Late-Stage Colorectal Cancer Cases in Young People
- New research suggests that more young people are getting colorectal cancer and they’re getting diagnosed at later stages of the disease.
- Colorectal cancer screenings have made a big difference in colorectal cancer prevention. But with colorectal cancer cases in younger people on the rise, the recommended age for beginning screening has been moved from 50 to 45.
- Researchers are trying to understand whether changes in the average person's gut bacteria, a wave of chronic inflammation or environmental factors may be responsible, however there is no conclusive evidence.
In a recent study, researchers compared data from more than 100,000 people with colorectal adenocarcinoma (most colorectal cancers are adenocarcinomas) from the years 20002002 with 20142016. Its findings showed that young patients ages 20 to 39 years old have had the highest increase in rates of new colorectal adenocarcinoma cases diagnosed at later stages, though case counts still “remain relatively low.” Subgroups of non-Hispanic Black and Hispanic participants, in particular, saw the highest increases.
Read MoreUnderstanding Colorectal Cancer
Colorectal cancer is a type of cancer that occurs in the colon or rectum. Signs of this cancer can include a change in bowel habits, a change in stool color, abdominal pain, unexpected weight loss and anemia. Colon Cancer SymptomsLike any cancer, colorectal cancer presents its own unique challenges for patients on the road to recovery. But Dr. Heather Yeo, a surgical oncologist and colorectal surgeon at New York Presbyterian Weill Cornell Medical Center, wants to remind people how far the treatment of this disease has come.
RELATED: 5 Possible Signs of Colon Cancer; Don't Be Afraid to Look in the Toilet!
"One of the most exciting things about my job is that we've made a lot of progress on treatment options," Dr. Yeo said in a previous interview with SurvivorNet. "However, patients are still while they're living longer, they are still living with colon cancer, and so I think it's really important that we talk about how some of the things in your life affect you."
How to Approach Treatment for Advanced Colon Cancer
Dr. Yeo also wants people to know how important colorectal screenings can be. In fact, she says most colorectal cancers can be prevented early with screening.
"In the United States, on a national level, colorectal cancer has been decreasing for the last 20 years," Dr. Yeo explained. "And much of that is thought to be directly due to screening for colon cancer."
Even still, colorectal cancer cases are rising among younger people. And in the United States alone, rates have increased every year from 2011 to 2016 by 2 percent among people younger than 50. Because of this increase, the United States Preventive Services Task Force has recently updated its colorectal cancer screening recommendations to begin at age 45 as opposed to 50.
"We know that colon cancers can be prevented when polyps are found early," Dr. Yeo said. "Lowering the screening age helps somewhat with this. But access to care is a real problem."
RELATED: Why Do So Few Black Men Get Colon Cancer Screenings?
And 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.
But Why More Advanced Colon Cancer Cases for Young People?
"There appears to be a rise of esophageal, gastric and colon cancer among young people (<50 years old), which is a population that is typically less likely to get diagnosed with gastrointestinal cancer," Dr. Emily Nachtigal, a UCLA-Olive View hematology-oncology fellow, previously told SurvivorNet.
But it’s crucial to understand that it’s not just the ‘typical’ colon cancer cases arising amongst younger people. In fact, the increased colorectal cancer cases we’re seeing in younger people are actually different from the older-onset colon cancers in many ways.
"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.
Dr. Yeo also previously explained that while we don’t know exactly why we’re seeing earlier onset and death from colon cancer, there could be various potential factors to point to.
"It is likely a combination of factors, including diet and genetics as well as access to care and some environmental factors," Dr. Yeo said.
RELATED: Can the Stuff in My Gut Cause Cancer? There May Be A Link to Colon Cancer
Researchers are pursuing several possible theories, including diet, gut bacteria, and inflammation.
A growing body of 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 may raise your risk for an earlier diagnosis, too. A sedentary lifestyle may also play a role in risk for early-onset disease. While these interrelated factors may be unsurprising, research underway explores lesser known theories, too.
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Certain types of bacteria that can grow in your gut may promote colorectal cancer. Other gut bacteria, studies suggest, could influence how well cancer treatment works. An unhealthy lifestyle increase levels of harmful bacteria and lower levels of beneficial bacteria in your gut.
Chronic inflammation, which may come from a poor diet, stress and trauma, or another underlying condition, may also promote cancer. In fact, about half of younger adults who get colorectal cancer already have a chronic disease that causes gut inflammation.
Other research explores the role that air and water pollution, pesticides and other chemicals in the environment might play in early-onset colon cancer risk.
What Should You Do?
Research suggests that tailoring colon 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. And, as always, if you ever develop any possible symptoms of the disease, you should consult your doctor right away.
Additionally, there is research being done that could allow for a more mathematical approach to assessing your colorectal cancer risk. Comparing 3,486 adults under age 50 who developed bowel cancer between 1990 and 2010 with 3,890 similar young men and women without the disease, researchers from NYU Langone Health and its Laura and Isaac Perlmutter Cancer Center found that a new risk score could identify men and women under age 50 most likely to develop colorectal cancer. The score, a number between 0 and 1, was based on 141 genetic variants (changes in the DNA code) more common in people with the disease and 16 lifestyle factors known to increase people’s chances of bowel cancers including smoking and age as well as how much dietary fiber and red meat they consume.
The study found that people with with a score in the top third were four times more likely to develop colorectal cancers than men and women who scored in the bottom third.
"Our study results help address the rising rates of colorectal cancer among younger adults in the United States and other developed countries, and show that it is feasible to identify those most at risk of the disease," study co-senior investigator Richard B. Hayes, DDS, MPH, PhD, said in a statement.
The test will still need to undergo further testing in larger trials to refine the system, figure out how best it can be used by doctors and prove that it can, in fact, prevent illness and death. And while Hayes says his team’s tool is not yet ready for clinical use, it does show promise for the future of early colorectal cancer detection.
"Our ultimate goal is to have a predictive test for all people to gauge when they, based on their own genetic and personal health factors, need to start routine screening for colorectal cancer," Hayes said.
Contributing: Sonya Collins
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