A surgeon’s mission to increase colorectal cancer screening in Canada 

Colorectal cancer is a highly preventable and treatable cancer, yet it remains one of the most commonly diagnosed, and is the second leading cause of cancer-related death, in Canada. For Colorectal Cancer Awareness Month (March), the Canadian Partnership Against Cancer (the Partnership) spoke with Dr. Hendrik du Plessis on barriers some communities experience in accessing colorectal cancer screening, and why earlier screening and greater awareness are increasingly critical to increase participation rates.

Note: The interview has been edited for clarity and length.

Can you start by telling us a bit about your background and how you came into medicine? 

Dr. Hendrik du Plessis: I grew up in South Africa. My father was a school principal who taught math and biology, and my mother was a registered nurse, so I was surrounded by the sciences from a young age. 

After completing medical school, I spent many years working in remote regions – including the Sahara Desert, Indonesia, Nigeria, and Angola – providing services to underserved communities. That work took me all over the world before I eventually made the transition into general surgery residency, which is what I’d wanted to pursue all along.

How did you become involved in colorectal cancer screening in Saskatchewan? 

When I arrived in Saskatchewan many years later, awareness of the benefits of screening was growing. I had the opportunity to get involved just as the provincial colorectal screening program was launching. A medical advisor invited me to join the initiative, and through various connections and collaborations with people working in colorectal cancer screening, I became deeply involved in this work. I now also serve as a Screening Advisor with the Partnership. 

What kind of barriers do people who live in rural and remote areas – like in rural Saskatchewan – experience in accessing colorectal cancer screening? 

Working in the northwest region of Saskatchewan, we face a unique set of challenges. Many people live extremely far from our general surgery practice, where we often see referrals for colonoscopy. Some patients have to travel six to eight hours to reach a centre where they can be seen – even after already visiting a regional facility. That alone creates major hurdles: long distances, difficult road access, harsh winter conditions, and unreliable mail service. Canada Post delays over the past few years have made it particularly hard to get screening invitations to some communities. Others don’t have mailing addresses at all – some residents live in cabins deep in the woods – making communication even more complicated.

Reaching people is only part of the challenge; helping them understand why screening matters is another. Patients often have questions about the purpose of the test, and I sometimes need to speak with their families or communities to explain the benefits of the screening program. We’re fortunate to have hospital liaisons who can speak with people from remote and northern regions in their own languages or who share similar cultural backgrounds. That support makes a tremendous difference. 

You’ve prioritized supporting the expansion of colorectal cancer screening among underserved communities in the territories and in First Nations communities. Why is this important? 

The number of people living in the Prairies and the territories is sometimes underestimated, and there can be opposition or misconceptions about Western medicine. It’s our responsibility to ensure people understand the intent and process of screening and treatment through culturally safe, community-led initiatives. The government of Nunavut is a good example – they use local systems, school nurses and translators to share information effectively.  

Colorectal cancer, and colonic disease in general, disproportionately affects underserved populations, so increasing screening in rural and remote areas, and within Indigenous communities, is critical in reducing the incidence of these diseases and improving outcomes.

– Dr. Hendrik du Plessis

From the patient side, how does someone discuss getting screened for colorectal cancer with their family physician? 

For individuals at high risk of colorectal cancer, the recommendations differ from individuals at average risk that population-based screening programs are geared towards. If a patient has a strong family history of colorectal cancer – particularly in first degree relatives such as parents, siblings, or, for older adults, even their own children – their individual risk is higher. In these cases, screening may begin earlier, typically at age 40 or ten years before the age at which the close family member was diagnosed.  

The second part of the equation involves recognizing symptoms. Family physicians need to ask about red flag symptoms that may warrant further investigations. These worrisome symptoms include persistent rectal bleeding, ongoing changes in bowel habits that last for months (not just short-term illness), significant and unexplained weight loss, or signs of anaemia or iron deficiency without another clear cause. From the patient’s perspective, advocating for themselves by raising these concerns is essential. In turn, primary care providers should follow up with the right questions about family history and symptoms that may require further investigation.

