Colorectal cancer patients are younger; doctors advise getting screenings

Colorectal cancer is the third deadliest cancer for men and women in the United States and its victims are getting younger, according to a recent study by the American Cancer Society.

"Researchers showed the proportion of individuals in the United States diagnosed with advanced-stage colorectal cancer (CRC) increased from 52% in the mid-2000s to 60% in 2019," the report stated. "In addition, diagnoses of people under 55 years of age doubled from 11% in 1995 to 20% in 2019."

Patients ages 20 to 49 have seen an increase in incidence and mortality, the study showed.

Dr. Antonio Caycedo, the chief colorectal surgeon at Orlando Health, said Central Florida is seeing the trend of younger patients, with about one in five patients being younger than 50, and said screening is more important than ever.

"We know it is the No. 1 cancer related to men ages 25 to 50. Furthermore, we are identifying a trend for younger individuals to be diagnosed with this compared to what the historical records show," he said.

Dr. John Monson, the chief colorectal surgeon at AdventHealth Central Florida, is seeing the trend as well. Colon cancer can be particularly more deadly for people in their 20s, 30s, and 40s, as these populations ignore red flags such as weeks of rectal bleeding, abdominal pain, or unexplained weight loss, he said.

"And so when they develop so-called red flag symptoms, they have tended to ignore them, or assume they were not likely to be due to colorectal cancer," Monson said. "And that's a problem with colorectal cancer because the outcome, the treatment, and the survival are totally dependent on the stage at the time of diagnosis. Stage 1 cancer is almost 100% curable, and Stage 4 cancer is most certainly nothing like that."

When should you check?

The American Cancer Society urges people 45 or older to get a screening or ask their doctor about a colonoscopy, and then continue regular screenings every five to 10 years through the age of 75. After, people ages 76 through 85 should speak with their healthcare providers about whether or not they should continue.

However, there are reasons to get screened earlier. If there is a strong familial history of colon cancer, it is recommended to speak to a doctor about a possible screening for patients younger than the age of 45, Monson said. Another reason to check early would be if someone is manifesting symptoms, Monson added.

"If there is no underlying disease, as far as they're aware, they're perfectly fit and healthy with no symptoms, 45 is fine," he said. "But if you develop symptoms, any of the symptoms we mentioned before the rectal bleeding, the change in bowel habit, the abdominal pain, or the weight loss, all bets are off at that point."

The growing number of colonoscopies has slowed over the past decade with decreasing trends now confined to people 65 and older, the ACS study showed.

Caycedo has noticed a similar trend with fewer colonoscopies. He believes it's because of the invasive nature of the process, but said it isn't a reason to avoid the life-saving procedure.

“People think, well, it's too hard. It's too onerous. It's too difficult to get a colonoscopy developer, but it's a one-time event over five or 10 years. I will say it's much harder to deal with cancer than to have a colonoscopy,” he said.

Why are more younger people getting colon cancer?

"There isn't really a clear answer," Monson said. "It's maybe related to obesity and various things. But the point is, there's no absolutely definitive answer, but the reality is, (the trend is) true."

The ACS study offered no answers as to why the defined trend was happening, but Caycedo offered some speculation.

First, he referenced that about 30% of colon cancer patients have a familial history of the disease.

"The vast majority of those individuals are going to have no family history, so (their disease) is probably associated then with lifestyle factors, you know, more processed food, more red meats or processed meat, a lack of exercise, alcohol consumption, or smoking," he said. "Obesity is playing a role in the development of new cancer. Lifestyle is a significant factor."

Free take-home tests require a stool sample and aren't invasive. After the test is completed, it can be dropped off at a primary physician.

However, while these screenings are helpful if someone tests positive, the patient will require a colonoscopy, Monson said, which can be a limiting factor for some patients since the procedure is expensive.

"Remember also that a stool test is simply a screening test for colonoscopy. In other words, if your stool test is positive, it means you must go and have a colonoscopy at that point," he said. "None of these tests is the panacea that resolves all the issues of access to health care and costs."

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