Screening age drops due to rising rates of bowel cancer

A key five-year Bowel Cancer Australia campaign has reached a milestone with updated clinical practice guidelines lowering the bowel cancer screening start age recently endorsed by the National Health and Medical Research Council (NHMRC).

For the first time, population screening (for people at average risk of developing bowel cancer, i.e., without any symptoms) is recommended every two years for people aged 45-74 (previously 50-74), along with a lowering of the National Bowel Cancer Screening Program (NBCSP) start age from 50 to 45. 

People aged 40-44 (previously 45-49) are also able to request screening via their healthcare professional prior to receiving their first NBCSP invitation.

1,716 Australians are diagnosed with bowel cancer under the age of 50 each year. People aged 40-49 account for 56 per cent of new cases and 64 per cent of deaths in those diagnosed under 50.

“It has been years of tireless advocacy, and we remain grateful to our passionate team of advocates for their support,” Bowel Cancer Australia CEO, Julien Wiggins said.

“However, work remains, and we are now calling on the Federal Government to approve, fund and implement a lower NBCSP screening start age to stop people dying from early-onset bowel cancer,” he added.

“Youthfulness should not be a barrier to timely diagnosis, so it is equally imperative the updated guidance for people aged 40-44 is implemented by healthcare professionals,” he said. 

Recommendations to begin screening from age 45 were first introduced in the United States in 2018, when the American Cancer Society (ACS) updated their guidelines in response to rising rates of bowel cancer incidence and mortality in young and middle-aged populations. 

By 2021, the American College of Gastroenterology (ACG), the US Preventive Services Task Force (USPSTF), and the US Multi-Society Task Force (USMSTF) on Colorectal Cancer (CRC), had all joined the ACS in updating their guidelines to recommend screening from age 45 rather than 50.

“While we recognise lowering the screening age is one step forward for people aged 40 and over, it doesn’t address the rise in early-onset bowel cancer,” said Bowel Cancer Australia Medical Director, A/Prof Graham Newstead AM.

“We still don’t know why younger people are getting bowel cancer,” he added.

“What we do know, is that people under the age of 50 have an increased risk of developing bowel cancer when they experience one or more symptoms of abdominal pain, rectal bleeding, diarrhoea, and iron deficiency anaemia between 3 months and 2 years prior to diagnosis.”

“Younger people need to be aware of, and act on, these potential signs and symptoms and have them investigated to rule out bowel cancer as an underlying cause,” said A/Prof Newstead.

Recent Australian research has shown that self-advocating is the only consistent and reliable resource for overcoming age bias, barriers to diagnosis, and optimising outcomes for a disease that is not only on the rise, but the deadliest cancer for those aged 25-44.