Rates of colorectal cancer among adults under 50 have been rapidly rising, and it is estimated that people between 45 and 50 are two to two-and-a-half times more likely to be diagnosed than in previous generations.Melissa Tait/The Globe and Mail
Ontario will be the second province to lower the starting age for colorectal cancer screening to 45 from 50 in July, a move advocacy groups say will prevent cancer and ultimately save lives.
Cancer Care Ontario quietly updated its guidance online this week, announcing the lower screening age for average risk participants and other program changes to reflect the “evolving evidence on colorectal cancer.” ColonCancerCheck, the provincial screening program, will implement the changes on July 1, according to resources posted for health care providers.
Rates of colorectal cancer among adults under 50 have been rapidly rising, and it is estimated that people between 45 and 50 are two to two-and-a-half times more likely to be diagnosed than in previous generations. Organizations, such as the Canadian Cancer Society and Colorectal Cancer Canada, have urged provinces and territories to lower the screening age to combat these growing rates.
Brandon Purcell, advocacy manager of prevention and early detection at the Canadian Cancer Society, said lowering the age is a “fantastic move.” He is hopeful that momentum will build for all other provinces and territories to follow suit.
“Now that Canada’s largest and smallest provinces are aligned on this start age for 45, the path is clear for the rest of the country and we don’t want them to sit on this opportunity,” he said.
Prince Edward Island in March became the first province to expand screening eligibility by five years. Islanders aged 45 to 74 are now eligible for a take-home fecal immunochemical test every two years to help detect early signs of colorectal cancer.
PEI changing age for colorectal cancer screening in response to higher rates of disease
FITs can detect microscopic blood in stool, which may indicate precancerous growths.
An Ontario government document prepared for primary care providers said the decision to lower the threshold to 45 was informed by modelling and emerging evidence. Additionally, it was in response to feedback from an expert panel including medical and surgical specialty groups, as well as primary care, national and international experts.
“The epidemiology of colorectal cancer is changing in many countries around the world, including in Canada, and is showing a notable increase in colorectal cancer incidence in people younger than age 50,” the document stated, adding that the earlier screening age has more benefits than harms.
“Modelling was performed to understand the impact of lowering the screening start age from age 50 to 45 in Ontario. This modelling showed that this lower start age would lead to fewer persons diagnosed with colorectal cancer and fewer deaths from colorectal cancer.”
The Canadian Cancer Society urges provinces and territories to provide fecal immunochemical tests (FIT) to everyone 45 to 74 years of age.
The Canadian Press
Ontario Health, in this document, also said the shift could help to reduce the burden of colorectal cancer in the First Nations population, which has higher incidence rates. First Nations people are more likely to get colorectal cancer at an earlier age but get diagnosed at a later stage.
Barry Stein, president of Colorectal Cancer Canada and himself a cancer survivor, said lowering the screening age will help with early detection of polyps and prevent them from developing into cancer. Early cancer detection can also help improve treatment and survival rates.
“We’re going to reduce the amount of people who die from this disease and save hundreds of millions of dollars to our health care system. So, it’s almost a no-brainer,” he said, pointing to the United States and Australia as places that have shown lowering screening ages is cost-effective.
Ontario said screening invitations will be sent to people aged 45 to 49 in phases over the next two years after the launch. Health care providers can order FITs starting July 1, regardless of whether a letter has been received.
Additionally, the province is lowering the recommended age for colonoscopies for people who have an immediate relative diagnosed with colorectal cancer before 60 or multiple immediate relatives who were diagnosed at any age. Screening can now begin at 40, instead of 50, or 10 years earlier than the age their youngest relative was diagnosed.
Those who have one immediate relative diagnosed with colorectal cancer that was diagnosed at 60 or older should also now screen with FIT every two years instead of a colonoscopy.
The webpage that hosted these documents and others outlining the new guidelines became “temporarily unavailable” on Tuesday afternoon. The Ontario Ministry of Health did not respond to a question about the outage.
Ema Popovic, a spokesperson for the ministry, said in a statement on Tuesday that updating the screening age for colorectal cancer builds on previous steps taken by the government to improve cancer care, including by lowering the starting age for self-referred breast screening to 40 from 50.