And of course, individuals who already fall within the current screening age or eligibility criteria should be strongly encouraged to participate in their provincial or territorial screening programs. 

Are there behavioural changes that can reduce the chances of getting colorectal cancer?  

Evidence shows that diets high in red meat are associated with a higher risk of colorectal cancer. Eating healthy food, being physically active and adopting healthier lifestyle habits – like stopping smoking – can all help reduce risk.

Of course, these behaviours don’t guarantee prevention. We sometimes see very healthy, active individuals diagnosed with colorectal cancer, but in some of these cases, earlier symptoms such as rectal bleeding may have gone unnoticed or unreported. Still, the broader evidence suggests that environmental and lifestyle factors meaningfully contribute to risk, and making healthier choices can help lower that risk. 

And it’s important to keep in mind that while individual factors play a role in cancer prevention, cancer causes are also impacted by broader economic and public health factors such as an individual’s social, financial, quality of life measures, and psychosocial well-being. An individual’s ability to access resources to practice a healthier lifestyle are deeply rooted in system level inequities that persist in Canada and need to be contextualized in the primary prevention of cancers such as colorectal cancer.

Once you know you may be at higher risk, there are several steps you can take: follow recommended guidelines, stay in communication with your family physician, pay attention to any concerning symptoms, participate in colorectal cancer screening, and make healthy lifestyle changes where possible.  

– Dr. Hendrik du Plessis

There’s no single action that prevents cancer. Instead, prevention is about putting together many pieces of the puzzle; the more you do, the more complete the picture becomes in helping reduce your risk and ensuring cancers are found early when they are most treatable. 

What is the significance of March as Colorectal Cancer Awareness Month? 

When I talk to patients, I often use a simple comparison: your body is like a vehicle. You wouldn’t drive your car for 20 years without changing the oil, replacing the tires, or doing regular maintenance. The same goes for your body – you need to take care of it to keep it running well. 

Colorectal cancer screening is one of those essential maintenance tools. It doesn’t change your risk of heart disease, stroke, or diabetes, but it does give us a straightforward way to see whether you might be at risk for colorectal cancer. We can start with a non‑invasive test, and if needed, offer a colonoscopy to check things more closely.

The more people who participate in screening, the more people we can keep healthy and “on the road” for longer. Leveraging national events like March’s Colorectal Cancer Awareness Month is significant for this purpose.

– Dr. Hendrik du Plessis

In addition to being a Screening Advisor at the Partnership, you are also a member of the Canadian Screening for Colorectal Cancer Research Network, the National Colorectal Cancer Screening Network and the Colorectal Cancer Screening Community of Practice. Why do you think it’s important to work in and bring together the colorectal cancer screening community in this way?

Being a member of the two networks and the Community of Practice exposes you to the experiences of others. Across the country, different jurisdictions face different levels of colorectal disease burden, and each has its own way of overcoming the challenges that come with that. What works in the Maritimes might look different from what works in the Northwest Territories or on Vancouver Island, but across the board, we can do better at ensuring patients are informed. By sharing those approaches – what’s worked, what hasn’t – we’re able to learn from one another. 

Overall, these collaborations create a space where we all benefit from collective experience.  

Is there anything else you’d like to add? 

The Partnership really does have a unique, nationwide reach. Hopefully, as we track participation over time, we’ll see the impact of increased awareness and greater screening uptake reflected in the statistics and metrics, which is already showing that colorectal cancer rates and mortality are trending down.   

All of this work is rooted in collaboration, and the Partnership’s support has been instrumental in moving the needle towards higher screening participation across Canada.

– Dr. Hendrik du Plessis

And one last message for the readers: if you have symptoms, please make sure they are investigated properly. And if you are in the recommended screening age group, get screened as soon as possible. The earlier these issues are identified, the higher the chances we have in preventing and successfully treating colorectal cancer.

---

Explore the 2023–24 colorectal cancer screening environmental scan.