There was a time when physicians were most concerned about people over the age of 55 being diagnosed with colorectal cancer.
It was considered “a disease of older people,” said Dr. Arif H. Kamal, chief patient officer for the American Cancer Society and an associate professor of medicine at Duke University’s School of Medicine.
Recent research has shown a trend of increased cases in younger people, a finding confirmed in a study published Wednesday in the American Cancer Society Journal, “CA: A Cancer Journal for Clinicians.”
The study, which was released during Colorectal Cancer Awareness Month, finds that the disease is showing up more in people under the age of 50, and often in more advanced stages.
In the last three decades or so, cancer rates overall have been declining, but there’s been a 2% increase per year in colorectal cancer among people under the age of 55.
“It’s mixed news,” Kamal said. “So this catches people’s attention, as it should. It sends the message that we really need to catch it early before it spreads.”
In 2018, the American Cancer Society recommended that regular colon cancer screenings begin at age 45 for those at average risk, lowering the age from 50 after noting an increase in tumors in younger adults.
The “Black Panther” actor Chadwick Boseman privately battled colon cancer for several years before dying in 2020 at age 43.
“Why it’s happening is sort of an unknown,” Kamal added. Part of the reason, he said, may be related to lifestyle such as lack of exercise, obesity and excess alcohol use, but also the low screening rate for younger people.
He said the colonscopy rate for people under the age of 50 is about 20%. That’s important because the screenings enable doctors to find and remove pre-cancerous and cancerous polyps, which are small “clumps” of cells. According to the Mayo Clinic, most colon polyps are harmless, but over time some can develop into cancer. Colon polyps often don’t cause symptoms.
People may not be aware that the recommended ages for colon cancer screenings has been lowered and that some screening options can be done at home.
Additionally, there are factors like the lack of access to gastroenterologists and surgeons in rural areas.
In 2023, roughly 153,020 people nationally are projected to be diagnosed with colorectal cancer with 52,550 dying from the disease, including 19,550 cases and 3,750 deaths in people under the age of 50, according to the study, which is done every three years.
In all, more than 1.9 million new cancer cases are expected to be diagnosed in the U.S. in 2023.
Most people diagnosed with colorectal cancer will be over the age of 65 still, but 20% will be under the age of 55, according to the study, which is based on information from the National Center for Health Statistics.
In Georgia, the incidence of colon cancer between 2015 and 2019 was 39 out of every 100,000 residents; 38 for non-Hispanic whites; 44 for non-Hispanic blacks; and 36 for Hispanics.
“This is a global trend,” said Dr. Karthi Subbannan, who specializes in oncology and hematology at Northside Hospital. "It’s not anything that’s just here in the U.S. or just in recent years.”
She has noticed an increase in younger patients with colorectal cancer in their 30s and 40s at her practice, although the majority are still older.
“Unfortunately, what happens in younger patients is that when they have symptoms like a change in bowels or rectal bleeding, cancer is not the first thing they think about, specifically if they don’t have a family history.”
For women, who often start having mammograms at age 40, the idea of screenings are better accepted.
Sandy Ingraham, a mother of four from Peachtree City, knows the risks first hand.
Ingraham, now 48, has a family history of colon cancer. A first cousin was diagnosed with Stage 4 metastatic colon cancer at 36 and died at 39. Her mother had a history of polyps, although none were ever found to be malignant.
In the summer of 2021, Ingraham noticed rectal bleeding, but figured it could be hemorrhoids. About a week and a half later she noticed blood in her stool, although she was never in any pain.
Still, it scared Ingraham enough to visit her primary care physician who recommended a colonscopy. She said he assured her it was probably not cancer because of her age and general good health.
After an exam he then referred her to a gastroenterologist. It was during the pandemic, which meant she had to wait more than a month for the procedure.
During a colonoscopy the doctor found a “fairly large” polyp that was too big to remove immediately. They did a biopsy instead and she was referred to a surgeon to remove the polyp.
When she awoke from the procedure, her husband was sitting next to her. Not a good sign, she thought. Still, she said she was told not to be too concerned because of her age.
She later learned she had Stage 1 colon cancer.
She and her husband were in shock. Surgeons removed part of her colon. The cancer hadn’t spread and she didn’t need chemotherapy or radiation.
“It was a huge blessing,” said Ingraham, who must have a colonoscopy every year for now and lab work every three months.
“I listened to my body and did something about it. I was young. I didn’t think it could happen to me.”
To learn more about colorectal cancer, its causes, risk factors, prevention, early detection and treatment, go www.cancer.org/coloncancer.
Colorectal Screening
Most colorectal cancers grow slowly and do not produce symptoms right away, so screening is important to find these tumors early, when removal and treatments are more likely to work.
If you develop colon cancer, several treatments are available including surgery, radiation therapy and drug treatments, such as chemotherapy, targeted therapy and immunotherapy.
Who should get screened for colorectal cancer?
Screenings are recommended for anyone at average risk starting at age 45. Those at high risk or with a family history of these cancers may be asked to begin younger. The Colorectal Cancer Alliance suggests getting screened for the first time at age 40 or 10 years before the age of the youngest case in your immediate family.
What type of tests are available?
A colonoscopy is an in-office procedure in which a flexible fiber-optic instrument is inserted through the anus in order to examine the interior of the colon. While the procedure can be done under anesthesia, it requires a one- or two-day preparation involving a limited diet and plenty of fluids.
A fecal occult blood test is a lab test used to check stool samples for hidden (occult) blood. There are several types of these tests, which require a sample of a bowel movement that is tested for blood or DNA markers. These tests can give false negative and false positive results and may result in the need for further testing. Occult blood in the stool may indicate colon cancer or polyps in the colon or rectum — though not all cancers or polyps bleed.
What are the symptoms of colorectal cancer? Most colorectal cancers start as precancerous polyps, or abnormal growths in the colon or rectum, which may not cause symptoms. Not all polyps turn into cancer. Symptoms that may develop include:
— A persistent change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
— Rectal bleeding or blood in your stool
— Persistent abdominal discomfort, such as cramps, gas or pain
— Unexplained weight loss
