Colorectal Cancer Screening: Why March Is the Month to Get Checked in Ontario

Why Colorectal Cancer Screening Matters More Than You Think

Colorectal cancer often develops silently. It typically begins as a small, noncancerous growth called a polyp on the inner lining of the colon or rectum. These polyps can take years to become cancerous, which is exactly what makes screening so powerful. If you catch them early, they can be removed before they ever turn into cancer. If cancer has already formed, finding it at an early stage dramatically improves survival rates.

The Canadian Cancer Society estimates that roughly 1 in 14 Canadian men and 1 in 18 Canadian women will be diagnosed with colorectal cancer in their lifetime. Those numbers are sobering, but there's a hopeful counterpoint. Regular screening has been shown to reduce colorectal cancer deaths by a significant margin. In Ontario, the ColonCancerCheck program has been working since 2008 to improve screening rates, yet participation remains lower than it should be. Many eligible adults in Toronto and across the province have simply never been tested.

Part of the challenge is access. If you don't have a family doctor, or if getting an appointment takes weeks, screening often falls to the bottom of the priority list. That's one of the reasons Care& exists. Our Family Practice model ensures you have a dedicated Nurse Practitioner who can flag when you're due for screening, order the right tests, and follow up on results without the usual delays.

Ontario's Screening Guidelines: Who Should Be Tested and When

Ontario's ColonCancerCheck program provides clear guidelines for colorectal cancer screening based on your age and risk level. Understanding which category you fall into is the first step toward protecting yourself.

Average Risk Individuals

If you're between 50 and 74 years old, have no symptoms of colorectal cancer, and don't have a strong family history of the disease, you're considered average risk. The recommended screening test for you is the fecal immunochemical test, commonly called the FIT test. You should complete a FIT test every two years. It's a simple stool sample you collect at home, and it looks for tiny amounts of blood that aren't visible to the naked eye. This hidden blood can be an early sign of polyps or cancer.

Increased Risk Individuals

If you have a first-degree relative (parent, sibling, or child) who was diagnosed with colorectal cancer, your risk is higher than average. Ontario guidelines recommend that increased-risk individuals begin screening earlier, often at age 40 or 10 years before the age your relative was diagnosed, whichever comes first. For this group, colonoscopy rather than the FIT test is typically the recommended screening method, repeated every five to ten years depending on findings.

People with certain hereditary conditions, such as Lynch syndrome or familial adenomatous polyposis, fall into a high-risk category that requires specialized screening protocols. If you suspect you may have a hereditary predisposition, your healthcare provider can help determine the right plan for you.

The Age Conversation Is Changing

You may have seen headlines about rising rates of colorectal cancer in younger adults. Both the American Cancer Society and some Canadian experts have discussed lowering the starting age for screening to 45. As of now, Ontario's official program still begins at age 50 for average-risk individuals. However, if you're in your 40s and have symptoms or concerns, you shouldn't wait for a guideline change. Talk to your provider about whether earlier screening makes sense for you.

The FIT Test Explained: What It Is and How It Works

The fecal immunochemical test is the backbone of Ontario's colon cancer screening program for average-risk adults. It's non-invasive, doesn't require any bowel preparation, and you complete it in the privacy of your own home. Despite how straightforward it is, many people put it off because they find the idea uncomfortable or they're not sure where to get one.

Your Nurse Practitioner can provide you with a FIT test kit during a regular visit. The kit includes a small collection device and clear instructions. You take a single stool sample, seal it in the provided container, and return it to a lab within a set timeframe, usually within a few days. The test detects human hemoglobin (blood) in the stool using antibodies specific to human blood, which means it won't be triggered by what you ate the night before. No dietary restrictions are needed beforehand.

If your FIT test comes back normal, you'll repeat it in two years. If the result is abnormal, meaning blood was detected, that doesn't automatically mean you have cancer. In fact, most abnormal FIT results are caused by non-cancerous conditions like hemorrhoids, inflammatory bowel disease, or benign polyps. But an abnormal result does mean you'll need a follow-up colonoscopy to investigate further. Your provider will arrange the referral and walk you through the next steps.

Know Your Risk Factors for Colorectal Cancer

Some risk factors for colorectal cancer are within your control and some aren't. Understanding both can help you make informed decisions about screening timing and lifestyle choices. Your Nurse Practitioner can review these with you and determine whether you need screening earlier or more frequently than the standard guidelines suggest.

