Ontario is set to lower the colorectal cancer screening age from 50 to 45, a change driven by a notable increase in diagnoses among younger individuals. New guidelines published by Cancer Care Ontario indicate that the adjustment will take effect on July 1.
Rising Incidence in Younger Adults
The decision comes as evidence shows that people under 50 are two to 2.5 times more likely to be diagnosed with colorectal cancer than previous generations. Prince Edward Island became the first Canadian province to lower its screening age in March. Colorectal Cancer Canada and the Canadian Cancer Society have urged all provinces and territories to adopt similar measures, citing data from the United States and Australia, which have already lowered their screening ages to 45.
Details of the New Screening Protocol
An Ontario Health document intended for primary care providers outlines that the change is based on expert panel guidance, evidence of increased early-onset colorectal cancer in the province, and modelling that shows earlier screening reduces incidence and mortality. The routine screening test, a fecal immunochemical test (FIT), involves swabbing stool at home and sending it to a lab. Those with normal results are advised to repeat the test every two years. If blood is detected, a colonoscopy is recommended.
The government will send screening invitation letters in a phased manner after July 1, but doctors can already order FIT for individuals aged 45 to 49. Additionally, the recommended age for colonoscopies has been lowered for those with an immediate relative diagnosed with colorectal cancer under age 60. This group will start screening at age 40 or 10 years earlier than the youngest relative's diagnosis, whichever comes first, with a five-year screening interval.
Impact on Healthcare Resources
The government anticipates a modest increase in abnormal test results and higher demand for colorectal cancer surgeries and pathology specimens. However, it expects volumes to stabilize over time as pre-cancers are detected and removed. Barry Stein, president and CEO of Colorectal Cancer Canada, called Ontario's decision a huge step forward and urged other provinces to follow suit.
Ontario's Ministry of Health noted that the program changes build on the province's earlier move to lower breast cancer screening age from 50 to 40. The drop-off locations for completed FIT kits are also changing; patients can leave them at any Rexall location or mail them to In-Common Laboratories.
