Bowel cancer incidence among younger Australians has more than doubled over two decades, with one in ten diagnoses now occurring in people under 50, according to medical professionals. Between 2001 and 2021, the rate in people aged 20 to 39 rose from 4.4 to 10.3 cases per 100,000.
Australia's national bowel cancer screening programme currently offers free stool tests to people aged 50 to 74, but similar increases in young-onset bowel cancer have been seen in the UK, US, Canada and New Zealand, while rates in older populations have stabilised or declined. Bowel Cancer Australia has called for the screening age to be lowered to 40, or at least to 45, in line with US guidelines.
Young-onset bowel cancer patients are more likely to be diagnosed at an advanced stage, and delays in follow-up remain a concern. A national monitoring report found that in 2020 the median wait for a colonoscopy after a positive stool test was 49 days, with only 53.9% of patients undergoing the procedure within the recommended 120 days. Public hospital waits were longer, with a median of 77 days, compared with 44 days in private clinics.
Anthony Ellison, a 39-year-old personal trainer from Newcastle, was told he would face a five-month wait for a colonoscopy in the public system. He paid for a private procedure within a month and was diagnosed with stage IV bowel cancer that had spread to his liver. He began chemotherapy a month before his originally scheduled public colonoscopy, and says he "probably wouldn't be here" if he had waited.
Some experts worry that lowering the screening age could overburden colonoscopy services. Associate Professor Savio Barreto of Flinders University said a key question was whether Australia had the financial capacity and manpower to handle more referrals. However, a 2018 study estimated that starting screening at 45 would cost between A$17,053 and A$29,512 per life year saved, within the threshold considered cost-effective, though higher than the A$2,984 to A$5,981 for the current 50–74 programme.
