Ontario lowers colorectal cancer screening age to 45 – a positive shift Medcan's long championed
Ontario Health recently announced updated colorectal cancer screening guidelines that lower the starting age for testing from 50 to 45, effective July 1. The decision comes in response to a concerning rise in diagnoses among younger adults.
As a leader in proactive health, this is a change Medcan is glad to see. “I've been promoting screening at age 45 for over 5 years given colon cancer has been rising in younger people,” says Medcan Clinical Director of Endoscopy, Dr. Jeffrey Axler.
Ontario introduced the change after several other jurisdictions, including the United States, Australia, and PEI, made regulatory changes. The Ontario government’s decision also comes after numerous calls from Colorectal Cancer Canada and the Canadian Cancer Society.
“At Medcan, we refuse to be late to the game if it will save lives,” says Dr. Axler. This is why Medcan has long promoted early proactive screening – recommending starting at age 45 (or earlier based on individual risk or preference), with repeat screening every 5–10 years guided by clinical assessment.
For years, we have advocated for earlier conversations, earlier screening, and a more individualized approach to care based on evidence that screening should start earlier. We’ve seen it as especially important given that Canada has high colorectal cancer rates compared to the global average, yet Ontario’s colorectal cancer screening rates remain below both the national average and recommended targets.
Dr. Axler emphasizes that every time colorectal cancer is found in a patient that was not screened when they should have been, it means the system was not successful in preventing that cancer. “We need more screening, and better screening, because early screening for colon cancer is effective.”
This is also why at Medcan, we also use colonoscopy (and prefer it over the fecal immunochemical test) as it remains the gold standard for colorectal cancer screening – not only for detection, but for prevention.
To make the best-informed decisions, here we outline Medcan’s recommendations and everything you need to know about colorectal rates and screening options.
"We need more screening, and better screening, because early screening for colon cancer is effective.”- Dr. Jeffrey Axler, Clinical Director of Endoscopy at Medcan
Colorectal cancer rates are rising in young adults
CRC is no longer a condition primarily affecting older adults. Incidence is rising most notably in individuals aged 30–49, and nearly 10% of cases in Ontario now occur before age 50.
Addressing younger adults is impactful as evidence demonstrates that Canadians born after 1980 are 2-2.5 times more likely to be diagnosed with CRC before age 50 than prior generations at the same age. At the same time, younger patients are more likely to be diagnosed at later stages, with approximately 60% presenting at Stage III or IV.
For many years, there has been a critical gap where traditional, population-based screening thresholds have not kept pace with shifting risk patterns.
“It’s important for patients to understand that public screening programs are designed to optimize outcomes at a population level by balancing effectiveness, risk, and system cost,” says Dr. Axler.
As a result, the public system relies on fixed age thresholds and standardized intervals. However, these frameworks do not always account for individual variability when it comes to risk.
Rather than following a one-size-fits-all approach, Medcan physicians assess each client through a clinical lens, considering personal and family history, evolving evidence, and individual preferences. This means we:
- Start screening at 45 – or earlier when appropriate
- Tailor screening intervals (often within a 5–10 year range) based on clinical context
- Engage clients in informed decisions about their risk and prevention strategy
The bottom line is when it comes to CRC, risk is not uniform – and screening shouldn’t be either.
The CRC testing process
Currently, there are two ways to screen for colorectal cancer: a fecal immunochemical test (FIT test) or a colonoscopy.
Routine colorectal screening involves a fecal immunochemical test (FIT). This at‑home test involves collecting a small stool sample and sending it to a lab for analysis. It is generally recommended every two years. If blood is detected in the sample, the next step is a colonoscopy to investigate further and rule out or diagnose colorectal cancer.
The government announced it will be sending FIT test screening invitation letters in a phased manner to establish new regulations. However, after the July 1st start date physicians will be able to order a FIT test for anyone aged 45 to 49.
At Medcan, our standard of care is to use colonoscopy. Unlike FITs tests, which can miss up to 20% of cancers and are not preventive, colonoscopy allows physicians to identify and remove precancerous polyps before they progress.
“This distinction is fundamental. The FIT test is ok, but there are better options. Colonoscopy doesn’t just find cancer; it can stop it from developing,” Dr. Axler explains.
