Why this Ontario rapper says colon cancer screening should start at age 30, not 50

A Hamilton, Ont., musician and actor who is fighting fourth-stage colon cancer is calling on his provincial government to lower the minimum age for colonoscopy screening from 50 to 30.

Bishop Brigante, a rapper with hits like his 2017 single Hard Times and an actor with turns on shows like Orphan Black, was diagnosed with colon cancer in October 2023.

But it was two years earlier when, in his early 40s, he first started seeking care for stomach pain, diarrhea and blood in his stool.

“My doctors would say, ‘That’s hemorrhoids.’ They told me that I had irritable bowel syndrome, which at that time I was told, ‘You just gotta kind of work on your diet, fix the food you eat’ and stuff like that,” he told Dr. Brian Goldman, host of CBC Radio’s White Coat, Black Art.

By the time Brigante pushed for and eventually received a colonoscopy, followed by MRI and CT scans, he had an eight-centimetre tumour that had penetrated the wall of his rectum and spread to other places like his liver and lungs.

Hearing that news “was a pretty heavy load to bear.”

Brigante is part of a puzzling rise of colon cancer in a younger group of adults than is typical. The Canadian Cancer Society says it’s now the second leading cause of cancer deaths in men, and the third leading cause in women.

The trend prompted the United States in 2021 to lower the age for routine colonoscopies in average-risk individuals from 50 to 45, and has led to calls like Brigante’s and others to change how health systems approach both screening for and awareness of the disease.

“I’ve been treating colorectal cancer for over 20 years, and no doubt we are seeing patients being diagnosed at an earlier age,” said Dr. Sharlene Gill, a professor of medicine at the University of British Columbia and B.C. Cancer oncologist whose work focuses mostly on gastrointestinal cancers.

She said it’s now estimated that about 10 to 15 per cent of new diagnoses of colorectal cancer are in people under age 50.

Looking back earlier in her career, Gill would estimate that only about one in 40 of her colon cancer patients were under 50, which is considered early onset of the disease.

She said cancer stats show that the risk of early onset colorectal cancer is now almost two and a half times higher for people born after 1980 versus previous generations.

“I do feel that we need to, in Canada, look very seriously at lowering our age of screening to age 45.”

Brigante is now nearing the end of a series of 12 chemotherapy sessions and says his main tumour appears to be shrinking. The goal is to get to a place where he can have colorectal and peritoneal surgeries.  

But he said the experience has driven him to try and enact change to prevent other people from having colorectal cancer diagnosed at such a late stage.

Colorectal cancer screening

Most provinces and territories offer a fecal immunochemical test, or FIT test, which detects the presence of blood in a stool sample collected at home. 

During the more invasive colonoscopy, a health-care provider examines the inside of the colon — also known as the large intestine — using a long flexible tube with a light and tiny camera on one end. They may remove abnormal growths called polyps for further testing. Left alone, some polyps can grow into larger tumours, and some of those can become cancerous.

That’s why Brigante says it bothers him that the current screening guidelines are based on what he described as “very outdated” statistics. 

Both the FIT test and colonoscopy screening are made available to average-risk individuals starting at age 50.

His petition on change.org had nearly 30,000 signatures as this story reached publication time, and was presented in the Ontario legislature by NDP health critic France Gélinas on Feb. 20.

Ontario’s colorectal cancer screening program “continues to recommend screening for colorectal cancer starting at age 50,” the Ontario Ministry of Health said in a statement.

The ministry said it aligns with similar screening programs across Canada, and is the recommendation by the Canadian Task Force on Preventive Health Care and International Agency for Research on Cancer.

It also said individuals with a parent or sibling who’ve had the illness may start screening earlier — 10 years younger than the age their relative was when they were diagnosed — and that people of any age with symptoms can seek testing through their primary care provider.

The Canadian Task Force on Preventive Health Care told CBC in a statement it will be updating its 2016 screening guidelines with a detailed review of recent studies.

“This will include studies on the rising incidence of colorectal cancer in younger age groups and the effectiveness of screening for colorectal cancer.”

No publication date has been set at this time.

Checks and balances

But expanding the age range for standard colonoscopy screening isn’t quite as straightforward as it may sound.

Barry Stein, president and CEO of Colorectal Cancer Canada — himself a survivor of Stage 4 colorectal cancer diagnosed at age 41 back in 1995 — said while there seems to be movement internationally toward re-examining age-based screening criteria, Canada is still gathering information.

“Because when we bring in a screening program, the idea is to do no harm,” said Stein. While the FIT test is non-invasive, it’s a different story with a colonoscopy.

There’s a small risk that the colon can be punctured, or perforated, during the procedure, he said. One study pegged the incidence of this at around three in every 10,000 tests, or 0.03 per cent.

While very rare, perforations are extremely serious, leading to fatality between 21 and 53 per cent of the time, depending on the nature of the tear and the age of the patient, and whether they had other risk factors. 

Colorectal Cancer Canada estimated that 24,100 people were diagnosed in 2023, with about 2,500 of those under the age of 50, Stein said.

It pegged fatalities from the disease at around 9,300 in that same time frame, which represents 11 per cent of all Canadian cancer deaths.

Stein said the incidences of these cancers in younger people seem to be happening more often in the lowest part of the colon, the rectum, for unexplained reasons. 

“We are looking into different things with some of the researchers that we’re engaged with, for example, in the microbiome. So far, we do believe it’s due to healthy lifestyles — diet and exercise, in other words.”

Gill from UBC said while research is still ongoing, the so-called Western diet — low in fibre and plants and high in processed foods — indeed negatively impacts the microbiome, which “is understood to have a role in controlling inflammation as well as immune surveillance, i.e. how our immune system works, which can affect cancer development.”

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Getting the public on board

Another aspect to the colon cancer prevention effort in Canada is addressing the general population’s reluctance to undergo routine screening — or lack of awareness that it’s even an option.

“More than, probably, 40 per cent of people who are eligible for screening aren’t getting screened,” said Gill. “Even in their early 50s and 60s, people aren’t doing it, and we are in a public health system where it’s at no cost to you to do the test.”

Gill said there is also an effort underway to let family physicians and other primary care providers know that the picture with colon cancer is changing.

“If someone young presents with symptoms, you know, typically we would say, ‘You’re too young for cancer to be on the top of my list of things I’m worried about.’ But that narrative probably needs to change now.”