Colon and rectal cancer – sometimes called colorectal cancer, or “CRC” – is the third most common cause of cancer-related deaths in American women, and the second most common cause of cancer deaths in American men. Stronger screening measures leading to early diagnoses have led to a recent decline in U.S. colorectal cancer deaths overall, particularly in patients over 50 (UpToDate ). But a new study by researchers at the American Cancer Society and the National Cancer Institute has illuminated a surprising new trend: while CRC rates in older Americans continue to drop, the incidence of rectal and colon cancer in teenagers and young adults appears to be on the rise (Journal of the National Cancer Institute).
Doctors aren’t certain what’s causing the uptick in colorectal cancer in teenagers and young adults, but most agree that the need for further research is clearly indicated to find out more. Until then, teenagers and young adults can certainly benefit from a greater understanding of the disease and what measures they may take to prevent it.
UNDERSTANDING COLORECTAL CANCER
As the name suggests, colorectal cancer is a type of cancer that originates in a person’s colon or rectum. Most colorectal cancers start as polyps (or growths); not all polyps are cancerous, but some may later develop into cancer (American Cancer Society ). Modern preventative screening measures (such as colonoscopies) enable doctors to detect and remove more of these growths before they become malignant, thusly reducing the incidence of colorectal cancer overall. And for patients who have already developed CRC, an early diagnosis through screening often means an improved prognosis and greater chance of survival (STAT).
As described by the ACS/NCI study, incidence and mortality rates of both colon and rectal cancer have declined significantly for older American adults (those born circa 1950 or before), due in large part to these preventative screening measures. And since older adults have historically comprised the majority of CRC cases, they’ve had a huge impact on driving the statistics: between 2003 and 2012 alone, overall incidence of colorectal cancer has decreased in the U.S. by about 3% per year (Journal of the National Cancer Institute).
Unlike their elders, however – and contrary to the overall downward trend – younger adults have seen a curiously accelerating incidence of CRC. The study found that individuals born between 1950 and 1990 have double the risk of colon cancer, quadruple the risk of rectal cancer, and a similar risk profile to individuals born circa 1890 (Journal of the National Cancer Institute).
SCREENING SAVES LIVES
Younger people are less likely to be screened for colorectal cancer. As a result, cancers and precancerous polyps are less likely to be detected early, leading to a increased incidence of full-blown (and more advanced) CRC when it occurs in younger patients.
Even with the results of the ACS/NCI study, the recommended age to begin preventative screening measures has remained unchanged: 50 years of age for adults of average risk. Study coauthors Drs. Philip Rosenberg and William Anderson state they hope their findings will pave the way for further research, along with a potential reassessment of the recommended screening age. Until then, they hope to promote awareness of colorectal cancer in young people amongst doctors and patients alike, and encourage the public to follow through with the most current screening guidelines for detecting the disease (NIH: National Cancer Institute).
Talk to your doctor about colorectal cancer screening and prevention, even if you think you’re too young to get it. Don’t hesitate to get checked out if you notice any unusual symptoms: abdominal pain, bloating, rectal bleeding, fatigue, unexplained weight loss, or a change in bowel habits may be signs of colon or rectal cancer (UpToDate ). Your doctor can better help you to assess your personal risk and establish a prevention and screening strategy that’s appropriate for you.
Even though rates are rising, colon cancer in teenagers and young adults is still relatively rare: of around 135,000 new CRC diagnoses that are made each year, less than 15,000 cases are in people under the age of 50 (STAT). Many doctors still aren’t accustomed to diagnosing and treating colon cancer in teenagers and young adults, so don’t be afraid to ask questions if you experience any suspicious symptoms.
And remember, it’s ok to get a second opinion, especially if you suspect you have been misdiagnosed. If you don’t know where to turn, help is available; a reputable medical referral service (like OncoLogic Advisors) can help match you with a new doctor and explore your options for treatment.
HOW CAN I LOWER MY RISK?
A person’s age and a family history of colorectal cancer are still considered to to be the the leading risk factors for developing the disease. As such, doctors typically recommend more stringent screening measures for patients over the age of 50, as well as for individuals of any age who have a genetic predisposition for CRC. People with a history of inflammatory bowel disease (like ulcerative colitis or Crohn’s) may also be at increased risk (UpToDate ).
Overall, the American Cancer Society advocates a common-sense approach to reduce your risk for colorectal cancer (and colon cancer in teenagers & young adults): get regular exercise, eat a healthy diet rich in fiber and whole grains, drink moderately, and don’t smoke. Some doctors hypothesize that obesity might contribute to CRC, and recommend watching your weight as a sound measure to decrease your personal risk for colon cancer and bolster your overall health (American Cancer Society ).
We still have much to learn about the recent rise in rectal and colon cancer in teenagers and young adults. Until we know more, patients of every age should get to know the risks and symptoms associated with the disease and pursue common-sense measures in the service of a healthier lifestyle. Above all, see your doctor right away (and don’t hesitate to get a second opinion) if you suspect something is wrong.
Remember: early detection saves lives.
UpToDate  – Clinical presentation, diagnosis, and staging of colorectal cancer. Finlay A Macrae, MD, Johanna Bendell, MD. Topic last updated: 26 June 2017
Journal of the National Cancer Institute – Colorectal Cancer Incidence Patterns in the United States, 1974-2013. Rebecca L. Siegel, Stacey A. Fedewa, William F. Anderson, Kimberly D. Miller, Jiemin Ma, Philip S. Rosenberg, Ahmedin Jemal. 28 February 2017.
American Cancer Society  – What is Colorectal Cancer?
STAT – Colorectal cancer mystery: Rising rates among millenials, Gen X
NIH: National Cancer Institute. Colorectal Cancer Incidence Rising in Young Adults: An Interview with Drs. Philip Rosenberg and William Anderson. NCI Staff. 23 March 2017.
UpToDate  – Screening for colorectal cancer: Strategies in patients at average risk. Chyke Doubeni, MD, FRCS, MPH. Topic last updated: 18 May 2017.
American Cancer Society  – Study Finds Sharp Rise in Colon Cancer and Rectal Cancer Rates in Young Adults. Stacy Simon. 28 February 2017.