Colorectal cancer screening in Canada: 2021/2022
Screening individuals at increased risk
Individuals at increased risk have certain risk factors that makes them more susceptible to developing colorectal cancer, developing more aggressive colorectal cancers, or developing colorectal cancer at an earlier age. Individuals at increased risk may be screened differently than individuals at average risk and are often screened outside of organized programs.
Many provinces and territories have specific factors they consider when identifying an individual at increased risk for colorectal cancer. The most common risk factor that places individuals at increased risk is having a 1st degree relative that was diagnosed with colorectal cancer. Some provinces and territories specify that the 1st degree relative needs to be less than 60 years old, whereas in other jurisdictions the 1st degree relative can be of any age.
Definitions of increased risk for colorectal cancer
| P/T | One 1st degree relative diagnosed with: | Two or more 1st degree relatives diagnosed with: | Two 2nd degree relatives diagnosed with: | Personal history of: |
|---|---|---|---|---|
| YT | Colorectal cancer*, Adenomatous polyps* | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps |
| NT | Colorectal cancer* | Colorectal cancer | Colorectal cancer, Adenomatous polyps | |
| NU | Colorectal cancer* | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | |
| BC | Colorectal cancer* | Colorectal cancer | ||
| AB | Colorectal cancer*, Adenomatous polyps* | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps |
| SK | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | |
| MB | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | |
| ON^ | Colorectal cancer | Colorectal cancer | ||
| QC~, ** | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps |
| NB | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps |
| NS‡ | Colorectal cancer*, Adenomatous polyps* | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | |
| PE | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | Colorectal cancer, Adenomatous polyps | |
| NL | Colorectal cancer* | Colorectal cancer | Colorectal cancer | Colorectal cancer, Adenomatous polyps |
YT, NT, NU, BC, AB, NS, NL: *age ≤60
ON: ^The criteria for definition of increased risk for colorectal cancer are currently under review in Ontario.
QC: ~In Québec, one 2nd or 3rd degree relative diagnosed with colorectal cancer or adenomatous polyps, one 1st degree relative and one 2nd degree relative from the same side of the family diagnosed with colorectal cancer at any age are considered. Also, slight or moderate increased risk is considered.
QC: **The algorithms for risk-based monitoring and management and clinical monitoring depending on the condition are currently under review. The algorithms can be found here: msss.gouv.qc.ca/professionnels/cancer/pqdccr/
NS: ‡Criteria for definition of increased risk of developing colorectal cancer are currently under review in Nova Scotia.
Increased risk recommendations
Provinces and territories may, outside of their population-based screening programs, recommend specific screening protocols and follow-up measures for individuals at increased risk. The Canadian Association of Gastroenterology (CAG) has issued guidelines for screening individuals at increased risk.
Most provinces and territories recommend screening individuals at increased risk starting at age 40, or 10 years earlier than the participant’s youngest relative’s age at diagnosis, with colonoscopy every five or ten years. In some cases, the recommendation is that individuals at increased risk are screened similarly to those of average risk, but that they begin screening at age 40. Other provinces follow the recommendations outlined in the CAG guidelines for screening individuals at increased risk.
Recommendations for individuals at increased risk of colorectal cancer
| P/T | Screening recommendation for increased risk population | Follow-up recommendations after normal colonoscopy |
|---|---|---|
| YT | · Screening through colonoscopy. · 1st degree relative diagnosed with colorectal cancer or adenomatous polyps at age ≤ 60 years or 2 or more 1st degree relatives diagnosed at any age with colorectal cancer or adenomatous polyps. Refer at age 40 years, or 10 years prior to index case, whichever comes first. FIT is not recommended. · 1st degree relative diagnosed with colorectal cancer age ˃60 years screen with FIT every 2 years starting at age 50. |
· Colonoscopy in 5 years or as directed by specialist |
| NT | · Screening through colonoscopy at age 40, or 10 years earlier than the youngest relative’s diagnosis. | · Colonoscopy in 5-10 years |
| NU | · Screening through colonoscopy, depending on result. | · Varies based on polyp type |
| BC | · Strong family history of colorectal cancer or personal history of low risk adenoma: Screening through colonoscopy every 5 years. · Personal history of high risk adenoma on last colonoscopy: Screening through colonoscopy in 3 years. |
· Colonoscopy in 5 years |
| AB | · Screening through colonoscopy. | · Follow-up in 5-10 years · If history of colorectal cancer, surveillance 1 year post surgery. Has to have 3 normal colonoscopies to return to 5 year interval. |
| SK | · 1st degree relative diagnosed with colorectal cancer: Screening through colonoscopy beginning at age 40 or 10 years earlier than the youngest relative’s diagnosis. · 1st degree relatives diagnosed at age ≥60: Screening through FIT starting at age 40. |
