Preventing Colorectal Cancer, a not-for-profit organization, encourages policymakers, health officials, health plan executives and others to support colonoscopies as the Gold Standard colorectal cancer screening method. This issue brief is one in a series of publications exploring the actions key stakeholders can take together to make a difference and serve as champions for patient safety.
Colorectal cancer (CRC), the second most deadly cancer in the United States, has developed two significant trends that were recently identified by the research community in a new study published online in JAMA Surgery. The positive trend found that the incidence of colorectal cancer in adults aged 50 and over is decreasing. Unfortunately, the negative trend is that young adults aged 20-49 are facing an increased risk of colorectal cancer.
Data from the SEER CRC registry indicated a 1.99% increase for young adults 20-34 and a 0.41% increase for young adults 35-49. According to the study authors, the absolute risk in the very young (age 20-34) is still quite low (less than 0.5/100,000/yr) when compared to persons aged 50-74 (32/100,000/yr) and those older than 75 (>100/100,000/yr).
Projections for the Future
While the decrease in colorectal cancer in older Americans is certainly good news, the increase in the number of younger Americans receiving diagnoses is unsettling. Despite the noticeable trend, this data will require further study in order to clearly understand why young adults are suddenly experiencing a higher diagnosis rate. Although there is no clear reason for the trend, it is worth noting that a portion of the very young Americans in the research had hereditary symptoms that placed them at a higher risk for developing colorectal cancer.
According to the study, the incidence of colorectal cancer will continue to increase in young Americans. By 2020 and 2030, colon cancer rates are expected to jump by about 38% and 90%, respectively, among people aged 20 to 34, but fall by about 23% and 41%, respectively, among people older than 50.
“[The study] reflects what practitioners are seeing in the real world – two decades ago, it was rare to treat patients in their 20s, 30s or 40s for colorectal cancer. Now, unfortunately, it seems much less surprising,” said Dr. David Bernstein, a gastroenterologist with North Shore University Hospital in Manhasset, NY. Bernstein believes that doctors “should be more aggressive investigating reports of minor rectal bleeding in younger adults, which is usually dismissed as hemorrhoids but may in fact indicate colorectal cancer.”
For now, there is no recommendation to lower the screening age below 50.
Possible Risk Factors
Unfortunately, there are currently no clear indicators as to why the incidence of colorectal cancer is rising among young adults. Despite the uncertainty, young adults can make a few lifestyle changes in order to lower their risk of developing colorectal cancer, including maintaining a healthy weight, reducing belly fat, exercising regularly, not smoking, limiting alcohol intake and eating a healthy diet low in red and processed meats and rich in fruits, vegetables, nuts, seeds, yogurt and high-fiber foods.
The study’s lead author, Dr. Krasimira Aleksandrova of the Institute's Department of Epidemiology, elaborates on the need to change lifestyle habits, “These data provide additional incentive to individuals, medical professionals and public health authorities to invest in healthy lifestyle initiatives. Each person can contribute a lot to avoid cancer; the more healthy lifestyle changes, the better.” Interestingly, previous studies have found links between higher rates of this cancer and Western lifestyles; 55% of colorectal cancer cases occur in developed nations in North America and Western Europe.
The American Cancer Society also notes that lifestyle-related habits are the strongest indicators that a person may develop colorectal cancer. However, there are several other risk factors that can contribute to an increased threat of developing colorectal cancer. These include:
A personal history of colorectal polyps or colorectal cancer
A personal history of inflammatory bowel disorder (IBD)
A family history of colorectal cancer or adenomatous polyps
Inherited syndromes, such as familial adenomatous polyposis (FAP), hereditary non-polyposis colon cancer (HNPCC), Turcot syndrome, Peutz-Jeghers syndrome and MUTYH-associated polyposis
Racial and ethnic backgrounds, especially African-Americans and Ashkenazi Jews
Type 2 diabetes
If a person has a familial or personal history of polyps, the American Cancer Society will recommend a more frequent or earlier course of screening. For example, a person who has a first-degree family member with colorectal cancer before age 60 should begin screening at age 40 and continue every five years, and a person with HNPCC should begin screening at 20-25 years old and continue every 1-2 years.
In addition, people should watch for bloody stools, unexplained weight loss and changes in bowel movements as signs of colorectal cancer developments.
While further research is required in order to determine the real cause for the rise of colorectal cancer in young adults, these Americans can take several preventative steps in order to lower their risk of developing colorectal cancer. Even though the data indicates a rise in colorectal cancer in the future, experts agree that this small but unfortunate trend is not enough justification to lower the screening age below 50 years old.
As always, regular screening colonoscopies are the best way to catch pre-cancerous polyps early and prevent colorectal cancer. Colorectal cancer screening with colonoscopy, the Gold Standard, is an exceptionally effective tool in the fight against this dreadful disease, which, if caught early, is often curable. Thankfully, the future holds many bright possibilities for the fight against colorectal cancer.
About Preventing Colorectal Cancer:
Headquartered in Annapolis, MD, PCC is a not-for-profit 501(c) 6 advocacy organization with the primary mission to educate both public and private stakeholders about the opportunities to reduce the incidence of colorectal cancer through promoting effective screening, prevention and care options for patients. Membership is open to all individuals and groups. For more information, see www.preventingcolorectalcancer.org.
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1 Bailey CE, Hu CY, You N, et al: Increase in incidence of colorectal cancer in young adults, rates expected to rise. JAMA Surg. November 5, 2014 (early release online).
2 Lieberman, MD, AGAF, D. (2014, November 13). Commentary on New Research Finding Increase in CRC in Young Adults. Retrieved December 16, 2014. link
3 Preidt, R. (2014, November 5). Colon Cancer on the Rise for U.S. Adults Under 50. Retrieved December 16, 2014. link
4 Colorectal cancer risk decreases with multiple healthy behaviors. (2014, October 13). Retrieved December 16, 2014. link
5 Risk factors for colorectal cancer. (2014, October 29). Retrieved December 16, 2014. link
6 American Cancer Society recommendations for colorectal cancer early detection. (2015, February 5). Retrieved March 4, 2015. link
7 Seaman, A. (2014, November 5). Colon cancers may be increasing among young adults. Retrieved December 16, 2014. link