Colorectal cancer is the second leading cause of cancer death in Canada, with approximately 24,100 Canadians diagnosed with the disease in 2023. The incidence of colorectal cancer has been declining in Canadians over 50 years of age, largely due to population-based screening programs. Recent evidence has shown, however, that rates have been increasing in adults younger than 50 years. Given that younger adults are typically classified as at low risk for colorectal cancer, this epidemiologic shift is cause for concern. Individuals under the age of 50 now represent a significant number of colorectal cancer cases. The disease is often being diagnosed at a later stage, and tumour characteristics tend to be more lethal. As for what is accounting for the increasing trend, ongoing research efforts focus on environmental toxicities, lifestyle patterns, and the gut microbiome. In this webinar, we will present an overview of the current evidence surrounding the rising rates of colorectal cancer in young adults and discuss the unique needs of this patient population, through screening, diagnosis, treatment, and survivorship. A young colorectal cancer patient will share his lived experience in managing this disease and the impact that cancer has had on himself and his family.

1. Early Age Onset
Colorectal Cancer
Ms. Cassandra Macaulay
Senior Manager of Programs & Education
Colorectal Cancer Resource & Action Network (CCRAN)

2. AGENDA
Who is the Colorectal Cancer Resource & Action
Network (CCRAN)?
What is Colorectal Cancer?
Colorectal Cancer Facts & Statistics
Colorectal Cancer in Young Adults
Patient Perspective
Support & Information for Early Age Onset Colorectal
Cancer Patients
Q & A / Thank You

3. THE COLORECTAL CANCER RESOURCE &
ACTION NETWORK (CCRAN)
Who Are We?

4. CCRAN is a national, patient-focused advocacy group championing the health and
wellbeing of Canadians touched by colorectal cancer and others at risk of developing
the disease. We provide support, education, and advocacy to patients (and their
caregivers) to help improve patients’ quality of life, as well as their longevity.
CCRAN has recently expanded its patient-focused mandate to serve multiple tumour
type patients, outside of the colorectal cancer space, through our HTA patient
evidence submissions, educational events, and advocacy initiatives, to ultimately
reduce the burden of cancer in Canada.

5. WHAT IS COLORECTAL CANCER?

6. What Is Colorectal Cancer (CRC)?
• Cancerous growths that start
in the cells that line the inner
colon or rectum
• Most colorectal cancers grow
slowly and quite predictably,
starting as benign growths,
called polyps
• The cancer is 90% curable
when diagnosed at an early
stage
6

7. 7
Stages of Colorectal Cancer
Courtesy of Nirmal Hospital. https://www.proctologyexperts.com/rectal-
and-colon-cancer/

8. Common Sites of Colorectal
Metastases
Liver Lungs Peritoneum
Bone Ovaries Lymph Nodes

9. COLORECTAL CANCER
FACTS & STATISTICS

10. 2ND
• Leading cause
of cancer
death1
3RD
• Most
diagnosed
cancer1
6.3%
• Lifetime
probability of
developing
CRC1
2.9%
• Lifetime
probability of
dying from
CRC1
66
• Canadians
diagnosed
with CRC every
day2
25
• Canadians die
from CRC
every day2
9 out
of 10
• Cases are
curable if
caught early1
Colorectal Cancer:
By the Numbers

11. COLORECTAL CANCER IN
CANADA:
The Facts
11
Canada has one of
the highest
incidence rates of
colorectal cancer
in the world 3,4
Affects
men and
women
equally
CRC incidence &
mortality are
expected to increase
after 2030, driven
largely by the
population currently
under 40 years old5
Approximate
ly 50% of
cases are
diagnosed at
later stage

12. COLORECTAL CANCER
IN YOUNG ADULTS

13. Colorectal Cancer in Young Adults
Early Age Onset
Colorectal Cancer
(EAOCRC) is generally
defined as colorectal
cancer diagnosed in
individuals under the age
of 50

14. Colorectal Cancer in Young Adults
“Contrary to the declining rates of CRC
observed in Canadians aged 50 –74, the
incidence of CRC in Canadians under 50 has
been rising rapidly since 2000.
The population born since 1980 is now 2
to 2.5 times more likely to be diagnosed
with CRC than were previous generations at
the same age.”10
-Dr. Michael Raphael et al., CCRAN Early Age Onset Colorectal
Cancer Symposium Publication
Actor Chadwick Boseman, who
died at age 43 due to colon cancer.

