Colorectal cancer is not typically viewed as a disease of younger people. Yet over the last two decades, its incidence and mortality have increased significantly for people ages 20 to 49.
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This uptick is expected to persist over the next two decades. “Of all the new colorectal cancers in young patients, most are found between the ages of 45 and 49,” says colorectal surgeon Matthew Kalady, MD.
That’s why the 2018 American Cancer Society guidelines recommend routine colorectal cancer screening starting at age 45 instead of age 50.
An unexplained trend
As colorectal cancer rates have fallen in older adults, researchers are trying to understand why they’re rising in younger adults.
No definitive data explain the increase, especially in the very young. But rising obesity rates and dietary trends may be factors.
“We also know certain diets and environments may increase the risk for colorectal cancer in older adults,” says Dr. Kalady. “This may play a role in younger people too, as our diets are constantly changing and evolving from generation to generation.”
What is clear is the need for colorectal cancer prevention. Dr. Kaladay recommends taking the following steps to protect yourself:
Start colorectal cancer screenings at age 45
Experts largely attribute the decline in overall colorectal cancer incidence after age 50 to regular colonoscopy screenings. By screening average-risk patients between ages 45 and 50, they hope to see a similar outcome.
Why not start at age 40? “The largest increase in colorectal cancer is in people ages 45 to 50,” explains Dr. Kalady. “We must always balance our desire to screen patients with the risk of complications and cost.”
Although the numbers are increasing, the overall incidence in this age group is still low. But it’s imperative to keep updating the guidelines as we learn more about screening risks and benefits, he notes.
“Other screening options, such as highly sensitive stool-based DNA tests for colorectal cancer, are becoming more effective,” he says. “They are available and will be used increasingly in the future.”
Don’t ignore rectal bleeding with bowel changes
Young adults have repeatedly heard colorectal cancer called a disease of middle age and beyond.
“We see a number of young patients who may have initially ignored symptoms or were told they were ‘too young’ to have colorectal cancer,” Dr. Kalady says.
“Many of the advanced cases of colorectal cancer we see are in young people who were misdiagnosed or had a delayed evaluation for this reason.”
Any sort of bowel changes accompanied by rectal bleeding should prompt a visit to your doctor, he says. Keep in mind that not everyone with colorectal cancer has the same symptoms:
- Some people develop anemia (a low red blood cell count).
- Others find blood mixed in with bowel movements.
- Others report belly pain or other symptoms of blockage (sometimes, but not always, suggesting that the cancer is more advanced).
Know your risk and family history
Often, patients have no symptoms in the early stages of colorectal cancer, when it’s easier to treat.
That’s why it is critical to identify those at higher risk of developing the disease. Primary care physicians can help assess your risk, as can online risk assessment tools.
“I encourage patients of all ages to know their family history. It’s extremely important that everyone know if a close relative was ever treated for colorectal cancer or colon polyps,” Dr. Kalady says.
Eat healthier, exercise, and stop smoking
Fresh fruits and vegetables and other high-fiber foods, as well as regular exercise, help keep your colon healthy.
Experts still have much to learn about how lifestyle affects colorectal risk, says Dr. Kalady. But he advises young adults to reduce their consumption of red meats and overly processed foods.
And if you smoke — now’s the time to quit.
Don’t be afraid to talk to your doctor
Take your health seriously — even if you’re in your 20s, says Dr. Kalady.
He also suggests developing a good relationship with a primary care physician. Then you’ll feel comfortable reporting any unusual or worrisome symptoms.
“Don’t just assume you have hemorrhoids if you see blood on the toilet paper or in the toilet. There’s no such thing as ‘normal’ bleeding. Tell your physician so he or she can assess you immediately,” he stresses.
As scientists learn more about the specific biology of colorectal cancer, they will develop new ways to treat the disease in each individual patient, regardless of age, Dr. Kalady says.
“We’re learning so much each day,” he says. “It could be that the colorectal cancer which develops in younger people has a different biology or behavior pathway than that in older adults.”