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
Provincial and territorial governments should lower the age at which they start colorectal cancer screening to 45 from 50 to help combat rising rates of the disease among younger patients, according to the Canadian Cancer Society.
The national charity announced Wednesday that it supports offering all Canadians stool tests every second year between the ages of 45 and 74 to look for early evidence of colorectal cancer.
“We’ve seen a worrying trend over the last number of years where more and more adults are being diagnosed with colorectal cancer at a younger age, to the point where folks who are in that age bracket – 45 to 50 – are now two to two-and-a-half times more likely to be diagnosed than in previous generations,” said Brandon Purcell, advocacy manager of prevention and early detection at the Canadian Cancer Society.
The society unveiled its new position knowing that Ottawa is preparing to launch a revamped version of the Canadian Task Force on Preventive Health Care next month.
The federal government shut down the task force, which provides formal advice to family doctors on everything from cancer screening to preventing falls, about a year ago in the wake of controversy over its refusal to lower the recommended age for mammograms for average-risk women to 40 from 50.
The federal government has promised a new-look task force will incorporate the recommendations of an external committee, led by University of Waterloo president Vivek Goel, that released a report last June suggesting the task force be “modernized” and reformed.
The old task force last published guidance on colorectal cancer screening in 2016. The panel’s advice at the time was for average-risk Canadians between the ages of 50 and 74 to be screened every two years with a stool test or flexible sigmoidoscopy, a scoping procedure that examines less of the colon than a full-fledged colonoscopy.
Nearly every province and territory has an organized colorectal cancer screening program that follows those age guidelines, according to the Canadian Cancer Society.
Darren Brenner, a cancer epidemiologist at the University of Calgary and the co-chair of the Canadian Cancer Statistics Advisory Committee, said evidence is piling up that colorectal cancer is striking Canadians at younger ages, necessitating earlier screening.
The shift is clearly generational, he added.
“If you look at people born around 1988, they have a 2.3 times higher rate than people born in 1958. If we look at even the youngest cohort – which is kind of terrifying, this is people that are diagnosed in their late 20s – it’s 2.7 times higher,” Dr. Brenner said. “It’s one of the most profound shifts in cancer we’ve seen in my time doing research.”
The scientific jury is still out on what’s causing the rise. Dr. Brenner said preliminary research points to changes in the gut microbiome that could be caused by modern diets laden with ultra-processed foods, lack of exercise, high alcohol intake, early exposure to antibiotics or other environmental factors.
Dr. Brenner and his colleagues published a paper last week modelling what might happen if Canada lowered the screening age to 45. The study, released in the Journal of the Canadian Association of Gastroenterology, predicted the change would result in 15,000 fewer cases of colorectal cancer and 6,100 fewer deaths over the next 45 years.
Colorectal cancer screening can prevent cancer because abnormal stool tests prompt doctors to perform colonoscopies during which precancerous lesions can be spotted and removed before they become dangerous.
The modelling study also suggested that lowering the screening age could save Canada’s public health system $233-million over the lifespan of newly eligible patients over the modelled period. That’s because the significant upfront costs of mailing and analyzing more at-home stool tests and performing more colonoscopies may be offset by saving on expensive, late-stage cancer treatments.
Monika Krzyzanowska, chief of the Odette Cancer Program at Sunnybrook Health Sciences Centre in Toronto, would like to see provincial governments answer the Canadian Cancer Society’s call and lower the starting age.
“Hopefully we’ll pick up cancer at an earlier stage, where you can intervene and hopefully get rid of the cancer,” she said. “I think this is a good idea.”