The Quebec government has rejected recommendations by health experts to lower the colorectal cancer screening age from 50 to 45 years.

In Quebec, the recommended ages for colorectal cancer screening in patients with no symptoms are 50-74 years. Experts are advocating for lowering the age to 45 years in response to data showing that Canadians born after 1980 are 2-2.5 times more likely than previous generations to be diagnosed with colorectal cancer before age 50.

“Doctors across the country are telling us that they’re seeing younger people being diagnosed at an unprecedented rate,” Barry Stein, president and chief executive officer of Colorectal Cancer Canada, told Medscape News Canada.

Ontario and Prince Edward Island were the first Canadian provinces to lower the screening age, and the other provinces are studying modeling data to determine whether they will follow suit.

Cancer remains the leading cause of death in Canada, and Quebec has the highest number of cancer cases in the country. Younger adults are often diagnosed at later stages when outcomes are far worse. According to the most recent data, roughly 7300 Quebecers will be diagnosed with colorectal cancer in 2026, and nearly 2350 will die from it.

Risk factors are under investigation. “The research indicates a possible link between sedentary lifestyle and other poor lifestyle choices,” said Stein. “However, cancer researchers with Cancer Grand Challenges in the United Kingdom, as well as the National Institutes of Health, are considering the microbiome as a possibility. Certain bacteria have been suggested as risk factors, but it isn’t yet known if this is an associative or causal link.”

Economic and Emotional Burden

A study published on March 7 in The Journal of the Canadian Association of Gastroenterology estimated that screening at 45 years would lead to 15,000 fewer cases and 6000 fewer deaths.

It would also mean roughly $60 million in savings to the Canadian healthcare system, said Stein. “Savings will increase over the years because the price of targeted therapies and immunotherapies will skyrocket. Also, that figure doesn’t include related costs like unemployment, money spent traveling to the hospital, and childcare,” he added.

The financial cost of a colorectal cancer diagnosis is compounded by the emotional toll it can take on patients and families, Stein added. The diagnosis can have a major impact on family planning and fertility, and ostomy can seriously affect sexuality. “People can become depressed and suicidal over these issues. I’ve seen that many times. For doctors, this is a frustrating situation because they’re seeing these patients in the more advanced stages, knowing that it could be prevented.”

The Quebec Association of Gastroenterologists doesn’t agree with the Quebec government’s decision to keep the screening age at 50 years. “The threshold deserves a serious re-examination,” Mélanie Bélanger, president of the association and gastroenterologist at Hôpital Pierre-Boucher in Longueuil, Quebec, told Medscape News Canada. “We believe that all efforts should point toward a major increase in screening, including the consideration of starting at a younger age. But doing so shouldn’t limit access by the rest of the population.”

Colorectal cancer is highly preventable and often silent in its early stages, Bélanger added. “With cases rising among people under age 50 years, a threshold of 50 years is harder and harder to justify. Other provinces have already moved to a younger age. Quebec is out of step with comparable jurisdictions, despite a growing scientific consensus.”

Quebec Lacks Screening Program

For colorectal cancer care advocates, Quebec’s lack of a formal colorectal cancer screening program is an additional concern. Nearly 3 years ago, the National Assembly of Quebec unanimously adopted a motion to implement the Quebec Colorectal Cancer Screening Program before the end of the current government’s mandate. The program aimed to offer structured screening to individuals aged 50-74 years through systematic invitations and free access to the fecal immunochemical test (FIT).

Nevertheless, Quebec remains the only province without an organized screening program. In the absence of an organized program, responsibility for screening largely rests with citizens, who must request the test themselves.

“What we see in the latest [screening] strategy is a focus on the FIT test and on endoscopy access. But the more fundamental problem is that Quebec is still stuck in opportunistic screening instead of an organized program,” said Bélanger. “When screening depends on individual initiative, you get unequal access and diagnostic delays. Patients get screened when they happen to ask, not because the system reaches out to them. Fixing the age matters, but it must be done in concert with that deeper shift.”

Medical capacity is not the main barrier to increased screening, Bélanger continued. “Colonoscopy waiting lists have significantly decreased since the pandemic began, and endoscopists are available to perform colonoscopies, although budgetary cuts in hospitals are a concern that available doctors face every day. The problem revolves around organizing the pathway, getting people to come forward, and making sure the resources are present. Preventing cancer or catching it early means avoiding advanced cases that are more costly and far harder to treat. Colorectal cancer is one of the most preventable and treatable cancers, and no one should be missing that window because of how the system is organized,” Bélanger concluded.

Stein and Bélanger reported having no relevant financial relationships.

Evra Taylor is a widely published freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.