Each year almost 1,900 Australians are diagnosed with early-onset bowel cancer, and they are currently managed according to clinical practice guidelines that are not age specific.

Until now.

The National Health and Medical Research Council (NHMRC) has agreed to consider for approval the Clinical Practice Guidelines for the Early Diagnosis and Management of Early-Onset Colorectal Cancer (EOCRC), to be developed by Bowel Cancer Australia in collaboration with the Australian Living Evidence Collaboration (ALEC) and funded by Bowel Cancer Australia.

“Development of co-designed age-appropriate guidelines is essential given the rising rates of bowel cancer among Australians under 50 to ensure they reflect the unique clinical challenges of younger people,” Bowel Cancer Australia CEO Julien Wiggins said

“The guidelines will use an established ‘living’ approach to generate up-to-date, evidence-based guidance to support clinical decision-making. As soon as new research becomes available, it can be incorporated into the guidelines and translated into clinical practice in near real-time,” he added.

“Young Australians diagnosed with bowel cancer face a very different disease trajectory compared to older patients, yet they are managed under the same clinical framework,” Medical Oncologist and Bowel Cancer Australia spokesperson Dr Prasad Cooray said.

“That gap has real consequences, contributing to delayed diagnosis, more advanced stage at presentation, poorer survival outcomes, and long-term impacts on fertility, survivorship, and quality of life.”

“Dedicated, age-specific guidelines are essential to ensure young patients are recognised earlier, assessed appropriately, and managed with both survival and life-stage considerations in mind.”

“Pregnancy-associated bowel cancer is a particularly under-recognised subgroup. Overlapping symptoms can delay diagnosis, and balancing maternal treatment with foetal safety adds further complexity,” he added.

Guideline Prioritisation

The Australian Living Evidence Collaboration (ALEC) and Bowel Cancer Australia are seeking advice from health care professionals, researchers, policy makers and people living with or beyond bowel cancer and their loved ones and carers about the topics and questions to address in the guidelines.

Through this survey, we aim to identify the topics that should be addressed in order to best support clinicians providing care to people with suspected or diagnosed with early-onset bowel cancer.

We are especially interested in the areas with the highest uncertainty in clinical practice, that cause the most difficulty for clinicians, and that are the most important for people with lived experience.

Collective responses will help us shape the clinical guideline and the order of clinical topics developed over the months ahead. 

Survey closed: 17 May 2026


Expression of Interest

People with a lived experience of early-onset bowel cancer, loved ones, care givers, advocates, as well as healthcare professionals, researchers, and policy makers with expertise in early-onset bowel cancer, are invited to submit an expression of interest to be involved development of the guidelines using the form below.

Expression of Interest closed: 13 March 2026 

A doctor and patient are discussing, with a clipboard and pen visible on the table. Bowel Cancer Australia logo is displayed.

Clinical practice guidelines for early-onset bowel cancer

Dr Prasad Cooray, Medical Oncologist

In 2023, a multidisciplinary international group (DIRECt), composed of a panel of 69 experts, was convened to develop the first evidence-based consensus recommendations for early-onset bowel cancer.

The DIRECt group produced 31 statements across various topics, including: risk factors; symptoms, endoscopic detection, diagnosis, and treatment; genetics; pathology; surgery; oncological treatment; fertility; supportive care; and surveillance.

Each statement underwent three rounds of voting and reached a consensus level of agreement of ≥80%.

The main recommendations were as follows:

  • If you are younger than 50, you should undergo risk stratification (based on family history) and prompt symptom assessment for bowel cancer.
  • If you have been newly diagnosed with early-onset bowel cancer, you should receive germline genetic testing (multigene panel), ideally before treatment.
  • If you have been diagnosed with early-onset bowel cancer, you should be referred to a reproductive medicine or fertility specialist to discuss:
    • Potential impact on your reproductive function and any risk of infertility
    • Fertility preservation options, if needed
    • Potential issues with pregnancy or menopause.
  • Endoscopic, surgical, and oncologic treatment of early-onset bowel cancer should not differ from later-onset bowel cancer, except if you have a genetic variant of concern.

The DIRECt group highlighted areas to prioritise in future research, including screening start age for the general population, use of faecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for early-onset bowel cancer.

A brochure titled "Early-Onset Bowel Cancer Clinical Practice Guidelines" with a man holding his stomach.

Early-onset bowel cancer

Summary of the DIRECt Group Clinical Practice Guidelines