Canadian Colorectal Cancer Screening Guidelines: Do They Need an Update Given Changing Incidence and Global Practice Patterns?
Division of Medical Oncology, BC Cancer/University of British Columbia, Vancouver, BC V5Z 4E6, Canada
Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
Cancer Control Research, BC Cancer, Vancouver, BC V5Z 4E6, Canada
Division of Gastroenterology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
Division of General Surgery, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(3), 1558-1570; https://doi.org/10.3390/curroncol28030147
Received: 20 January 2021 / Revised: 7 April 2021 / Accepted: 19 April 2021 / Published: 21 April 2021
Colorectal cancer (CRC) is the third most commonly diagnosed cancer and second leading cause of cancer death in Canada. Organized screening programs targeting Canadians aged 50 to 74 at average risk of developing the disease have contributed to decreased rates of CRC, improved patient outcomes and reduced healthcare costs. However, data shows that recent incidence reductions are unique to the screening-age population, while rates in people under-50 are on the rise. Similar incidence patterns in the United States prompted the American Cancer Society and U.S. Preventive Services Task Force to recommend screening begin at age 45 rather than 50. We conducted a review of screening practices in Canada, framing them in the context of similar global health systems as well as the evidence supporting the recent U.S. recommendations. Epidemiologic changes in Canada suggest earlier screening initiation in average-risk individuals may be reasonable, but the balance of costs to benefits remains unclear.