The planned change by Ontario to lower its colorectal cancer screening age from 50 to 45 is “wonderful” news and will ultimately save lives, according to survivors of the disease.
The new standard beginning July 1 comes in response to a “notable” increase in younger people being diagnosed, states an Ontario Health document outlining the new recommendation.
“I think it’s wonderful. Personally, I think it’s fantastic, it will save lives, that’s unquestionable,” said three-time cancer survivor Christopher Mammoliti.
Mammoliti was diagnosed with colon cancer shortly before his 38th birthday. Prior to that, he was diagnosed with thyroid cancer at 29 with a recurrence at 31.
“I had already survived cancer twice, we had just had an 11-month-old son … and of course, when you’re diagnosed again with a new primary tumour type, you’re saying to yourself, why me,” he told Global News in an interview.
It’s been nearly three years with no evidence of the disease for Mammoliti.
The move by the province comes after Colorectal Cancer Canada and the Canadian Cancer Society pushed for all provinces and territories to make the change. The organizations cited evidence showing people under 50 are two-to-2.5 times more likely to be diagnosed with colorectal cancer than they were in previous generations.
Prince Edward Island was the first province in the country to lower its screening age in March, with Nunavut confirming to Global News last month it plans to make the same shift.
The Ontario government document that’s meant to inform primary care providers says the decision is based on expert panel guidance, evidence of an increase in early onset colorectal cancer in the province, and modelling showing earlier screening reduces the incidence and mortality of the disease.
Ontario’s Ministry of Health said in a statement the program changes will help detect and treat cancer earlier.
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“Unfortunately, every week in our clinic, we’re seeing young people with colon cancer,” said Dr. Peter Stotland, chief of surgery at North York General Hospital. “If we can capture something at that early stage, we can often deal with it even without surgery. We can deal with at the time of colonscopy.”
Obesity, changes to diet, processed food or lack of exercise are among the factors contributing to the increase, Stotland said.
But for Jason Abramovitch it was a shock. He told Global News he didn’t have lifestyle factors that would hint at a diagnosis at 36.
“There was nothing to lead me to believe that something like cancer would be on the radar,” Abramovitch said.
When he learned Ontario was changing the screening age limit was “pretty huge.”
“I have lost a lot of people that potentially could have been diagnosed at a much earlier stage with this change, right, if this would have been changed five or 10 years ago,” Abramovitch said.
A routine colorectal screening is called a fecal immunochemical test — or FIT — and it involves swabbing stool at home and then dropping it off or sending it to a lab. It’s recommended that those with normal test results repeat the process after two years.
If the sample tests positive for blood in the stool, that person is referred for a colonoscopy to check for cancer.
The government says in the guidance that screening invitation letters will be sent out in a “phased manner,” but after the July start date doctors can order the FIT for anyone aged 45 to 49.
Yet Mammoliti said the province should consider lowering it further, noting the experiences of people diagnosed in their 30s.
“I think 40 is probably a better target long term to save lives and when we look at the net benefit to our health-care system, I think we’re going to see the value of that,” he said.
Ontario’s also lowering the recommended age for colonoscopies for people who have an immediate relative who was under the age of 60 when they were diagnosed with colorectal cancer.
That group will start screening at 40 — rather than 50 — or 10 years earlier than the age their youngest relative was diagnosed, whichever comes first, with a screening interval of five years.
Those who only have one relative diagnosed with colorectal cancer at the age of 60 or older will now be screened with FIT every two years starting at 45, instead of a colonoscopy.
The government tells health providers to expect a “modest increase” in abnormal test results as more people get the test.
“We’re gearing up now with the decrease from 50 to 45 to accept more and more patients for colonoscopy to build that capacity,” Stotland said.
It also says there will be an increased demand for colorectal cancer surgeries and pathology specimens.
“Ontario’s decision to lower the screening age to 45 is a huge step forward,” said Barry Stein, president and CEO of Colorectal Cancer Canada.
“It’s time for all other provinces and territories to follow suit.”
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