Editor’s note: This article was originally published in October 2024 and was updated to include new research and testing information.

As a gastroenterologist, I’m encouraged by the progress Canada has made in screening for and treating colorectal cancer. At present, 90 percent of cases are treatable when caught early. That said, it remains the second leading cause of death from cancer among Canadian men which is partly because many men still hesitate to discuss their bowels with their family doctors.

A common thing I encounter in my practice is embarrassment. People don’t want to talk about their bowel movements or bring up symptoms like rectal bleeding. I get it — these aren’t exactly dinner table conversations. But the truth is, we need to normalize talking about our digestive health. It’s not something to be ashamed of; it’s your health, and addressing issues early can save your life. 

Screening is vital

If there’s one thing I can’t stress enough it’s the importance of regular screening for colorectal cancer. This isn’t just for those with obvious symptoms or a family history. Everyone should be proactive about reducing the risk of the disease. After all, screening is the only proven way to reduce your risk because it helps catch the cancer before it becomes life-threatening.

What does screening involve?

Talk to your doctor or nurse practitioner to determine which form of colorectal cancer screening is right for you. These are the main screening tests and procedures:

Fecal immunochemical test (FIT): This is a simple, safe, and non-invasive way to screen for colorectal cancer at home. If it detects small amounts of blood in your stool, it may indicate colorectal cancer or precancerous polyps (abnormal growths in the colon or rectum). 

You only need one stool sample to do the test and there’s no need to change your diet or medications. Once collected, you send the sample to a clinic or drop it off within two days. You’ll receive your results by mail and your doctor will also get a copy. 

If your results are abnormal, further testing like a colonoscopy (see below) will be needed to investigate. If your results are normal, repeat the test every two years until age 74 to ensure ongoing monitoring.

Colonoscopy: For those at higher risk of colorectal cancer, a colonoscopy is the most thorough screening method as it examines the entire colon. It allows doctors to take biopsies and remove polyps that could become cancerous. 

While it’s not recommended for average-risk individuals, it’s crucial for those with a family history, previous polyps or symptoms like rectal bleeding. Follow up with a colonoscopy within eight weeks after an abnormal FIT result  to ensure early detection.

Who should be screened and when?

Most colorectal cancer cases are still diagnosed in people over 50, which is why screening guidelines typically recommend starting at that age. If you have a family history of colorectal cancer — especially if a close relative was diagnosed under the age of 60 — you may need to start screening earlier. Depending on your risk factors, some people begin screening in their teens. 

For people living with inflammatory bowel diseases (IBDs) such as Crohn’s or ulcerative colitis, the story changes a bit. Chronic inflammation in the bowel is associated with an increased risk of colorectal cancer. Good news though! By optimally controlling the inflammation you can reduce your risk.

Use Men’s Health Check as a check-in to understand how your habits and history relate to eight common men’s health conditions, including colorectal cancer. It’s not a diagnosis, just simple guidance to help you make informed choices.

What symptoms should you watch for? 

One of the tricky things about colorectal cancer is that it doesn’t always present obvious symptoms, especially in its early stages. Again, that’s why screening is so vital. But there are some red flags you should never ignore:

Blood counts: Iron deficiency, for instance, can sometimes be the first indication that something’s wrong with your colon, even if you don’t have any bowel-related symptoms.

Blood in the stool: This is one of the most important symptoms. It’s not normal and always warrants further investigation.

A change in your bowel habits: People often ask me, “How many bowel movements should I have per day?” The truth is, there’s no magic number. What matters is what’s normal for you. If your usual routine suddenly changes. Whether it’s frequency, consistency, or urgency that’s a sign you should talk to your doctor.

Abdominal discomfort: This one is easy to overlook. Sometimes, it’s nothing, but it could also be an early sign of a problem.

The rise of colorectal cancer in young adults

There has been an increase in cases of colorectal cancer among younger adults. It’s a trend that’s hard to ignore, though we don’t yet fully understand why it’s happening. 

There are hypotheses out there. Perhaps it’s linked to the growing sedentary lifestyle many people lead today along with poor eating habits and obesity. But again, we’re cautious about jumping to conclusions. What we do know is that younger adults can and do develop colorectal cancer so it’s essential to take any symptoms seriously, regardless of your age.

Recently, there’s been evidence to show that if your diet is high in ultra-processed foods then your risk of developing colorectal cancer increases substantially, even at a young age. Diagnosis rates for younger adults are even projected to double every 15 years which is linked to this factor. 

A simple way to avoid consuming too many of these products is to stick to shopping the “outside” aisles of a grocery store. This is where you’ll find more produce, as well as grains, meats and dairy that usually aren’t highly processed. You can also follow the 80/20 rule: keep 80% of your shopping cart loaded with whole foods and 20% with processed foods. It’s okay to enjoy some processed foods on occasion.

Improving screening and awareness

While screening has improved our ability to catch the disease early there’s still work to be done. In Canada, we rely heavily on stool tests as a primary screening tool. While they’re good, I’m hopeful that science will eventually give us a more accessible screening method to encourage more people to get tested.

In the meantime, we’re diagnosing more cancers at earlier stages which is a huge win. The earlier we catch it the better the outcomes. However, the trend of younger patients being diagnosed is something that humbles us. There’s still much more to understand about why it’s happening.

Still, you should pay attention to your body, get screened when appropriate and don’t be afraid to talk about your bowel health. It’s a conversation that could save your life.

Do you have experience with colorectal cancer and would like to share your story? Please leave us a message below, and we’ll contact you. Or, email us at [email protected]. 

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