Ontario Has Lowered The Screening Age For Colorectal Cancer

On July 1, Ontario will officially implement its new colorectal cancer screening guidelines, making people age 45 and older eligible for a publicly funded at-home screening test every two years in the province. Previously, eligibility for publicly funded testing in Ontario began at age 50, and younger patients would only be able to access it after symptoms or a physical exam indicated testing was advisable.

The change, the province says, will open access to early detection screening to about one million Ontario residents.

Dr. Ian Bookman, a gastroenterologist at Unity Health in Toronto, says the new guidelines are warranted.

“I am happy to see our government being proactive in protecting the lives of our younger citizens by making sure that we all do everything we can to prevent the rise in colon cancer rates,” he says.

The shift in Ontario follows a trend elsewhere in the country and in the world: In March, P.E.I. was the first province in Canada to lower its screening age for colorectal cancer. And Australia and the U.S. have also lowered their screening ages to 45.

If you have risk factors, you’re eligible for screening at age 40

Individuals who have a higher risk of developing the disease, which is the second deadliest form of cancer for men in Canada and the third deadliest for women, will be able to access screening at age 40.

People who have a family history of colon cancer—for example, a parent, sibling or child who has had the disease—are considered to have increased risk.  

The reason for the change in colorectal screening

Rates of colorectal cancer have been rising globally among younger populations. That’s also the case in Canada. The Canadian Cancer Society, which has advocated for lower screening ages, cites a 2019 review of national data that found people under age 50 are now two to two-and-a-half times more likely to be diagnosed with colorectal cancer than their parents or grandparents. It’s this concerning rise in the disease among younger people that’s behind pushes for changes to screening recommendations, says Bookman.

Unfortunately, says Bookman, many younger people with symptoms of the disease have been dismissed by primary-care providers who aren’t aware of rising rates in younger populations. Making the test accessible to younger people can also help educate healthcare providers to be more aware of this increased incidence.

To raise greater awareness of this rising risk and the subsequent need for more preventive screening, Bookman organized an annual 5K charity event called the Bum Run. Now in its 15th year, the run takes place in four cities in Canada, including Toronto and Vancouver.

“People don’t think it occurs as frequently as it does,” says Bookman, “but almost everybody knows somebody or has somebody that's close to them” deal with the disease.

The earlier the cancer or pre-cancerous cells are detected, the higher the positive outcome, with a nearly 90 percent survival rate when the cancer is found in early stages.  

What about colonoscopies?

In an ideal world, Bookman says, provincial governments would also cover the cost of people 45 years old and over getting colonoscopies, too. That's because that procedure can reveal polyps at a very early stage of development, he says. “But we not only see them, we can remove them,” he explains. “And by doing so, we can prevent the cancers from ever forming.”

OHIP currently only covers colonoscopies when they’re deemed medically necessary, if you have a family history and if you are 50 or older (or 10 years younger than the age at which your relative was diagnosed, whichever comes first).

What will happen in July

According to Ontario Health, Ontarians between the ages of 45 ro 49 can expect to receive letters in the mail from the ColonCancerCheck program once the new guidelines begin on July 1. If you don’t have a family doctor or a primary care provider, you can also access the test by calling Health811 at 866-797-0007.

The test

A fecal immunochemical test (FIT) is a simple stool test you can do from the comfort of your own home. According to ColonCancerCheck, who facilitates access to the test, test kits will be sent via mail. Once you’ve completed the instructions, you can send the stool sample back for lab testing via mail or drop it off at a nearby LifeLabs, where the sample will be tested for the presence of blood. Blood in the stool can indicate polyps or the presence of colon cancer. Results take a few weeks and if there are concerns, it’s likely you’ll be sent for follow-up testing like a colonoscopy.