Key takeaways

• Rising early onset colorectal cancer rates and projected reductions in cases, deaths, and costs consistently support further consideration of starting biennial FIT screening at age 45 in Canada where jurisdictional context and readiness support implementation.
• Although empirical data describing the effectiveness of colorectal screening in younger persons is quite limited at this time, the field is evolving rapidly, and it is likely that new evidence will emerge in the coming years.
• Regarding the changing epidemiology of colorectal cancer in Canada, the most notable increase in incidence rates in younger persons is among those 45-50 years. However, the incidence is also increasing among those in even younger age groups, and lowering of the age to start colorectal screening to age 45 would not address this. Rates of colorectal cancer in individuals over the age of 50 continue to increase as well, demonstrating the need for screening participation to increase across all age groups.
• From 2018 to 2023, several international associations recommended lowering the age to start CRC screening to 45, including the American Cancer Society, the US Preventive Services Task Force (USPSTF), the US Multisociety Task Force (USMSTF), and the National Health and Medical Research Council of Australia.
• If the age to start colorectal screening is lowered to 45 years, this would lead to clinical impact in terms of a reduction in colorectal cancer incidence and deaths but would require an increase in FIT kits and colonoscopies as well as staffing resources.
• If a decision is taken to lower the age to start colorectal screening, additional resources will be required to ensure this does not adversely impact access to diagnostic colonoscopy.
• If a decision is taken to lower the age to start colorectal screening, there should be a clear plan in place to monitor and to evaluate the implementation, so that a full picture of its impacts on clinical outcomes and resources can be determined.
• Regardless of the decision whether to lower the age to start colorectal screening, it is important that younger people with large bowel symptoms, such as rectal bleeding, undergo prompt investigation.