Australians as young as 45 should be screened for bowel cancer, according to new guidelines approved by Australia’s peak body for medical research.
With rates of bowel cancer in people under 50 rising, the National Health and Medical Research Council has endorsed lowering the age at which bowel cancer screening starts from 50 to 45 in its clinical practice guidelines, a position advocated by Bowel Cancer Australia for the past five years.
Bowel Cancer Australia on Monday called on the federal government to approve, fund and implement the lower age for the national bowel cancer screening program, which would bring Australia into line with the US.
Lowering the screening age would also allow for people aged 40 to 44 (previously 45-49) to request a screening via their healthcare professional before their first invitations for the national screening program.
The Bowel Cancer Australia chief executive, Julien Wiggins, said while the endorsement represents a milestone for the organisation, “work remains … to stop people dying from early-onset bowel cancer”.
Rates of bowel cancer – also known as colon, rectal or colorectal cancer – have risen sharply in Australians under 50, disproportionate to population growth. A 2021 Australian Institute of Health and Welfare report noted that between 2001 and 2021 the incidence of bowel cancer in people aged 20 to 39 more than doubled, from more than four cases for every 100,000 people to more than 10.
One in nine new bowel cancer cases (1,716) now occur in people under the age of 50.
“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,” Wiggins said.
The recommendation will not see bowel screening kits sent out to 45- to 49-year-olds without the government committing funding and approval.
A Department of Health and Aged Care spokesperson said the government was “committed to reducing deaths, and improving outcomes for people with bowel cancer in Australia”.
“Since 2006, the Australian Government’s National Bowel Cancer Screening Program (NBCSP) has played a key role in reducing the incidence of bowel cancer in Australia,” the spokesperson said.
“The government is carefully considering the implications of the recommendation in the updated Guidelines to lower the eligible age of the NBCSP to 45 years, including the costs and flow on implications for the broader health system.”
George Barreto, an associate professor in medicine at Flinders University, said lowering the age of the existing effective screening program would help detect more of the increasing bowel cancer cases among young individuals.
Compared with older people, young bowel cancer patients are more likely to present with more advanced stages of cancer, Barreto said.
“In general, it is believed that younger people tend to get diagnosed at a later stage because no one believes that you can get cancer,” he said. “For us, cancer has always been something that happens in an older age person.
“So bleeding from the rectum, for example, talking about bowel cancer, is put down to more benign causes, things that are common, like haemorrhoids and fissures, and people don’t often think about cancer as the first diagnosis.”
The medical director of Bowel Cancer Australia, Graham Newstead, said while it was still not known why more and more younger people are getting bowel cancer, the lowering of the screening age is “one step forward”.
“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 three months and two years prior to diagnosis,” Newstead said.
“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,” he said.
