The Shift In Colorectal Cancer Diagnoses
- Actress Kirstie Alley’s death from colon cancer at 71 was a shock.
- The average age at the time of a colon cancer diagnosis for men is 68 and for women is 72. For rectal cancer, it is age 63 for both men and women.
- But a recently published report in CA: A Cancer Journal for Clinicians found that more young people are being diagnosed with colorectal cancer (cancer that starts in the colon or rectum).
- According to the report, rates increased by 1.9% per year in people younger than 50 years from 2011 through 2019. Rates have been increasing in adults aged 2039 years since the mid-1980s.
- The report also notes that patients younger than 50 are more likely to be women, younger patients are more likely to present with rectal bleeding and abdominal pain, and early-onset patients are more often diagnosed with advanced disease.
- Researchers are pursuing several possible theories for the shift including diet, gut bacteria and inflammation.
Alley died of colon cancer on Dec. 5, 2022. The news was shared by her children Lillie Price Stevenson, 28, and William True Stevenson, 30 on Alley’s official Instagram page.
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A Shift in the Colon Cancer Patient Population
Alley’s diagnosis shortly before her passing at 71 almost perfectly aligns with the documented average age at the time of diagnosis for colon cancer: 68 for men and 72 for women, according to the American Cancer Society. For rectal cancer, it is age 63 for both men and women.
But there’s a concerning trend of more and more younger people being diagnosed colorectal cancer.
"We know rates are increasing in young people, but it's alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population," said Rebecca Siegel, lead author of a recently published report in CA: A Cancer Journal for Clinicians that outlines up-to-date- colorectal cancer statistics.
Looking at the data itself, it’s easy to see why researchers are concerned.
“In contrast to decreasing CRC [colorectal cancer] incidence in older adults, rates have been increasing in adults aged 2039 years since the mid-1980s and in those aged 4054 years since the mid-1990s,” the report reads. “From 2011 through 2019, rates increased by 1.9% per year in people younger than 50 years and in those aged 5054 years.
Plus, the research found an increase in people being diagnosed at more advanced stages than in the mid 1990s, before there was widespread screening.
But why the shift? According to Dr. Heather Yeo, a surgical oncologist who specializes in colorectal cancers at Weill Cornell Medicine, it could be caused by variety of things.
"We don't know for sure why we are seeing earlier onset and death from colon cancer," Dr. Yeo told SurvivorNet. "It is likely a combination of factors, including diet and genetics as well as access to care and some environmental factors."
Researchers are pursuing several possible theories for the shift including diet, gut bacteria and inflammation.
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Some of the less-surprising evidence links an unhealthy diet high in processed meats and fat and low in fruits and vegetables with early-onset colon cancer. Being overweight or obese as well as living a sedentary lifestyle may also raise your risk for an earlier diagnosis.
Lesser known theories point to the idea that certain types of bacteria that grow in your gut may promote colorectal cancer. Studies also suggest that other gut bacteria could influence the effectiveness of cancer treatment. That being said, it’s crucial to know that an unhealthy lifestyle increases levels of harmful bacteria and decreases levels of beneficial bacteria in your gut.
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Chronic inflammation which can be caused by a poor diet, stress, trauma, or other underlying conditions may also promote cancer.
Other researchers are looking into the role that air and water pollution, pesticides and other chemicals in the environment might play in early-onset colorectal cancer risk.
Overall, colorectal cancer mortality continues to decline. But with “one in five new cases” now occurring in people in their early 50s or younger, we have to adapt to the shifting patient population.
And a part of that adapting means looking into how these earlier-onset colorectal cancers differ from the later onset ones.
"Early-onset colorectal cancers seem to be more aggressive, and found at later stages in younger adults, but they are not necessarily more fatal if they are caught early," Dr. Yeo said.
According to the recently published report, patients younger than 50 years are more likely to be women. And younger patients are more likely to present with hematochezia (rectal bleeding) and abdominal pain at least in part because of the predominance of left-sided tumors.
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And, as Dr. Yeo previously noted, early-onset patients are more often diagnosed with advanced disease including 27% with distant metastases versus 20% of older patients. In fact, the rising rate of early-onset colorectal cancer is confined to advanced diagnoses because rates increased by about 3% per year for regional-stage and distant-stage disease versus a decline of 1% per year for localized-stage disease from 2010 to 2019.
What Can We Do?
Given that colorectal cancer cases are rising among younger people, the United States Preventive Services Task Force recently updated its colorectal cancer screening recommendations to begin at age 45 instead of 50.
"We know that colon cancers can be prevented when polyps are found early," Dr. Heather Yeo told SurvivorNet. "Lowering the screening age helps somewhat with this. But access to care is a real problem."
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Increasing access is crucial to making sure that we don't see racial disparities within the world of colorectal cancer. Whites and Asians are significantly more likely to be up to date with their colonoscopies than African Americans, Latinos and Native Americans.
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Research suggests that tailoring colorectal cancer screenings to each person's individual risk may be beneficial. If you are not yet 45 but have concerns about your risk, talk to your doctor. Ask about your individual risk based on your lifestyle and family history and find out when screenings would be right for you.
In addition, it’s important be your own healthcare advocate. Colorectal cancer might not immediately cause symptoms, but you should always talk with your doctor about changes to your health. Possible symptoms to look out for include:
- A change in bowel habits such as diarrhea, constipation or narrowing of the stool that lasts for more than a few days
- A feeling that you need to have a bowel movement that's not relieved by having one
- Rectal bleeding with bright red blood
- Blood in the stool which might make the stool look dark brown or black
- Cramping or abdominal (belly) pain
- Weakness and fatigue
- Unintended weight loss
Displaying some of these symptoms does not mean you necessarily have colorectal cancer. Alternatively, you could not display any of these symptoms and still have colorectal cancer. Regardless, it is important to bring up any symptoms to your doctor should they arise.
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