New guidelines to tackle spike in early onset bowel cancer

St Vincent’s gastroenterologist, Associate Professor John Nik Ding, is confronting a growing clinical challenge as more young patients present with bowel cancer. Co-chairing an expert panel developing new guidelines for early-onset disease, he has led bowel cancer screening at St Vincent’s hospitals in Melbourne for nearly a decade.

Bowel cancer is the most expensive cancer to treat in Australia, costing at least $1.1 billion annually. But the nuances tell a complex story.

“Currently one in eight people diagnosed with bowel cancer are under 50 years,” A/Professor Ding said. “I have been advocating hard to increase awareness of early onset of this cancer and was part of Bowel Cancer Australia’s Call on Canberra initiative, which advocated for lowering the screening age to 45 years.

Bowel cancer is the deadliest cancer for Australians aged 25-54. Almost 1,900 people under the age of 50 are diagnosed each year, contributing to 12.6% of all bowel cancer cases.

“Screening ages around the world have been dropping, in line with increasing rates of younger people being diagnosed. The need is there for potentially even younger screening,” A/Professor Ding explained. “I have seen people in their 20s and 30s with bowel cancer and that is the motivation for my advocacy work.”

Until now, clinical practice guidelines were not age specific.

A/Professor Ding is deputy co-Chair of a new expert panel tasked with developing guidelines for the diagnosis and management of bowel cancer in people under 50. The guidelines are being developed by Bowel Cancer Australia and the Australian Living Evidence Collaboration and funded by Bowel Cancer Australia. 

“It is a peer review process. I am part of a multidisciplinary team gathering evidence and focusing on what matters to young people, including mental health, family planning, financial considerations and social implications,” A/Professor Ding explained. 

Public consultations are planned in December 2026 and April 2027, prior to final approval of the guidelines by the National Health and Medical Research Council (NHMRC).

“Our hope is to have a set of guidelines that will standardise how we practice across hospitals, with equitable care across the board and clear benchmarks. This will be a living document; we will continue to generate evidence and add new information as it comes to light,” he added. “By having a colonoscopy, we can get rid of any polyps which lead to bowel cancer. There are not many other cancers where you have the ability to prevent it in a very real way.”

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