Colorectal cancer screening age lowered in Ontario. Experts say it could help address ‘growing number’ of cases in young people

Colorectal cancer survivor Nadia Maffucci Di Rienzo speaks with CP24 to share her story and talk about lowering the screening age in Ontario.

Doctors and cancer survivors are applauding a move by Ontario to lower the age for colorectal cancer screening as the disease continues showing up in younger patients.

“It’s a change that we’ve been waiting for, and we’re excited to hear about from the government,” Dr. Sami Chadi told CP24.

Chadi, a colorectal surgeon at the University Health Network, said the change is “a really big step forward” in colorectal cancer screening.

“We’re seeing a large increase in the risk of colorectal cancer in younger patients, especially over the past 10 to 20 years,” Shadi said. “So having this lower age of screening is going to be quite helpful for us in detecting tumors earlier and detecting precancerous tumors at an earlier stage, so that they can be managed effectively.”

Cancer Care Ontario recently said in new guidelines for physicians that the province is lowering the age for colorectal cancer screening from 50 to 45 due to an increase in younger people being diagnosed what the illness.

The changes mean that starting in July, doctors will be able to order a fecal immunochemical test (FIT) for anyone 45 to 49. The test involves swabbing a stool sample at home and sending it to a lab to be checked for the presence of blood. Doctors can then order a colonoscopy if someone tests positive.

Those with a family history involving a close relative will also be able to get a colonoscopy earlier.

In line with other places

Dr. Peter Stotland, a surgical oncologist and chief of surgery at North York General Hospital, said the change in guidance brings Ontario in line with other jurisdictions.

“In the U.S., for example, it’s been 45 for at least five years or so. And locally in Ontario, there’s been discussion amongst experts and groups to really try to mirror that,” Stotland told CP24.com.

He emphasized early detection is key to preventing the illness from progressing to a stage where there may be serious complications.

“If we can catch things at an earlier stage, at an earlier time point in the development, then we can remove polyps, we can remove things (to) prevent cancers from forming,” Stotland said. “So I’m fully in agreement, and I think it’s great that we’re going to be offering screening to people at a younger age.”

He said the colorectal cancer rates among younger patients in Ontario are representational of what’s happening in North America as well as parts of Europe.

“It’s a very common cancer. In men and women, it’s the second and third most common cancers that we see in North America and in Ontario. So it’s not to be overlooked.”

According to the Canadian Cancer Society, about 1 in 17 men in Canada will develop colorectal cancer during their lifetime and 1 in 40 will die from it. About 1 in 19 women in Canada will develop colorectal cancer during their lifetime and 1 in 42 will die from it, according to the organization.

That said, Stotland points out that a negative FIT test is “extremely” reliable according to data from around the world.

“The chance of a false negative is really small,” he said.

Similarly, he said a colonoscopy is considered a very “sensitive test,” meaning the chance of a false positive is quite low.

Patients welcome change

Iris Karry, a program manager at Colorectal Cancer Canada, welcomed the changes as “an important first step” in addressing rising rates of the disease in Canadians under 50.

“We’re seeing a growing number of cases being diagnosed too late, simply because people are not qualifying for routine screening yet,” she said. “So starting at 45 helps to close that gap.”

Colorectal Cancer Canada is a patient-focused non-profit group that has been pushing for lower screening ages for colorectal cancer.

“Earlier screening matters because colorectal cancer often develops silently, meaning that symptoms don’t show up in the early stages,” Karry said.

It’s a message echoed by colorectal cancer survivor Nadia Maffucci Di Rienzo.

“I was diagnosed with cancer in 2022 and my early signs were very minimal,” she told CP24. “I had some rectal bleeding, I had a change in my bowel habits, and just a lot of fatigue and back pain.”

A family history and pre-existing IBS put her at higher risk for cancer. Di Rienzo was diagnosed when she was just 40.

While she survived the illness, she said daily physical and emotional challenges remain.

“I do live with a permanent ileostomy. Now, it did save my life. So I am very grateful, but it has its daily challenges,” Di Rienzo said.

She said she’s pleased to see screening ages lowered and encourages those who are eligible to make sure they get tested.

She acknowledged that there is still some stigma around the test but said the preparation at home the day before is the “worst” part of the process.

“But it would very much be worth it to prevent a (positive) diagnosis.”