Colorectal Cancer Among Younger Adults: An Einstein Perspective
Research findings suggest the rates of colon cancer and rectal cancer are rising among young and middle age adults. Of particular note, an American Cancer Society study published in February suggested the risk of colon cancer is double the risk and four times the risk for rectal cancer among adults born in 1990, compared to adults born in 1950.
A research letter published last week in the Journal of the American Medical Association appears to reinforce those conclusions. The research letter also suggests that among whites, the rate of diagnosis and death due to colorectal is rising compared to African Americans, where the rate of diagnosis and mortality is declining.
We asked Einstein medical oncology specialist John Leighton, Jr., MD, for his insights.
Q. Overall, the rate of colon and rectal cancers seems to be going down. Do we know why?
A. Screening for colorectal cancer, regardless of the test chosen by a patient and their doctor, has the potential to lead earlier detection of precancerous polyps and their removal before they become cancerous.
I believe that the public has become more aware of the importance of colorectal cancer screening and is less fearful of having the testing performed. Lifestyle changes, including the avoidance of tobacco, and the adoption of a healthy lifestyle in terms of diet and exercise can also offer benefits.
Q. At the same time, researchers have found dramatic increases in rates of colon and rectal cancers in adults under 50—including millennials. Do researchers understand why this is happening? Does lifestyle contribute?
A. I would say that the increases, particularly in white individuals, is more concerning than dramatic. Still, these cancers seem more common in black individuals overall. This current study presents the data but not an explanation.
Possible reasons include obesity (which is thought to affect whites and blacks equally) and changes in the bacteria in our GI tract which may be protective against colorectal cancer due to antibiotics, sanitizers and the like. This is not proven. I also think it is possible that young people may not be as aware of signs or symptoms of colorectal cancer and may not seek attention promptly.
Q. Have you seen similar trends?
A. I do think we are seeing more young people with colorectal cancer, but I am unsure that I have seen enough to call this a trend.
Q. Screening generally begins at age 50. Do these finding suggest that screening should begin at a younger age, or do we know enough to say?
A. I don’t think we can use this data to say that screening should begin before 50, but rather that any young person with unexplained change in bowel habits, change in stool color, unexplained weight loss, unexplained fatigue or abdominal pain does need to seek medical attention and consideration of gastroenterology evaluation.
The increase in mortality in the 50 to 54 age range suggests that an insufficient number of individuals are undergoing recommended screening. There is one society, the American College of Gastroenterology, that recommends screening for African Americans at age 45, but this is not unanimous amongst the different societies.
Q. Do the findings have any implications for physicians?
A. I think it means that we must take symptoms that are associated with colorectal cancer seriously, and not assume that a patient is “too young” to have colon or rectal cancer. Young patients with colorectal cancer are at a greater risk of having a family history of the disease, but a family history is not necessary for the diagnosis.
Q. Because adults in these younger age groups are not being screened, does that suggest that by the time their cancers have been discovered, they might be likely to be more advanced?
A. I would say yes. The reason for screening is to detect polyps before they become cancers, or to diagnose a cancer that has no symptoms earlier, so that the prognosis is better and the patients require less aggressive treatments—for example, avoiding chemotherapy or radiation therapy. There is a possibility that these cancers could be more biologically aggressive, but we do not know for sure.
Q. Regardless of age, what signs or symptoms of colon and rectal cancer should people look for?
A. Any person with unexplained change in bowel habits, change in stool color, unexplained weight loss, unexplained fatigue or abdominal pain does need to seek medical attention and consideration of gastroenterology evaluation.