Colon Cancer Rates Rise in Young Adults: Earlier Screening Advised

Many cancers develop for unknown reasons

Colon Cancer Rates Rise in Young Adults: Earlier Screening Advised

Although colorectal cancer rates have dropped overall, the incidence of this cancer is climbing in younger adults.

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The risk of getting colon cancer before age 50 is now twice as high, and the risk of getting rectal cancer is four times as high, for people born in 1990 as it was for those born in 1950.

As a result, the American Cancer Society (ACS) now recommends that routine colorectal cancer screenings begin at age 45 for those at average risk.

“This is a significant change in screening recommendations that will affect millions of people,” notes colorectal surgeon James Church, MD.

Younger patients’ cancers more advanced

Colorectal cancer remains the third leading cause of cancer in the United States. Each year, about 140,000 new cases are diagnosed.

While colorectal cancer accounts for just 10 percent of all cancer diagnoses before age 50, it is the upward trend in its incidence that disturbs experts.

A diagnosis of colon cancer is unusual in young patients, who have not been routinely screened. So their cancer symptoms are often ignored or dismissed as being due to benign disease such as hemorrhoids.

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That’s why their cancers are more often discovered at advanced stages. “With young patients, there is an average delay of six months between the time their symptoms start and a diagnosis is made,” says Dr. Church.

Why are more younger people affected?

Colon cancer in younger adults is sometimes attributed to hereditary or other risk factors — for example, having inflammatory bowel disease (such as Crohn’s disease or ulcerative colitis) or an inherited syndrome (such as Lynch syndrome).

However, experts say that for a growing number of younger adults, colorectal cancer develops for unknown reasons.

If you suspect something is wrong, don’t delay seeing your doctor. “Timely evaluation of symptoms consistent with colorectal cancer is essential, even if you are younger than age 45,” Dr. Church says.

Watch for bowel changes and rectal bleeding

Pay attention to any sort of rectal bleeding, or any unexpected or prolonged change in bowel habits, Dr. Church advises.

“If you’re young — even if you’re in your 20s — and have rectal bleeding that you think is because of hemorrhoids, don’t assume. Get it checked out,” he says.

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To catch problems early, he recommends:

  • Knowing your family history: Tell your doctor if colon cancer runs in your family.
  • Maintaining healthy lifestyle habits: Watch your diet, and exercise regularly.
  • Keeping an eye out for symptoms: Don’t ignore bowel changes or rectal bleeding.
  • Getting a thorough examination if symptoms arise: Never hesitate to talk to your doctor.

Remember that colorectal cancer is completely preventable. The most important factor when it comes to prevention is getting screened with colonoscopy as early as possible so that all precancerous lesions can be removed.

A role for less invasive screening at age 40?

Dr. Church says the ACS recommendation to start colonoscopies at age 45 remains controversial among colorectal cancer experts.

“Eighty percent of the colon cancers found in young people lie in the rectum or sigmoid colon, the lower 3 feet of the large intestine. We can examine this part of the bowel through flexible sigmoidoscopy, a less expensive and invasive process than colonoscopy,” he explains. 

Thus, because 70 percent of the young patients with colorectal cancers are between 40 and 49 years old, he personally recommends flexible sigmoidoscopy screening starting at age 40.

“Considering the expense and effort involved in screening, and the likely yield, we feel that this is a reasonable compromise,” says Dr. Church.

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