Colorectal cancer rising in young adults. Should the screening age be lowered?

There are growing calls to start screening earlier for colorectal cancer in Canada and some provinces are considering it amid an “alarming” increase in cases among young adults.

“The incidence of colorectal cancer among young adults under 50 years of age has rapidly climbed in recent years, challenging conventional perceptions of this disease as being a disease of older adults,” said Colorectal Cancer Canada in a statement Monday.

“This alarming reality serves as a stark reminder that vigilance and advocacy are paramount in the fight against colorectal cancer.”

A petition started by a patient and signed by thousands of people was tabled in Ontario’s provincial legislature last week, calling for the age criteria used for the fecal immunochemical test (FIT) and colonoscopy to be lowered to 30 from 50.

The petition started by Bishop Brigante, who was diagnosed with colorectal cancer last fall, says lowering the age criteria for screening will save lives.

“We urge medical professionals, policymakers, and healthcare providers to consider the strong evidence supporting the need for this change,” the petition states.

Colorectal cancer is the fourth most common form of cancer in Canada and the second deadliest, according to data recently published by the World Health Organization (WHO).

At the time, Dr. Freddie Bray, branch head of cancer surveillance at International Agency for Research on Cancer, said the gradual adoption of more westernized lifestyle, including changes in the diet and eating more red meat, could be a contributing factor for the rise.

For 2023, an estimated 24,000 colorectal cancer cases and 9,300 deaths were projected, government data showed.

Despite overall declines in incidence and death rates for colorectal cancer in Canada, cases have been increasing among the country’s younger population, according to the Canadian Cancer Society.

While the reasons for this shift aren’t definitive, research is under way to understand how this increase can be mitigated, said Elizabeth Holmes, director of health policy at the Canadian Cancer Society (CCS).

Guidance from the CCS and Canadian Task Force on Preventive Health Care is that anyone who is not at a high risk for colorectal cancer and has no signs or symptoms, should be screened from the ages of 50 to 74 with a stool test every two years.

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In Canada, at this time, it is not recommended that asymptomatic adults less than 50 years should be screened for colorectal cancer.

“We’re monitoring the discussion about the start age for colorectal cancer (screening) and having conversations with experts looking at the research, acknowledging that evidence evolves,” Holmes told Global News in an interview.

Sunnybrook Health Sciences Centre opened its Young Adult Colorectal Cancer Clinic in early 2020 amid increasing rates in the younger patients. It’s the only such clinic in the country that specifically treats colorectal cancer patients below the age of 50 years.

Dr. Shady Ashamalla, surgeon lead of Sunnybrook’s Young Adult Colorectal Cancer Clinic, said he’s seen many patients in their 20s and 30s diagnosed with the disease and “almost always that diagnosis is made late.”

“I was in clinic last Tuesday and I saw four patients in a row, all below the age of 40, so it is not rare.”

Ashamalla said given the rise in cases there is value in considering lowering the age criteria for screening that could help catch the disease early before symptoms evolve and cure the patient.

“Now that we are seeing these increased rates of colorectal cancer in younger patients, I think it certainly warrants rigorously investigating decreasing the age of screening,” Ashamalla told Global News in an interview.

Global News reached out to all the provinces and territories in Canada and asked if they are considering lowering the colorectal cancer screening age for average risk people.

Here is what they had to say.

The Ontario Ministry of Health said its colorectal cancer screening program, ColonCancerCheck, continues to recommend starting at age 50.

“ColonCancerCheck actively monitors colorectal cancer trends and research and continues to evaluate the program recommendations based on new and emerging data,” said W.D. Lighthall, a spokesperson for the Ontario Ministry of Health.

In Quebec, like other provinces, regular colorectal cancer screening starts at the age of 50 and is recommended every two years until the age of 74 for people at average risk.

However, screening can begin before the age of 50 for people who have a higher risk of developing colorectal cancer, the province’s website states.

“The Quebec Cancer Program remains on the lookout for new recommendations on cancer screening and could, therefore, be expanded to other age groups if necessary,” Marie-Pierre Blier, media relations for Quebec Health and Social Service Ministry, told Global News.

“In addition, opportunistic screening remains available to the entire population after medical evaluation,” she added.

Nova Scotia said it is considering changing the current screening age.

“Lowering the age criteria for average risk screening is under consideration in Nova Scotia,” said Dr. Michael Stewart, medical director of Nova Scotia’s Colon Cancer Prevention Program.

“We are part of a national working group to look at the evidence to help inform these decisions.”

Alberta Health said its colorectal screening program continues to monitor guidelines and applies best practice in the application of these guidelines to consider both the benefits and risks of screening.

Meanwhile, Manitoba said it was not looking at changing the screening age at the current time.

“We follow the guidelines outlined in the Canadian Task Force for Preventive Health Care,” said Twylla Krueger, of CancerCare Manitoba.

“If their recommendations change, which is based on a systemic review and synthesis of science, we will evaluate this.”

Nunavut is also not considering changing the age criteria for FIT screening from 50 to 74 years, said Dr. Sean Wachtel, the territory’s chief public health officer.

British Columbia, New Brunswick, Newfoundland and Labrador, Prince Edward Island, Saskatchewan, Northwest Territories and Yukon did not respond by the time of publication.

Health Canada and the Public Health Agency of Canada (PHAC) said they work with the Canadian Task Force on Preventive Health Care, which “assesses evidence surrounding the prevention of disease and provides regularly updated clinical practice guidelines for physicians.”

“Guideline development is based on systematic analysis of scientific evidence with input from patients and the public, health care practitioners, knowledgeable specialists, health professional associations, health charities, academic institutions, and guideline producers in other countries,” the agencies said.


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