New national guidelines recommend earlier screening for colorectal cancer

People whose parent, sibling or child has been diagnosed with colorectal cancer should undergo earlier and more frequent checks for the disease, according to new national guidelines from the Canadian Association of Gastroenterology.

The screening guidelines, published Tuesday in the journal Gastroenterology, are designed to encourage more high-risk people to get checked, regardless of their age. Provincial programs typically start screening people at age 50, but for some people, that’s too late, said Jill Tinmouth, a member of the guidelines working group and a gastroenterologist at Toronto’s Sunnybrook Health Sciences Centre.

The new guidelines recommend people with a history of the disease in their immediate family get colonoscopy screening between 40 and 50, or 10 years earlier than the age at which their first-degree relative, which includes parents, children and siblings, received a cancer diagnosis – whichever comes first. So if a parent was diagnosed with colorectal cancer at age 45, his or her child should start getting screened at age 35.

“If you have a family history in a first-degree relative, your risk is twice that of people without a first-degree relative,” Dr. Tinmouth said. “It’s a cancer that we can screen for and, by doing so, we can improve outcomes.”

Similar screening recommendations apply to people with an immediate family member who has a history of advanced precancerous polyps, which can develop into cancer if left untreated. But for people with a history of colon cancer in a second-degree relative, such as an aunt, uncle or grandparent, the guidelines recommend the same screening schedule as the general population, which begins at age 50.

Laura Jambrovic, who was diagnosed with colorectal cancer in June,2016, at her home in Peterborough, Ont., on Nov. 26, 2018. FRED THORNHILL/THE GLOBE AND MAIL

The Canadian Task Force on Preventive Health Care published guidelines in 2016 that state people who do not show symptoms and don’t have a strong family history of colorectal cancer start getting screened at age 50, but these new guidelines are specifically aimed at those with family history.

Shady Ashamalla, a colorectcal cancer surgeon at Sunnybrook, said the guidelines are “profound” because they don’t dictate a set age at which screening should begin. This is important because more people are being diagnosed with the disease at younger ages.

“It’s the first time we’re really seeing numbers less than 50,” said Dr. Ashamalla, who was not involved in drafting the guidelines. “Having a stringent age is a little too dogmatic.”

He said the guidelines are a signal to clinicians that they can, and should, start screening higher-risk patients at younger ages, even in their 20s and 30s. Part of this shift will require primary-care health professionals to ask people about their family history of colorectal cancer so they ensure as many people get screened as possible.

For months, health-care professionals dismissed Laura Jambrovic’s symptoms, which included abdominal pain and bloody stools, because of her young age.

Finally, when she landed in the hospital in June, 2016, with a complete bowel blockage and in agonizing pain, a colonoscopy revealed she had a tumour. She was 22. Ms. Jambrovic has no family history of colorectal cancer, but she says her symptoms were ignored by health professionals who told her she was too young and healthy to have cancer.

“No one had really believed me or taken me seriously,” she said.

In the days and months that followed, Ms. Jambrovic underwent colostomy surgery, egg freezing, chemotherapy, and a second surgery to reverse the colostomy.

Now, Ms. Jambrovic is a nursing student in Peterborough, Ont., who says she is concerned more cases of colorectal cancer in young people could go undetected or undiagnosed because of the misconception that it only affects older people.

“It’s going to happen to young people and, until it happens to enough, unfortunately, I don’t think people are going to be aware of it,” she said.