In several countries, the age for universal screening for two of the leading cancers has been lowered to midlife. In Quebec, in most cases, you have to wait until you turn 50.
Posted at 1:12 a.m.
Updated at 5:00 a.m.
At what age can you be screened for cancer?
For the moment, screening tests for the main cancers (breast, colorectal) for asymptomatic individuals with no family history are only offered from the age of 50 in Quebec. But as soon as a member of one’s extended family has been affected by cancer, screening is often available from the age of 40, or even before. In the case of a first-degree relative (father, mother, child, brother or sister), screening is often recommended 10 years before the youngest age of diagnosis in the family – for example, a parent’s child who was diagnosed with cancer at the age of 45 should have their first screening at 35.
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESSE ARCHIVES
The Minister of Health, Christian Dubé
In several Canadian provinces, including Ontario and British Columbia, the age for breast cancer screening has been lowered to 40 years old. In September, the Minister of Health of Quebec, Christian Dubé, mandated the National Institute of Excellence in Health and Social Services (INESSS) to evaluate the potential expansion of breast cancer screening from the age of 40 years. A decision must be made by the end of the year.
Should we encourage women to have a mammogram in their 30s or 40s?
Yes, but with some reservations, says the Dre Saima Hassan, from CHUM. In younger patients, whose breasts are denser, mammography detects the presence of cancer less well. “We need to develop other ways to detect breast cancer,” she says. Blood tests or genetic tests, tools that would make it possible to more carefully select patients at risk.
If we had a way to determine which ones are at high risk, we could detect them before the cancer develops.
The Dre Saima Hassan, surgical oncologist and breast cancer specialist at CHUM
But until these tools are available, the Dre Hassan believes that screening should start from the age of 40.
In the case of colorectal cancer, should the screening age be raised?
Colorectal cancer is currently the second leading cause of cancer mortality in Quebec, after lung cancer. In the United States, as well as in several European countries, the age for starting screening has been lowered to 45 years. In Canada, many voices are being raised to follow the trend.
We should definitely put it at 40, especially with the availability of the stool blood test.
The Dr François Letarte, gastro-intestinal surgery specialist at CHU in Quebec
The “faecal occult blood immunochemical test” – the iFOBT test, also called the FIT test – is now available to people aged 50 to 74 without even having to consult a doctor. Simply obtain a free kit from a health professional (or through Clic Santé). In the event of a positive result, the patient will be invited to have a colonoscopy, this examination which consists of inserting a camera through the anus to see the inside of the intestines. Polyps – growths that develop in the intestine and cause bleeding – can then be removed before they become cancerous.
“A 40-year-old or a 30-year-old who has blood in his stools is sent for a colonoscopy even if he has no family history,” says Dr.r François Letarte. Most often these are hemorrhoids or a fissure. But one of the errors we often see in the case of young people is that they have been told for two or three years that they are hemorrhoids, when there is no cure. »
In addition to known risk factors, such as obesity and alcohol, what are the other avenues of research to explain the increase in cancer cases among those under 50?
Three elements particularly attract the attention of researchers.
Microbiota: Increasingly, researchers are examining the microbiota, the soup of good bacteria that colonizes the digestive system and provides an important shield for the immune system. Diet has an influence on the quality of the microbiota, as does taking antibiotics. Has the consumption of processed products since childhood, for example, altered the microbiota of Generations X and millennials? Researchers suggest that a weak microbiota allows pathogenic bacteria to proliferate that change the structure of cells and promote the development of cancer.
Sleep : Between 1905 and 2008, the average length of a night’s sleep for children and adolescents was reduced by one hour, according to an Australian study published in 2011. This is an element to which researchers do not pay enough attention, Shuji Ogino, a professor at Harvard University, said last month. “We are exposed to a lot of artificial light at night, even at the age of babies,” he explained in an interview with the BBC. A 2021 British study of individuals over the age of 50 linked poor sleep quality to a greater risk of cancer.
Pollution : Exposure to “environmental chemicals during early life and adulthood” is among the putative risk factors whose effect is “poorly understood,” according to ACS researchers. In June 2023, a New Zealand researcher urged his colleagues to look into a possible link between the ingestion of microplastics and bowel cancer. This fall, France agreed to compensate the mother of a little girl who died of cancer caused by exposure to pesticides before her birth.
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