· Recommendations at the discretion of the endoscopist and participant, monitored by PCP (based on CAG guidelines). |
| MB | · Screening through colonoscopy. | · Colonoscopy every 5-10 years starting at age 40 or 10 years earlier than the youngest relative’s diagnosis. |
| ON* | · ColonCancerCheck recommends that people who have no symptoms and are at increased risk of getting colorectal cancer be screened with a colonoscopy. Someone at increased risk should start screening at age 50, or 10 years earlier than the age their relative was diagnosed with colorectal cancer, whichever comes first. | · People with a first-degree relative diagnosed with colorectal cancer before age 60 should get screened again after a normal colonoscopy in five years. · People with a first-degree relative diagnosed with colorectal cancer at age 60 or older should get screened again after a normal colonoscopy in 10 years. |
| QC^ | · Slightly increased risk: Screening through FIT test starting at age 40. · Moderately increased risk: Screening through colonoscopy ever 5 years starting at age 40 or 10 years earlier than the youngest relative’s diagnosis. |
· Slightly increased risk: FIT test in 10 years · Moderately increased risk: colonoscopy every 5 years |
| NB | 1. One 1st degree relative with colorectal cancer or adenomatous polyps diagnosed at age <60 or two or more 1st degree relatives with colorectal cancer or adenomatous polyps diagnosed at any age: Screening through colonoscopy at age 40 or 10 years earlier than the youngest relative’s diagnosis. 2. One 1st degree relative with colorectal cancer or adenomatous polyps diagnosed at age >60 or two or more 2nd degree relatives with colorectal cancer or adenomatous polyps diagnosed at age >60: Screening through FOBT test starting at age 40 and/or referral to a specialist. |
· Colonoscopy every 5 years |
| NS | · One 1st degree relative with colorectal cancer age ≤60; colonoscopy starting age 40 or 10 years. younger than first degree relative age of diagnosis · Two or more 1st degree relatives with colorectal cancer; colonoscopy starting age 40 or 10 years younger than first degree relative age of diagnosis. |
· Colonoscopy in 5 years |
| PE | · Family history of colorectal cancer/adenomas in parent, sibling or child and participant is 40 years or older, screening recommendation is a colonoscopy every 5 years. · Family history of colorectal cancer/adenomas in parent, sibling or child and participant is younger than the age of 40, screening recommendation is a colonoscopy every 5 years, starting 10 years earlier than the affected relative. · Follow CAG guidelines for other increased risk such as genetic conditions with a predisposition to colorectal cancer, personal history of colorectal cancer or adenomas, inflammatory bowel disease or symptoms for colorectal cancer. · Increased risk is managed by PCP, recommendation is at discretion of the PCP. Rreferral is coordinated by PCP not the Program). |
· Recommendations at the discretion of the endoscopist, follow CAG guidelines |
| NL | · Screening through colonoscopy. | · Follow-up with colonoscopy |
ON: *Screening recommendations for individuals at increased risk of colorectal cancer are currently under review in Ontario.
QC:^ The algorithms for risk-based monitoring and management and clinical monitoring depending on the condition are currently under review. The algorithms can be found here: msss.gouv.qc.ca/professionnels/cancer/pqdccr/
Plans to implement stool-based screening (fecal test) rather than colonoscopy for individuals with a family history of colorectal cancer are under consideration in Yukon, Alberta, and Nova Scotia. Currently, no other provinces or territories are considering this change.
Plans to implement fecal test screening for individuals with family history of colorectal cancer
| P/T | Plans to implement stool-based screening rather than colonoscopy for individuals with family history |
|---|---|
| YT | Individuals with one 1st degree relative with colorectal cancer who were diagnosed over the age of 60 are offered FIT. No current plans to consider FIT for those with stronger family history. |
| NT | No current plans |
| NU | No current plans |
| BC | Individuals with one 1st degree relative with colorectal cancer who were diagnosed over the age of 60 are offered FIT. No current plans to consider FIT for those with stronger family history. |
| AB | Under consideration, new CAG and AB guidelines pending |
| SK | The Saskatchewan Screening Guidelines indicate that family history should be followed with colonoscopy but the Saskatchewan screening program invites all clients age 50-74 by mailing a FIT test to the home of all covered population. Therefore, a family history client will receive FIT unless client self-reports the family history and opts out of program or the colonoscopist recommends to the screening program that the client will remain on surveillance colonoscopy. |
| MB | No current plans |
| ON | No current plans* |
| QC | No current plans |
| NB | No current plans |
| NS | First degree relative with colorectal cancer age >60; average risk screening with FIT age 50. |
| PE | No current plans |
| NL | No current plans |
ON: *This may change as the definition for increased risk and the screening recommendations for individuals at increased risk of colorectal cancer are currently under review in Ontario.