As of July 1, Ontario will offer publicly funded colorectal cancer (CRC) screening to patients as young as 45 years. Patients at increased risk will be eligible for publicly funded screening starting at age 40 years. Lowering the CRC screening age from 50 years is expected to provide as many as 1 million Ontarians the opportunity for early detection and treatment.

Ontario is one of only two Canadian provinces (the other being Prince Edward Island) to lower the CRC screening age. The growing numbers of younger adults who are developing symptoms (eg, changes in bowel habits, rectal bleeding, and unexplained weight loss) are highlighting the value of earlier screening. British Columbia health authorities are also considering an earlier screening age, according to CTV News.

Findings from a recent report demonstrated that lowering the screening age to 45 years would yield 15,070 fewer CRC cases and 6100 fewer deaths from CRC between 2025 and 2071. Modeling underscored substantial cost savings of roughly $233 million over the lifespan of eligible cohorts. Why aren’t more provinces seizing the opportunity?

“Most of us look at it from a practical perspective,” Ian Bookman, MD, head gastroenterologist at St. Joseph’s Health Centre and adjunct assistant professor of gastroenterology and hepatology at the University of Toronto in Toronto, told Medscape News Canada. “We see the trends that are occurring and the direction in which other countries are moving, in terms of their guidelines. We see the immense cost, not just financially, but also socially, of treating and managing colon cancer.” Bookman founded Bumrun, a charity and an annual 5 km run dedicated to increasing CRC awareness and screening, decreasing stigma, and saving lives across Canada.

Support Without Action…Yet

CRC is the fourth most commonly diagnosed cancer in Canada (following breast, lung, and prostate cancers) and the second leading cause of cancer-related deaths. Data have suggested that 1 in 10 new colon cancers and 1 in 4 rectal cancers will be diagnosed in Canadians younger than age 50 years.

The Canadian Cancer Society has strongly urged all Canadian provinces and territories to lower the CRC screening age. Other key societies cautiously support the change, perhaps in anticipation of new screening guidelines from the National Advisory Committee on Preventive Health Services.

Though the Canadian Association of Gastroenterology (CAG) “strongly supports organized provincial CRC screening and surveillance programs, it was not involved in the development of the new Ontario CRC screening guidelines,” the organization told Medscape News Canada. Consequently, CAG believes that “it would be premature to comment on the recommendations or their implications at this time.”

Ontario Health Canada declined a request for comment from Catherine Dubé, MD, the clinical lead for ColonCancerCheck, Ontario’s CRC screening program. Dubé is associate professor and division chief of gastroenterology at the University of Ottawa and the Ottawa Hospital in Ottawa.

Encouraging Screening

In early July, eligible Ontarians will receive letters from ColonCancerCheck to connect them with an initial fecal immunochemical test. The program also offers various online CRC screening resources, tools, and forms on its website, including a list of laboratory locations and e-learning opportunities.

“We’ve struggled for decades to increase participation rates in colon cancer screening programs,” said Bookman, noting that the reason he started Bumrun was to help boost these efforts.

“Unfortunately, most people are motivated [to get screened] once it happens close to home, they have a relative — first degree, usually — who was diagnosed and become scared or pressured into getting themselves checked.”

CRC screening joins a long list of preventive measures that are discussed during primary care visits, meaning that they’re likely to be “drowned out,” even though most can be completed in one lab visit, said Bookman.

“All we can do is keep bringing it up at each patient visit. If they’ve not gotten screened, providers can remind them that CRC is still the number 2 cause of cancer deaths in men and women in Canada,” said Bookman.

Bookman reported no relevant financial relationships.

Liz Scherer is an independent health and medical journalist based in the US. She frequently reports on Canadian and Global health news.