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Colorectal cancer has traditionally been considered an older person’s disease. But according to the American Cancer Society, in 2020, 12% of colorectal cancer cases will be diagnosed in people under 50. From 2011 to 2016, colorectal cancer rates rose by 2.2% per year in people under age 50. Perhaps even more alarming, from 2008-2017, colorectal cancer death rates increased by 1.3% in that age group.
This is disturbing on several levels. First, the reasons for these increases aren’t entirely clear to doctors or researchers. Second, this age group is younger than the recommended age to start regular colon cancer screening. But one fact is clear: Young adults and their doctors need to understand their risk for colorectal cancer, so we can detect the disease early and treat it successfully.
LISTEN: Dr. Bello discusses colorectal cancer in young adults on the Medical Intel podcast.
What risk factors should young adults consider?
Research suggests that the increase might be caused by a combination of factors. A likely risk factor is unhealthy lifestyle choices. Young people today grew up eating more processed foods than generations past, and I see many patients who don’t get enough exercise.
Unhealthy #diet and lack of #exercise likely contribute to the growing rate of #colorectalcancer among young adults. https://bit.ly/2GivH6C via @MedStarWHC
Genetics are a known factor in overall colorectal cancer risk, and researchers are studying whether this affects young adults at a great rate. While we continue to study this problem, there are steps you can take to lower your risk:
- Avoid excess alcohol consumption.
- Avoid fatty and fried foods.
- Don’t smoke, or quit if you do. Our Section of Pulmonary Medicine offers services to help you quit.
- Eat a high-fiber diet.
Exercise for at least 20 minutes a day at least two to three days per week.
When should young adults get tested for colorectal cancer?
Even with colon cancer diagnoses trending younger, we don’t routinely test adults of all ages for colorectal cancer. We’ve found that routinely testing young adults can lead to more false positive results than true diagnoses, which leads to unnecessary testing and undue stress. The American Cancer Society recommends that people at average risk begin colorectal cancer screening tests once they turn 50. If you have a family history of colorectal cancer, particularly if a relative was diagnosed at 50 or younger, your doctor might recommend that you have a colonoscopy or alternative test earlier. Unfortunately, my research has shown that approximately 40 percent of patients here in Washington and across the U.S. don’t get appropriate colorectal cancer screenings. People give a variety of reasons for not getting screened:
- Their doctors don’t talk to them about colonoscopy
- They think it’s gross to talk about the colon
- Colonoscopy seems scary
- Preparing for a colonoscopy sounds unpleasant
Related reading: Tips to make colonoscopy prep more bearable Young adults and their doctors should watch for potential warning signs of colorectal cancer. These include:
- Chronic pain in the abdomen, or belly, that doesn’t go away
- Rectal bleeding
- Unexplained weight loss
- Unexplained anemia, or a low volume of red blood cells
If you notice any of these symptoms or if you’re concerned about your colorectal health, talk to your doctor about whether you should consider getting a colonoscopy.
What happens if we find colorectal cancer?
Our patients have a whole team of experts in their corner. We bring together surgeons, gastroenterologists, medical oncologists, pathologists, radiologists and other experts for every patient. Our colorectal cancer team reviews scans and biopsies at our regular tumor board meeting. The experts give treatment recommendations, and we work together to create a personalized care plan for each patient. This team-based approach benefits all patients, but it’s vital for unusual or complex cases. For example, we treated a patient in his 20s whose routine blood work showed he was anemic. His primary care doctor referred him to a gastroenterologist for a colonoscopy, which showed multiple large colon polyps. Biopsies on these polyps showed that the polyps were precancerous. Instead of simply removing them like routine polyps, the gastroenterologist referred the patient to me. I recommended that we remove part of his large intestine and the surrounding fatty tissue to prevent colorectal cancer from developing. He agreed, and I performed this procedure laparoscopically, which involved just a few small incisions. He was able to go home in just a few days. But had he not gotten his regular blood work, and had his doctors not worked as a team in his care, he might not be here today. Today’s young adults must be aware of their colorectal cancer risk. Pay attention to your body, and if something doesn’t seem right with your digestion or bowel movements, talk to your doctor. We’ve heard it all—we’ll never judge you, and our No. 1 goal is to protect your health. But if “toilet talk” makes you uncomfortable, remember this: It’s preferable to find and treat colorectal cancer early than to let it threaten your life.