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, and that’s partly because many men still hesitate to discuss their bowels with their family doctors.

One of the barriers I see 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, simply 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 three 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. It detects small amounts of blood in your stool, which could signal 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. After an abnormal FIT result, follow up with a colonoscopy within eight weeks 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 first-degree 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. 

To better understand your risk for colorectal cancer and other common men’s health conditions, use Men’s Health Check.

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. The good news: By optimally controlling the inflammation through medication, diet, or other treatments, you can significantly reduce your risk.

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 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.
  • 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.

How do lifestyle factors impact colorectal cancer risk?

Several lifestyle factors may contribute to a heightened risk of colorectal cancer. Obesity, increased consumption of red meat, and high alcohol intake have all been linked to a higher risk. 

However, it’s crucial to remember that an association is not the same as a cause. In other words, just because someone eats more red meat or enjoys the occasional glass of wine doesn’t necessarily mean they’ll develop colorectal cancer. But these are certainly things to keep in mind when thinking about your overall health.

The rise of colorectal cancer in young adults

There has been a recent 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 increasingly sedentary lifestyle many people lead today, combined 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.

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 an easier, 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, and there’s still much more to understand about why it’s happening.

Still, the message is clear: 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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