Non-Modifiable Risk Factors

Age is the single biggest risk factor. The majority of colorectal cancers are diagnosed in people over 50, though cases in younger adults are increasing. A personal history of colorectal polyps or colorectal cancer raises your risk of recurrence. A family history of colorectal cancer, particularly in a first-degree relative diagnosed before age 60, also significantly elevates your risk. Certain inherited genetic syndromes, including Lynch syndrome, account for a smaller but important percentage of cases. People with a long-standing history of inflammatory bowel disease, specifically ulcerative colitis or Crohn's disease affecting the colon, are also at increased risk.

Modifiable Risk Factors

Lifestyle plays a meaningful role in colorectal cancer prevention. Research consistently links higher rates of colon cancer with diets low in fibre and high in processed or red meats. Physical inactivity, obesity (particularly excess abdominal fat), heavy alcohol consumption, and smoking all increase your risk. The good news is that addressing even one or two of these factors can make a measurable difference. If you're working on weight management, smoking cessation, or dietary changes, your provider can support you through our Chronic Disease Management services, which include ongoing follow-up and accountability.

Type 2 diabetes has also been associated with a modestly increased risk of colorectal cancer, independent of other shared risk factors like obesity. If you're managing diabetes, this is another reason to stay current with your screening schedule.

When a Colonoscopy Referral Is Needed

A colonoscopy is a more thorough examination of the entire colon and rectum using a flexible camera. It's both a diagnostic and therapeutic tool. During the procedure, a gastroenterologist can visualize the colon lining directly and remove any polyps found. The removed tissue is sent to a lab for analysis to determine whether it's benign, precancerous, or cancerous.

You'll typically be referred for a colonoscopy in Ontario if you have an abnormal FIT test result, if you're in the increased-risk category due to family history, or if you have symptoms that suggest something may be going on in the lower digestive tract. Your healthcare provider may also refer you if you have a personal history of adenomatous polyps or inflammatory bowel disease.

What to Expect During a Colonoscopy

The preparation is often the part people dread most. You'll need to follow a clear liquid diet and drink a prescribed bowel preparation solution the day before. It's not pleasant, but it's essential for a clear view of the colon. The procedure itself is performed under sedation, so most people don't remember it. It typically takes 20 to 40 minutes. You'll need someone to take you home afterward because of the sedation.

Wait times for colonoscopy in Ontario can vary. Through the ColonCancerCheck program, patients with an abnormal FIT result should ideally have their colonoscopy within eight weeks. In practice, wait times in Toronto can sometimes be longer. Having a provider who follows up proactively and ensures your referral doesn't get lost in the system makes a real difference. At Care&, your NP tracks referrals and results through the Care& app, so nothing falls through the cracks.

When to See Your Nurse Practitioner

If you're 50 or older and haven't had a FIT test in the past two years, now is the time to book one. If you have a family history of colorectal cancer and haven't discussed screening with a provider, don't wait until you turn 50. You may need to start much earlier. And if you're experiencing any persistent changes in bowel habits, rectal bleeding, unexplained abdominal discomfort, or unintended weight loss, these warrant a conversation with your healthcare provider regardless of your age.

If you have an OHIP-covered family doctor, they can absolutely order these tests for you. The challenge many people in Toronto face is getting in to see their doctor in a timely way. Walk-in clinics aren't ideal for this kind of preventive care because there's no continuity. The provider doesn't know your family history, your past results, or whether you're overdue for screening. If you don't currently have a family doctor, or if you want more proactive and personalized care, Care& Family Health offers a membership model built around exactly this kind of preventive work. Your dedicated NP knows your health history, flags when you're due for screening, and follows through on every referral and result.

This is also the kind of visit where having unrushed time matters. A thorough review of your family cancer history, your personal risk factors, and your screening options isn't something that fits neatly into a seven-minute appointment. Care& appointments start on time and give you the space to ask questions and understand your next steps clearly.

A Note About Pediatric and Young Adult Screening

Colorectal cancer screening guidelines are designed for adults, and the FIT test is not routinely recommended for children or teenagers. However, families with known hereditary cancer syndromes like Lynch syndrome or FAP should discuss genetic counselling and age-appropriate screening with their healthcare provider. Pediatric management of hereditary colorectal conditions is specialized and differs from adult protocols. If you have concerns about your child's risk based on family history, our Pediatric Care team can help guide you to the right resources.

Frequently Asked Questions