This is why at Medcan we have long championed colonoscopy as a cornerstone of proactive health, rather than a reactive diagnostic tool. We have an onsite endoscopy suite at our Toronto location where we provide both OHIP funded and private pay proactive colonoscopies.
"The FIT test is ok, but there are better options. Colonoscopy doesn’t just find cancer; it can stop it from developing."- Dr. Jeffrey Axler, Clinical Director of Endoscopy at Medcan
Closing the gap between recommendation and action
Despite strong evidence, clinical experience has also shown that screening uptake has also been inconsistent. Only about two-thirds of Canadians receive appropriate CRC screening, and many report that it was never recommended to them.
When it comes to CRC, a lot of barriers are often driven by perception. Many have concerns about discomfort, embarrassment, or inconvenience, yet these concerns are outdated. Modern preparation protocols are well tolerated, and risks related to colonoscopy are minimal.
Risks include bowel tears and bleeding, which are more likely in older patients with multiple co-morbidities. In Ontario, these risks are approximately 0.02%, meaning that as an individual ages their risk of developing CRC is significantly higher than the risk of having a complication from colonoscopy.
Through education and open dialogue, our goal is to ensure clients understand both the reality of the procedure and its significant preventive value, stressing that screening is not only about whether you test - but when.
Delaying or avoiding colonoscopy can lead to cancers developing undetected, only to be discovered later when symptoms emerge, and disease is more advanced. The best time to catch cancer is when you’re being proactive, not reactive.
A 10-year screening interval is consistent with both US and Canadian guideline-based recommendations. However, interval cancers do occur, and the risk between examinations is not uniform across individuals.
At Medcan, we recommend an individualized approach to determining CRC screening intervals, supporting a shorter interval depending on clinical context and client interest. One large US study showed the cumulative incidence of CRC starting 1 year after a negative colonoscopy is 0.4% at 3 years, 0.8% at 5 years and 2.3% at 10 years.
This reinforces the need for ongoing, personalized reassessment rather than relying solely on fixed intervals.
Get tested at 45 or sooner if you have concerns about heightened risk
The updated Ontario guidelines are an important step forward, and one that aligns with where evidence and clinical practice have been heading.
At Medcan, colonoscopy is viewed not as a milestone tied to age, but as an opportunity to intervene earlier, reduce risk, and improve long-term outcomes. Proactive health looks like starting earlier when risk is rising, individualizing care rather than standardizing it, and using the most effective tools not just to detect disease, but to prevent it.
Go get screened, screen earlier and do the best screening test to prevent cancer.- Dr. Jeffrey Axler, Clinical Director of Endoscopy at Medcan
When it comes to colorectal cancer, the greatest impact comes not from finding it sooner - but from stopping it before it starts.
The bottom line, says Dr. Axler, is to “Go get screened, screen earlier and do the best screening test to prevent cancer.”
Take action
To learn more about colorectal screening options, speak to your Dedicated Care physician. Medcan also offers an Endoscopy Comfort Package that delivers peace of mind from start to finish for individuals seeking colonoscopy.
In addition to colorectal cancer screening, Medcan is the exclusive provider for the Galleri test by GRAIL, which sets the standard for multi-cancer early detection and is ideal for those who are seeking a more comprehensive proactive approach to cancer screening. Through a single blood draw, this innovative, clinically validated test screens for 50+ cancer types, like pancreatic and ovarian cancer, before they become symptomatic, maximizing the opportunity for early diagnosis, when treatment can be most effective. Learn more here.
This content is for informational purposes only and should not be taken as medical advice. Please consult a Medcan clinician or your healthcare provider for guidance tailored to your health needs.
This article was written by Medcan’s editorial team with review and contribution from Dr. Jeffrey Axler, Clinical Director of Endoscopy at Medcan and Dr. Jason Abrams, Medcan’s Vice President of Medical Affairs.
Relate services
Explore colorectal screening options through a Dedicated Care physician. Medcan also offers an Endoscopy Comfort Package, providing a supportive, streamlined experience for those preparing for a colonoscopy. Beyond colorectal cancer early prevention, Medcan is the exclusive provider of the Galleri test by GRAIL , a clinically validated test uses a single blood draw to screen for more than 50 cancer types, helping identify cancer earlier, when treatment can be most effective