15 Mar 2019

Colorectal cancer: a burgeoning issue in younger patients

We often think of colorectal cancer as an old man’s disease. Yet colorectal cancer is on the rise in younger patients, of all genders and ethnicities. A 2017 study found that once age is taken into account, people born in 1990—who are turning 29 this year—have double the risk of colon cancer and quadruple the risk of rectal cancer as people born around 1950.[1]

Overall, colorectal cancer death rates have dropped by 53% since 1970, and this is something to celebrate.[2] But that statistic camouflages the sharp rise in colorectal cancer in younger patients—a rise that, for some age groups, amounts to a 2% increase in colorectal cancer rates each year since the mid-1990s.[3]

Because of this, in 2018 the American Cancer Society updated its colorectal cancer screening guidelines. They now recommend that people at average risk of colorectal cancer should begin regular screenings at age 45 (their previous recommendation was to start screenings at 50).[4] However, the Centers for Disease Control stills recommend beginning screenings at 50. Either way, though, patients should begin screenings at or before 50.

Risk factors for colorectal cancer include:

● Being overweight or obese

● Being physically inactive

● Eating a diet high in red meats and processed meats

● Smoking

● Heavy alcohol use

● Age

● A personal history of inflammatory bowel disease, colorectal polyps, or previous colorectal cancer

● Family history and inherited genetic syndromes

The good news is that screenings are extremely effective at catching colorectal cancer early. Screenings are a big part of why colorectal cancer death rates have dropped so dramatically in recent years. Research suggests increased screening has directly caused more than fifty percent of the decline in colorectal cancer deaths.[5]

There are several different methods of colorectal cancer screening: the colonoscopy, of course, as well as stool tests, flexible sigmoidoscopy, and CT colonography (also known as a virtual colonoscopy).[6] Because fear of colonoscopies is common, alternative screening methods may increase an anxious patient’s likelihood of getting screened regularly.[7]

Although colorectal cancer is on the rise in young people, a young person’s absolute risk is still low. Screening the entire population of 20- and 30-somethings for colorectal cancer is not yet warranted. But clinicians ought to stay aware of this emerging issue.[8] As Rebecca Siegel, MPH and Strategic Director of Surveillance Information Services of the American Cancer Society notes, “Trends in young people are a bellwether for the future disease burden.”[9]

The good news is that many cases of colorectal cancer are preventable! As with many cancers, lifestyle can play a key role in lowering a person’s risk of colorectal cancer. With colorectal cancer on the rise, talk to your patients about it—both young adults as well as older adults. To lower their risk of getting or dying from colorectal cancer, your patients should:[10]

● Get regularly screened for colorectal cancer, beginning at age 50 at the latest.

● Eat lots of vegetables, fruits, and whole grains.

● Eat less red meat and processed meats.

● Exercise regularly.

● Maintain a healthy weight. Being overweight or obese increases a person’s risk of getting colorectal cancer.

● Quit smoking, if they smoke. Smoking increases risk of colorectal cancer as well as lung cancer and other health problems.

● Limit alcohol. Alcohol use has been linked with a higher risk of colorectal cancer.

With these tips, you can help patients of all ages reduce their risk of colorectal cancer!

 

Resources:

[1]https://www.cancer.org/latest-news/study-finds-sharp-rise-in-colon-cancer-and-rectal-cancer-rates-among-young-adults.html

[2] https://www.cancer.org/latest-news/facts-and-figures-2019.html

[3] https://www.cancer.org/latest-news/study-finds-sharp-rise-in-colon-cancer-and-rectal-cancer-rates-among-young-adults.html

[4] https://www.cancer.org/latest-news/american-cancer-society-updates-colorectal-cancer-screening-guideline.html

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412262/

[6] https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm

[7]https://onlinelibrary.wiley.com/doi/full/10.1111/j.1525-1497.2005.00164.x

[8] https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(17)30202-4.pdf

[9]https://www.cancer.org/latest-news/study-finds-sharp-rise-in-colon-cancer-and-rectal-cancer-rates-among-young-adults.html

[10] https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/risk-factors.html

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