Health

Rising Incidence Of Colorectal Cancer Among Young Adults Has Nearly Doubled In America

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Colorectal cancer, encompassing both colon and rectal cancers, has seen an alarming rise among adults in their prime years. Since the early 1990s, cases of colorectal cancer in individuals under 50 have nearly doubled in the United States.

This unsettling trend highlights the urgency of understanding the factors behind this increase and improving early detection methods.

New research presented at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco sheds light on this issue. The study reveals that young adults often face more aggressive forms of colorectal cancer, with diagnoses typically occurring at more advanced stages compared to older adults.

Aggressive Nature of Young-Onset Colorectal Cancer

“Our study corroborates prior studies demonstrating colon cancer in young adults has more aggressive molecular and genetic characteristics,” said Kelley Chan, MD, lead author of the study and clinical scholar with ACS Cancer Programs.

Dr. Chan and her team examined data from the National Cancer Database, analyzing cases diagnosed between 2015 and 2021. They found that of approximately 317,000 colorectal cancer patients, 6% were young adults aged 18 to 44, while 94% were older adults aged 45 and above.

The findings revealed that younger adults were more likely to present with late-stage disease and aggressive tumor types. These insights underscore the critical need for targeted strategies to address the unique challenges posed by colorectal cancer in this age group.

Unexplained Causes in Half of Young-Onset Cases

A significant concern arising from the study is the lack of identifiable causes for 50% of young-onset colorectal cancers.

“Younger adults with colon cancer are more likely to have an inherited syndrome, which accounts for 20 to 30 percent of cancers, such as Lynch syndrome, and inflammatory bowel disease, which also accounts for up to 20 percent,” explained Dr. Chan.

However, the absence of a clear cause in half of the cases leaves healthcare professionals grappling with unanswered questions.

Obesity, a family history of gastrointestinal malignancy, and symptoms like abdominal pain or rectal bleeding were identified as associated risk factors.

Yet, many young patients defy these patterns. John Marshall, MD, chief medical consultant for the Colorectal Cancer Alliance, noted, “The young patients we are seeing are not obese and have no family history or known risk factors.”

This diagnostic uncertainty often leads to delayed recognition of symptoms, reducing the likelihood of early, treatable interventions. “We all need to be more aware of the symptoms so we take them seriously right away,” urged Dr. Marshall.

Screening Guidelines and the Role of Awareness

Currently, the Centers for Disease Control and Prevention (CDC) recommends initiating colorectal cancer screenings at age 45. Dr. Chan emphasized that adhering to this guideline remains practical, as young adults constitute only 6% of colorectal cancer cases.

However, the rising incidence among younger individuals suggests a pressing need for heightened awareness and vigilance among both patients and healthcare providers.

Disparities in Cancer Risk Among Racial Groups

The study also highlighted racial and ethnic disparities in colorectal cancer incidence. Among young patients, non-Hispanic Black individuals represented 17% of cases, compared to 12.6% among older adults and 12% of the general U.S. population.

The reasons for this disparity remain unclear. “However, there may be differences [among ethnic groups] in dietary patterns, health behaviors, obesity rates, and other factors,” explained Nancy You, MD, MHSc, FACS, a professor of colon and rectal surgery at MD Anderson’s Young-Onset Colorectal Cancer Program.

Cathy Eng, MD, executive director of the Young Adult Cancers Program at Vanderbilt-Ingram Cancer Center, emphasized the importance of addressing systemic barriers.

“Community outreach and access [to care] remains an issue, along with potential time constraints due to work and family, possible language barriers, and lack of education and awareness,” she stated.

The Emotional and Practical Concerns of Young Patients

Beyond the physical toll of cancer, young patients face unique emotional and practical challenges. A separate study from the University of Michigan, also presented at the ACS Clinical Congress, explored these concerns through interviews with 35 young colorectal cancer patients.

Key worries included physical health, mental health, family planning, and career disruptions. Infertility, anxiety, uncertainty about long-term survival, and financial instability were recurring themes.

“This matches what our licensed mental health professionals across the country who run our support programs for people living with cancer and their loved ones hear on a daily basis,” said Claire Saxton, executive vice president of insights and impact at the Cancer Support Community.

The study underscores the need for enhanced mental health support tailored to young cancer patients, including nutrition guidance, telehealth services, support groups, and digital mental health tools.

Lifestyle Strategies to Reduce Colorectal Cancer Risk

While the precise causes of young-onset colorectal cancer remain elusive, lifestyle modifications can play a significant role in reducing overall risk. Saxton recommends the following strategies:

  • Increase physical activity: Regular exercise helps maintain overall health and reduces cancer risk.
  • Maintain a healthy weight: Obesity is a known risk factor for several cancers.
  • Adopt a balanced diet: Focus on low animal fats and high intake of fruits, vegetables, and whole grains.
  • Limit alcohol consumption: Men should limit themselves to two drinks per day, and women to one.
  • Avoid tobacco: Smoking is a major risk factor for numerous cancers, including colorectal.
  • Minimize sugar-sweetened beverages and fast food: These foods contribute to obesity and other health issues.

A Call for Proactive Action

The rise in young-onset colorectal cancer is a stark reminder of the complexities surrounding cancer prevention and treatment. By fostering greater awareness, addressing healthcare disparities, and encouraging healthier lifestyles, society can take meaningful steps toward reversing this troubling trend.

The insights gained from studies like those presented at the ACS Clinical Congress highlight the importance of early detection, targeted interventions, and holistic support systems.

Together, these efforts can improve outcomes for young colorectal cancer patients and move closer to a future where such diagnoses are less frequent and more manageable.