15. Potential CRC Causes / Risk Factors7
•Diet
•Antibiotics
•Pharmaceuticals
•Geography
•Stress
•Exercise
•Lifecycle stages
•Family history of CRC
•20 – 25% of cases
•Hereditary Syndrome
•5-10% of cases
•Inflammatory Bowel Disease
•Ethnic heritage
•Water pollution & additives
•Air pollution
•Exposure to night light?
•High BMI
•Physical inactivity
•Western diet
•Alcohol
•Smoking
•Sleep pattern changes?
Lifestyle factors
Environmental
exposures
Gut Microbiome
Genetics

16. CRC
SCREENING
IN CANADA
Incidence of CRC in
adults under the
age of 50 is RISING
AT AN ALARMING
RATE.6
Young Canadians
are being diagnosed
at a later stage with
more lethal disease
characteristics.
Early-age onset CRC
is missed by
Canada’s screening
programs.
NO SCREENING
AVAILABLE FOR
CANADIANS
UNDER
THE AGE OF 508
NO SCREENING
LATER
DIAGNOSIS
MORE
ADVANCED &
LETHAL CANCER

17. CRC Screening in Young Adults
$719
million
Cost
savings @
screening
age of 45 $1.1
billion9
Cost
savings @
screening
age of 40

18. Common CRC Symptoms
Rectal bleeding
Pencil-thin
stools
Diarrhea or
other changes
in bowel habits
Weight loss
Abdominal
pain
Fatigue
Nausea
No symptoms
at all

19. CRC Diagnosis in Young Adults10
Less likely to
seek medical
attention for
symptoms
related to CRC
EAOCRC patients report
having their symptoms
dismissed as something
benign based simply
upon their age
More likely to be
diagnosed at a
later stage
Asymptomatic
individuals under
50 without a family
history are
ineligible for
screening currently
in Canada
2 – 2.5 x
The population born since
1980is
more
likely to
develop
CRC

20. CRC Treatment
Radiation Therapy
• Sometimes used in
RECTAL cancers (neo-
adjuvant)
• Can be used to treat
metastatic sites
Surgical Resection
• Employed in stages I
– III on pathway to
NED
• Employed in stage IV
disease to “chip
away” at primary +
metastatic sites
• Can leave patients
with an ostomy
Systemic (Drug)
Therapy
• Neo-adjuvant or
adjuvant
• Chemotherapy +/-
targeted therapy
• Immunotherapy

21. EAOCRC:
THE PERSONAL IMPACT

22. SUPPORTS & RESOURCES FOR
EAOCRC PATIENTS

23. UNIQUE NEEDS OF EAOCRC PATIENTS10
This patient population has unique needs often not addressed by
traditional care models and EVERY EAOCRC patient should have
access to:
Surgical,
radiation,
medical
oncology
treatments
Fertility and
sexual health
Mental health
Genetic and
biomarker
testing
(CGP)
Family
supports
(childcare,
financial
support)
Education
and
collaboration
with primary
care and
patient
organizations
Access to
research
studies
Being diagnosed with cancer at a young age can feel very isolating

24. What Do Young Cancer Patients Seek?
Support
Advocacy
Education

25. “MY COLORECTAL CANCER CONSULTANT”
ONLINE TOOL
25
An online tool designed for the metastatic colorectal cancer patient or their caregiver to
encourage informed and joint decision-making between the patient and their treating
oncologist.
Patients are guided through a series of questions requiring their pathology/NGS report. At
the end, they receive a personalized report that outlines the potential treatment options
that may be appropriate for them based on their tumour’s biomarker status.
Endorsed and reviewed by expert clinicians and being scaled for other cancer types.

26. “MY EARLY AGE ONSET CRC” HUB
Evidence-based Information on the disease
Information on Sunnybrook’s Young Adult Colorectal
Cancer Clinic
Access to CCRAN’s Information and Support ChatBot
moderated by CCRAN
Access to experts across the continuum of colorectal
cancer care with questions relating to EAOCRC
Access to brave stories of our young fighters to inspire and
encourage others newly diagnosed
26
The Program aims to promote best practices in EAOCRC diagnosis and care, facilitating patient and expert collaboration
through working groups, symposia and the development of patient tools.
The Hub will provide various online resources to patients diagnosed with Early Age Onset Colorectal Cancer (EAOCRC),
such as:

27. “MY COLORECTAL CANCER COACH”
PROGRAM
27
Training:
• Volunteers undergo annual mandatory training and certification across the continuum of colorectal cancer care to respond to patient and
caregiver queries. Content acumen delivered throughout 6 full days by 22 experts.
Objective:
• To extend colorectal cancer support to Canadian communities in service of improving the healthcare experiences and outcomes of
colorectal cancer patients at every step of their cancer journey.
Portfolios:
• Each Coach is assigned a different portfolio representing a CRC discipline to ensure their expertise as a team covers/addresses various
aspects and unmet needs of the CRC journey

28. MONTHLY INFORMATION / SUPPORT
GROUP MEETINGS

29. 2
9
MY CANCER COMPANION:
A PEER-TO-PEER SUPPORT PROGRAM ACROSS
CANCER TYPES
Tumor type, disease stage & biomarker status
Age, gender, marital status & additional demographics
Language(s) spoken
Cultural background
Sexual orientation
Treatment journey
Geographical location, and so much more!
Cancer
Companions
will be
matched
according to…

