Once a disease primarily diagnosed after age 50, colorectal cancer is affecting more adults at younger ages:
About 1 in 5 colorectal patients are now under the age of 55, and colorectal cancer is now the leading cause of cancer death for men under age 50 and the second for women under 50.
For Colorectal Cancer Awareness Month, experts with the American College of Surgeons (ACS) are available for media interviews to share insights into why the disease is affecting more younger adults, including patients in their 20s and 30s, and what can be done to prevent it.
- Multiple factors are likely contributing to the rise in young-onset cases
Colorectal cancer is still most frequently diagnosed in people over 50, but people born in 1990 have nearly double the risk of colon cancer and quadruple the risk of rectal cancer compared with people born in 1950.
“We are unfortunately seeing younger patients being diagnosed with colorectal cancer more often and we’re all asking why this is happening, but I don’t know that anyone has the answer,” said Roberto Rodriguez-Ruesga, MD, FACS, a colorectal surgeon at Texas Oncology in Dallas, Texas. “The important thing we need to do is to raise awareness of this trend and promote prevention, early detection, and treatment.”
Research is ongoing into environmental, genetic, and lifestyle factors such as the high consumption of ultra-processed foods and alcohol that may be contributing to the growing incidence of the disease in younger adults, according to Dr. Rodriguez-Ruesga and other experts, but there likely isn’t one specific cause.
However, most experts agree that engaging in a healthy lifestyle with regular exercise and limiting the consumption of ultra-processed foods, alcohol, and sugar can help reduce, though not eliminate, your risk of developing colorectal cancer.
- Be in tune with your body
Though it may not be a common topic for the dinner table, talking about your bowel habits can be lifesaving, especially for younger adults who don’t yet receive routine colonoscopies. Blood in your stool should always prompt a discussion with your doctor, said V. Liana Tsikitis, MD, FACS, state chair of Oregon for the ACS Commission on Cancer and a professor of surgery at Oregon Health & Science University.
Other unusual changes, such as having more frequent bouts of constipation or diarrhea, experiencing abdominal pain or unintentional weight loss, and noticing changes in the color and consistency of your stool, are also important to discuss with your doctor.
“If you hurt your arm or leg, you would see a doctor. The same should be said for any pain or noticeable changes you experience during bowel movements,” Dr. Tsikitis said. “My advice to patients is to listen to your body—if things don’t seem right, ask a physician and be persistent about your questions.”
- Early detection saves lives
Early detection through colonoscopy can prevent colorectal cancer by removing polyps before they turn cancerous and catching the disease when it’s at an earlier stage and more treatable, yet only about 70% of eligible patients are up to date with their colonoscopy screening. U.S. Preventive Services Task Force guidelines recommend that most people begin screening with a colonoscopy at age 45.
People with a family history of colorectal cancer or other health factors (such as having inflammatory bowel disease or Lynch syndrome), as well as those who may not know their complete genetic family history, should talk to their doctor about screening earlier and other options.
- Treatment options should be tailored to the patient
Younger adults with colorectal cancer are often diagnosed at later stages when the cancer is more challenging to treat and outcomes tend to be worse, but there are still several options available to them, including surgery, chemotherapy, and newer immunotherapy treatments that have shown promise in younger patients.
“When it comes to the treatment of colorectal cancer, I like to think of it as management, which goes beyond medical treatment to also consider the whole patient and their personal needs and priorities,” said Y. Nancy You, MD, MHSc, FACS, a member of the ACS National Accreditation Program for Rectal Cancer committee and director of the Young-Onset Colorectal Cancer Program at The University of Texas MD Anderson Cancer Center.
Younger patients may be focused on their education, careers, social relationships, or building a family, Dr. You added, so they may require more support and counseling as they add cancer diagnosis and treatments to their busy lives.
Specific discussions about fertility preservation options, sexual health, emotional support, and survivorship services addressing other health issues that may be impacted by treatment are important.
“Treatments are in some ways converting cancer into a chronic disease, so I think that survivorship will be a rising area where we need to provide more support to patients,” Dr. You said.
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