The rates of colorectal cancer (which groups together colon and rectal cancer because of their similarities) have been increasing in young people around the world.
A new report by the American Cancer Society found that colorectal cancer diagnoses nearly doubled in people younger than 55 in recent years; it increased from 11% in 1995 to 20% in 2019. And the report says there’s a higher rate of advanced-stage colorectal cancer diagnoses, which increased from 52% in the mid-2000s to 60% in 2019.
Even before this new report, doctors and researchers had been aware of this rise in cases.
“We have seen an alarming and unsettling increase in the instance of colorectal cancer in younger people,” said Dr. Robin Mendelsohn, co-director of the Center for Young Onset Colorectal and Gastrointestinal Cancer at Memorial Sloan Kettering Cancer Center in New York City. “It’s been increasing about 1 to 2% per year since the 1990s.”
The overall numbers are small, but, still, any increase is cause for concern. And it’s especially shocking because the biggest increase in cases is in the youngest group of people — those who are 20 to 29, Mendelsohn explained.
Why are cases rising in young people? “We don’t have a definitive answer as to why we’re seeing rates rise,” said Dr. Nilofer Saba Azad, co-director of cancer genetics and epigenetics at Johns Hopkins Medicine in Baltimore. “But what is clear is that it’s not because anything new is happening genetically, which means it’s likely due to environmental factors.”
These factors mainly include a Western diet (particularly processed meats), excess body weight, alcohol, smoking and conditions including diabetes and other metabolic issues.
“Each of these individual factors isn’t a major risk factor, but when you put all of these things together it’s likely underpinning some of what we’re seeing — but we don’t have a definitive answer,” Azad noted.
Azad stressed that this doesn’t mean you can’t enjoy the foods that are part of a Western diet or have a glass of wine; many cancer risk factors, like genetics, are out of your control. Instead, this just underscores the importance of moderation and prioritising nutritious foods and exercise, too.
In addition to taking part in a lifestyle that limits certain risks, you should know the signs of colorectal cancer and follow official screening guidelines to stay healthy or catch the disease early.
Starting at 45, you should get screened for colorectal cancer.
Unfortunately, the youngest groups of people experiencing this increase in colorectal cancer are too young to get screened. Screenings aren’t covered by insurance plans until 45 for most people (more on this in a moment).
But that just makes it doubly important for you to get screened as soon as you can. The age for screenings to begin in the U.S. used to be 50, but as a result of this uptick in cases, the guidelines changed, said Dr. Arif Kamal, the chief patient officer at the American Cancer Society.
“The reason for that is we were seeing a remarkable increase in people ... in their early 50s with colon cancer,” Kamal said.
“The purpose of screening is twofold,” Mendelsohn stated. “One is if cancer is detected, it’s detected early ... in the early stages, colorectal cancer is extremely curable. And the other is to find polyps, which are precancerous growths that over time can turn into cancer.”
“The idea is if we can find polyps, to identify them and remove them and therefore prevent cancer — so both early detection and cancer prevention,” Mendelsohn added.
Certain groups of people can get screened earlier than 45.
People in certain high-risk groups can get screened and have it covered by their insurance plan before age 45.
“We do start earlier in people with a family history, so it’s really important for everyone to know their family history,” Mendelsohn said.
In other words, you’ll want to know if a parent, child or sibling has or had colon or rectal cancer, she noted.
Those with inflammatory bowel disease, which is Crohn’s disease or ulcerative colitis, also can get screened earlier, she said.
If you don’t fall into any of these groups but are worried something is wrong, it’s still worth bringing it up to your doctor. You know your body best. Together, you and your doctor may decide it’s worth getting a colonoscopy; this may not be covered by insurance or may be denied, but there are options you can explore with your medical provider.
Colonoscopies aren’t the only screening method.
It’s very common for people to be afraid of colonoscopies, though it’s unwarranted, experts say. “Colonoscopies are extraordinarily safe procedures ... and they are actually not uncomfortable at all,” Azad said.
Azad added that the most uncomfortable part for many people is the preparation (essentially cleaning out your system). But that minor inconvenience comes with major health benefits.
Many experts do consider colonoscopies to be the gold standard, Mendelsohn said, “because it’s really the screening method where we can at the same time identify these polyps and remove them, and if there is cancer, biopsy it — it allows us to do early recognition and cancer prevention at once.”
There are other screening tests available as well, like stool tests and a CT scan known as a virtual colonoscopy, Mendelsohn said.
In healthy people, colonoscopies should take place every 10 years, and virtual colonoscopies are required every five years. Stool tests should happen more frequently, ranging from every year to every three years, depending on the test, according to the Centres for Disease Control and Prevention.
“When people ask what is the best test … I do think [colonoscopy] is the best test because it allows us to do all the things that we talked about, but in the end, I think the best test is the one that gets done,” Mendelsohn said.
So, if you’re nervous about getting a colonoscopy (or the routine to prepare for one), there are other screening options.
Signs of colorectal cancer can vary.
According to Mendelsohn, “the most common symptom is rectal bleeding or blood in the stool, which can be in the toilet bowl, in the stool itself [or] on the toilet paper.”
But she stressed that the majority of people with rectal bleeding will not have cancer. Haemorrhoids are a common cause of this.
At the same time, though, not all rectal bleeding in young people is haemorrhoids, a dangerous misconception.
According to the Mayo Clinic, another colorectal cancer sign is if it feels like you can’t empty your bowel. Meaning, when you go to the bathroom, you don’t feel the relief and emptiness associated with pooping.
Anaemia could be another sign, too. “If you are diagnosed with anaemia, so if your blood count is low, that could be a sign that you’re losing blood” in the gastrointestinal tract, Mendelsohn said.
Changes in your stool is another red flag, according to Azad. This can include having black poop, Kamal added, or having issues with constipation. Though it’s also worth saying that not all constipation or poop changes are reasons to panic. Some of this could be stress-related or diet-related, Mendelsohn said.
And know that some of the other symptoms — like abdominal pain and weight loss — can be really vague. These can include abdominal pain, unexplained weight loss and unexplained appetite changes.
“That’s what makes this so difficult. If someone has some rectal bleeding, that’s a very easy sign … but some of the other symptoms can be a little bit more subtle,” Azad said. “It’s really about people knowing their bodies and knowing that something feels different than it has before.”
Everyone needs to monitor themselves for these symptoms, especially people under 45.
Since most people younger than 45 won’t be screened for colorectal cancer, it’s important to monitor yourself for these symptoms and get in touch with your doctor if you notice any of these signs. You can and should advocate for an earlier test. Additionally, even if you’re 45 or older and getting screened regularly, it’s necessary that you alert your doctor to any of these issues.
Kamal said that it’s important to know that while a colon cancer diagnosis is scary, the average survival rate of a person with Stage 4 colon cancer is measured in years, but the cure rate for people with local colon cancer ― meaning cancer that hasn’t spread ― can reach 100%.
Screenings and knowing the warning signs are important as the incidence of this disease continues to rise.