.
Butler says he “never thought colorectal cancer was something that could happen” to him and “didn’t realise how serious those early symptoms were.” He believes earlier screening at 45 might have caught his cancer sooner and spared him some of the complications he faced.
Now cancer-free, he believes earlier screening could change outcomes for others.
"I got lucky, but we shouldn't rely on luck. Screening at an earlier age gives people the chance to find colorectal cancer before symptoms appear. And when it's found early, you have better odds – and a better chance at life."
Across Canada, nearly all jurisdictions offer organized colorectal cancer screening for people ages 50 to 74 at average risk, while Nunavut and Quebec have announced or planned their screening programs.
At this time, no governments have announced plans to expand screening eligibility in light of new evidence.
CCS argues that changing the trajectory of colorectal cancer in Canada will require comprehensive action.
It recommends prioritizing areas such as investing in research, enhancing data, developing guidelines and screening programs for people at high risk, updating screening eligibility for those at average risk (including age), strengthening colorectal cancer screening programs, building awareness, reaching underserved communities, and investing in the healthcare workforce so programs can meet participation targets.
