Colorectal Cancer an Overlooked Danger to Younger Adults

Tuesday, March 13, 2018

Colorectal cancer cases increasing in people under age 50

By Kevin McKeough

Dana Hayden, MD, thinks that you’re never too young to be screened for colon cancer — provided you have symptoms of the disease, that is.

A colorectal surgeon at Rush University Medical Center, Hayden has a longstanding interest in colon and rectal cancer in younger adults, which is on the rise. The American Cancer Society reported that the incidence of colorectal cancer in adults younger than 50 increased by 1.6 percent a year from 2009 to 2013.

Worse, deaths from the disease also are increasing in those younger than 50 at a time when they’re declining among those over 50. Some of the same American Cancer Society researchers found that from 2004 to 2014, annual deaths from colorectal cancer per 100,000 adults ages 20 to 54 rose from 3.9 to 4.3 — the equivalent of 11 more deaths from colorectal cancer a year among Chicago residents.

The risk for colorectal cancer in younger adults today has risen back to the level it was for people who were born in 1890, and both health care providers and the general public need to be more aware of this risk, the researchers said in a report of their findings published in the Journal of the National Cancer Institute. (They presented the increasing mortality rate in a research letter published in the Journal of the American Medical Association.)

“We need to make people aware of the signs and symptoms of colorectal cancer and inform them on how and when to get screened,” Hayden says.

Colonoscopies have reduced cancer rates and deaths in people above age 50

The increase in colorectal cancer in younger adults is a stark and worrying contrast to the long-term decline in colon cancer in older adults. The American Cancer Society researchers found that from 2009 to 2013, the incidence of the disease dropped by 1.4 percent in people age 50 to 64 and 4.6 percent a year in people 65 or older. Death rates from 2005 to 2014 decreased annually by 1.4 percent and 4.6 percent for these groups, respectively.

These life-saving gains are attributed to widespread cancer screening. Colonoscopies — a procedure in which a physician examines the colon with a long flexible camera passed through the anus while the patient is sedated — are recommended for all adults starting at age 50 unless symptoms or family history is present, in which case screenings should begin sooner (usually at age 40 or 10 years earlier than the age of the family member with the disease at the time of diagnosis). Repeated screenings are recommended at least every 10 years after the initial colonoscopy, or more often depending on the findings.

“It seems clear that screening starting at 50 years old is working, but for whatever reason, there’s increasing incidence of cancer in those that are under 50,” says Hayden, who is the chief of the division of colon and rectal surgery and director of clinical research for the Rush Department of Surgery. “Why that is, we’re not really sure.”

The possible causes include poor diet, obesity, environment, unknown or undiagnosed family history and genetic disorders. Hayden thinks it’s probably a combination of these and perhaps other, unknown factors, noting that some cases of colorectal cancer occur in young adults with no known genetic risk for the disease.

Symptoms often are misunderstood and misdiagnosed

Given the success of screening in older adults and the increasing risk to younger adults, Hayden now recommends colonoscopy for anyone she sees who has symptoms of colorectal cancer, regardless of age. “I’m not looking at age as a risk factor. I have seen 20- and 30-year-olds diagnosed with metastatic colorectal cancer too often,” she says.

The symptoms include bloody or black stool, unexplained weight loss, fatigue, changes in bowel habits or stool caliber, and gastrointestinal problems including cramps, gas bloating and abdominal pain. “The problem is that all these symptoms are totally non-specific for cancer and are usually due to benign conditions,” Hayden says. Often, she notes, doctors will diagnose the cause as hemorrhoids and not consider colorectal cancer as a possibility because the patient seems too young.

“It’s really important to pay attention to symptoms. Just because you’re not older than age 50 doesn’t mean cancer can’t affect you,” Hayden says. “Go see a physician, and if they don’t recommend a colonoscopy, make sure the symptoms are being monitored and if persistent, then ask for one.”

The American Cancer Society concurs in the journal article, which states that “as nearly one-third of rectal cancer patients are younger than age 55 years, screening initiation before age 50 years should be considered.”

Colorectal cancer can be cured at any stage

Colonoscopies in older adults have been highly effective in reducing cancer rates in part because during the procedure, doctors can remove any early stage tumors or pre-cancerous polyps they discover, enabling them to prevent cancer from developing and spreading. The appearance of symptoms may indicate cancer already has developed, but there’s still time for screenings to save lives.

“If we find a cancer because of symptoms, it doesn’t mean your prognosis is terrible,” Hayden says. “It means you may have a large polyp or early cancer that’s bleeding, or causing a partial blockage because of the location. It doesn’t mean you don’t have hope by any means.”

Being able to offer patients hope is what led Hayden to her specialty. “What’s awesome about colorectal surgery is you’re able to improve people’s quality of life if they have benign colorectal problems, but you can  also save the lives of people with colorectal cancer,” she says.

“It can be a curable cancer at any stage. Even in stage four colorectal cancer cases, there’s still a good chance we can offer a cure. We should never be too scared to get examined.”