Why Ontario rapper says colon cancer screenings should start at 30, not 50

A Hamilton, Ont., musician and actor who is battling stage four colon cancer is calling on the provincial government to lower the minimum age for a colonoscopy from 50 to 30.

Bishop Brigante, rapper with hits such as 2017 single tough times and with actors Turn on shows like orphan blackI was diagnosed with colon cancer in October 2023.

But it was two years earlier that the man, in his early 40s, first started seeking treatment for abdominal pain, diarrhea and bloody stools.

“My doctors often say, 'It's hemorrhoids.' They say I have irritable bowel syndrome, and then I'm like, 'You have to work on your diet, modify what you eat,' etc. “I was told,” he told host Dr. Brian Goldman. CBC Radio's white coat, black art.

By the time Brigante underwent a colonoscopy, followed by an MRI and CT scan, the 8-centimetre tumor had penetrated the rectal wall and spread to other parts of the body, including the liver and lungs.

Hearing the news was “quite heavy.”

Brigante is part of a puzzling phenomenon in which colon cancer is increasing in younger adult groups than usual. The Canadian Cancer Society says cancer is now the second leading cause of cancer death in men and the third leading cause of death in women.

In response to this trend, the U.S. will lower the age for routine colonoscopies for average-risk individuals from 50 to 45 in 2021, leading to a reduction in the age limit for routine colonoscopies for people at average risk. This led to calls for changes in the way the health system approaches both screening and recognition of cancer.

“I've been treating colorectal cancer for over 20 years, and there's no question that more and more patients are being diagnosed earlier,” says Professor of Medicine at the University of British Columbia and BC Cancer Oncologist. said Dr. Charlene Gill. We mainly focus on gastrointestinal cancers.

He said it is currently estimated that about 10-15% of new colorectal cancer diagnoses are in people under 50.

Looking back at his early career, Gill estimates that only about 1 in 40 colon cancer patients were under the age of 50, which is considered an early onset of the disease.

He said cancer statistics now show that the risk of early-onset colorectal cancer is almost 2.5 times higher for people born after 1980 compared to previous generations. Ta.

“We feel that in Canada we need to seriously consider lowering the testing age to 45.”

Brigante is now nearing the end of a series of 12 chemotherapy sessions and says the main tumor appears to be shrinking. The goal is to get to a place where colorectal and peritoneal surgery is available.

But he said the experience motivated him to make changes to prevent others from being diagnosed with colorectal cancer at such a late stage.

Colorectal cancer screening

Most states and territories offer a fecal immunochemical test (FIT test) that detects the presence of blood in a stool sample collected at home.

In a more invasive colonoscopy, a health care professional uses a long, flexible tube with a lightweight, small camera on one end to examine the inside of the colon (also called the large intestine) . Abnormal growths called polyps may also be removed for further testing. If left alone, some polyps may It can grow into larger tumors, some of which can become cancerous.

That's why Brigante says it's worrisome that current screening guidelines are based on statistics he describes as “very outdated.”

Both the FIT test and colonoscopy screening become available to average-risk individuals starting at age 50.

By the time this article was published, his petition on change.org had garnered nearly 30,000 signatures and was submitted to the Ontario Legislature by NDP health critic France Gelinas on February 20. .

Ontario's colorectal cancer screening program “continues to recommend colorectal cancer screening starting at age 50,” the Ontario Ministry of Health said in a statement.

The ministry said this is consistent with similar screening programs in place across Canada and is a recommendation by the Canadian Preventive Health Task Force and the International Agency for Research on Cancer.

This also applies to people who have parents or siblings. People who get the disease are 10 years younger than their relatives when they were diagnosed and may be able to start testing sooner, and people of any age with symptoms can get tested through their health care provider. can.

The Canadian Preventive Health Task Force told CBC in a statement that it will update its 2016 screening guidelines after a detailed review of recent research.

“This includes research into the increasing incidence of colorectal cancer in younger age groups and the effectiveness of colorectal cancer screening.”

The publication date has not been determined at this time.

checks and balances

But expanding the age range for standard colonoscopies isn't as easy as it sounds.

Barry Stein, president and CEO of the Colorectal Cancer Society of Canada, and a survivor of stage 4 colorectal cancer diagnosed in 1995 at age 41, said age-based screening There appears to be an international movement to reconsider the standards, but Canada said it is still gathering information. .

“Because when we introduce screening programs, the idea is to do no harm,” Stein said. While the FIT test is non-invasive, colonoscopy is a different story.

He said there is a small risk of puncturing the colon during the procedure. a study This incidence is estimated to be approximately 3 in every 10,000 tests, or 0.03%.

Although very rare, perforation is very serious and can be fatal. Between 21% and 53% It depends on the nature of the laceration, the age of the patient, and whether there are other risk factors.

Stein said the Canadian government estimates that 24,100 people will be diagnosed with colorectal cancer in 2023, about 2,500 of whom will be under the age of 50.

During the same period, the disease caused approximately 9,300 deaths, or 11 per cent of all cancer deaths in Canada.

Stein said the incidence of these cancers in young people appears to be occurring more frequently in the lowermost part of the colon, the rectum, for unknown reasons.

“We're studying a lot of different things with some of the researchers we collaborate with, for example the microbiome. So far we think it's a healthy lifestyle – diet and exercise. Masu.”

UBC's Gill says that while research is still ongoing, the so-called Western diet, which is low in fiber and plants and high in processed foods, does have a negative impact on the microbiome, and is “prone to inflammation and immune surveillance.” It is understood that there is a role for control.” In other words, how our immune system functions can influence the development of cancer. ”

involve the public

Another aspect of colon cancer prevention efforts in Canada is addressing the general population's reluctance or lack of awareness that it is an option to undergo routine screening.

“Probably over 40 percent of people who are eligible to get tested are not getting tested,” Gill said. “There are people in their early 50s and 60s who haven't been tested. Testing is free in our public health system.”

Gill said efforts are also underway to inform GPs and other primary care providers that the colon cancer landscape is changing.

“If a young person develops symptoms, we usually say, 'You're too young to put cancer at the top of your list of things to worry about.' But perhaps that narrative needs to change now. I guess.”