30. Early Age Onset Cancer Symposia Series
Address system-level challenges limiting early
detection of EAOC with discussion through a value-
based healthcare lens
Stimulate discourse on optimal care and treatment
pathways, including the relevance of real-world
evidence & the value of CGP in helping to ameliorate
the patient’s journey
Present strategies to enhance the survivorship journey
to ameliorate the EAOC patient’s quality of life
Improve awareness around the incidence and
prevalence of EAOC.
30
CCRAN has proudly hosted a series of three symposia dedicated to bringing awareness to the rising
rates in young adult cancer and the growing number of young patients seeking support, education, and
advocacy throughout their advanced cancer journey.
In response to the feedback and success of the pan-tumor Biomarker Conference & CCRAN’s expanded
mandate, the 2023 symposium addressed multiple cancer types.

31. UPCOMING
EARLY AGE ONSET
CANCER
SYMPOSIUM
FALL 2024
Bring awareness around the
incidence and prevalence of EAOC in
Canada.
Additional tumor types will be
addressed
Experts will build on the outcomes
from the 2023 symposium exploring
research initiatives in the rising rates
of young adult cancer.

32. UPCOMING
BIOMARKERS
CONFERENCE
JUNE 20 – 21
2024
CCRAN is proudly hosting its 2nd annual Biomarker
Conference across multiple tumour types.
Session highlights will include:
Clinician Roundtable on the utility of ctDNA in the
adjuvant setting of cancer care
Clinician Roundtable on the value and feasibility of
comprehensive genomic profiling (CGP) in clinical
practice
Reporting on the results of a national pan-tumour
survey regarding access to biomarker testing results:
What are Canadian Advanced Cancer Patients Saying?

33. Key Take Aways
EAOCRC Is On The Rise
• If you are symptomatic, advocate to be checked for CRC
• If you are under 50 years old and average risk, you are
excluded from screening
EAOCRC Patients & Caregivers:
YOU ARE NOT ALONE
• Your unique needs SHOULD be addressed
• So much support & information is available

34. REFERENCES
1. Canadian Partnership Against Cancer. Key statistics on colorectal cancer screening in Canada.
https://www.partnershipagainstcancer.ca/topics/colorectal-indicators-2017-2018/key-statistics/
2. Canadian Cancer Society. (2023). Colorectal cancer statistics. https://cancer.ca/en/research/cancer-statistics/canadian-
cancer-statistics
3. Ferlay J, et al., (2008). DM.GLOBOCAN 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10
4. Canadian Cancer Society. (2021). Canadian Cancer Society’s Advisory Committee on Cancer Statistics: Canadian Cancer
Statistics 2021.
5. Ontario Health (Cancer Care Ontario). Cancer Fact: Colorectal cancer rates expected to climb again in the future. March
2020. Available at cancercareontario.ca/cancerfacts.
6. Brenner, D. et al. (2022). Projected estimates of cancer in Canada in 2022. Canadian Medical Association Journal
194(17):E601-E607. https://doi.org/10.1503/cmaj.212097
7. Colorectal Cancer Resource & Action Network. (26 – 27 October, 2023). Early Age Onset Cancer Virtual Symposium.
8. Ontario Health (Cancer Care Ontario). Screening for Colorectal Cancer. Available at
https://www.cancercareontario.ca/en/types-of-cancer/colorectal/screening
9. Kalyta A, Ruan Y, Telford JJ, De Vera MA, Peacock S, Brown C, Donnellan F, Gill S, Brenner DR, Loree JM. Association of
Reducing the Recommended Colorectal Cancer Screening Age With Cancer Incidence, Mortality, and Costs in Canada
Using OncoSim. JAMA Oncol. 2023 Oct 1;9(10):1432-1436. doi: 10.1001/jamaoncol.2023.2312. PMID: 37471076; PMCID:
PMC10360004.
10. Raphael et al. (2023). Breaking Down Barriers to Detection and Care in Early-Age-Onset Colorectal Cancer in Canada.
Current Oncology,2023,30,9392–9405. https:// doi.org/10.3390/curroncol30110680

35. THANK YOU!
QUESTIONS? COMMENTS?
www.ccran.org
@ccranorg
Email me: Cassandra.m@ccran.org
35
SCREEN IT! TREAT IT! BEAT IT!
TOGETHER, ANYTHING IS POSSIBLE.

36. Canadian Cancer Survivor Network
Contact Info
1750 Courtwood Crescent, Suite 210
Ottawa, ON K2C 2B5
Telephone / Téléphone : 613-898-1871
E-mail: jmanthorne@survivornet.ca or info@survivornet.ca
Website: www.survivornet.ca
Twitter: @survivornetca
Facebook: www.facebook.com/CanadianSurvivorNet
Instagram: @survivornet_ca
Pinterest: http://pinterest.com/survivornetwork/