Colorectal Cancer in Younger Adults: A Growing Concern and a Call to Action
Submitted by By Sara Wolfson, RN, MED-SURG-BC, OCN
Tags: cancer symptoms colon cancer Colonoscopy Colorectal cancer Genetic testing
Colorectal cancer is a type of cancer affecting the tissues of the colon and rectum. This type of cancer typically presents with no symptoms initially, with symptoms generally appearing once it has reached an advanced stage. Colorectal cancer is the primary cause of death in the United States for males under 50 and the second leading cause of death for women under 50. We have been observing a trend of younger people suffering from this disease since the mid-1990s, affecting adults between 20 and 39. Experts in the healthcare industry are taking steps to address these trends, which begin with conversation. Providers listening to their patients' concerns and symptoms, no matter how minor they seem, is crucial for the early detection of colorectal cancer. Recently, I have noticed providers during annual visits asking about bowel habits and any blood in the stool and/or hemorrhoids. This questioning is not just reserved for the 50+ community with risk factors for this cancer but also includes Millennials and Gen Z. The reason for this inquiry is to identify early warning signs of colorectal cancer, where we have seen an increase in cases in adults aged 20 to 39. Early warning signs of this type of cancer include changes in bowel habits, rectal bleeding or blood in the stool, unexplained weight loss, fatigue, abdominal pain, and iron deficiency anemia. Iron deficiency anemia can result from blood in the stool; anemia may be one of the first noticeable symptoms that require further investigation from providers. Typical of human nature, we dismiss some of these signs as a temporary occurrence or something minor, hesitant to visit the doctor. This is true for younger adults who may overlook some of these important warning signs.
The bottom line is that if you notice something out of the norm for you, listen to your body and get it checked out by a medical professional as soon as possible. According to article "Colorectal Cancer: From Risk Factors to Oncogenesis", an individual experiencing one sign mentioned above has twice the likelihood of developing colorectal cancer, while having three signs increases the likelihood sixfold. Early diagnosis is crucial; cancer caught early, localized to the colon or rectum before any spread, has shown a five-year survival rate of over 90%. The spread of this cancer to surrounding organs has shown a 15% five-year survival rate, a sharp decrease from cancer detected early enough to treat. Together, through awareness, we can halt this upward trajectory of colorectal cancer rates. A colonoscopy is considered the gold standard for detecting colon cancer but is usually covered by insurance if the patient meets the age requirement for this screening.
Some proponents advocate for screening reforms, seeking to change the recommended screening age from 45 to younger than 35. Individuals at high risk for developing colorectal cancer, such as those with a first-degree relative or second-degree relative with colorectal cancer, polyps, and/or inflammatory bowel disease, can undergo a flexible sigmoidoscopy at age 40. Flexible sigmoidoscopy is a procedure that uses a sigmoidoscope in visualizing the sigmoid colon and rectum, although it has limitations to visualize the entire colon. Flexible sigmoidoscopy can help detect polyps and precancerous growths, in addition to cancerous tissue. Although a flexible sigmoidoscopy may not be as sensitive in detecting small lesions as a colonoscopy, it is ultimately still better than nothing. CDC guidelines suggest that patients do a fecal occult blood test along with a flexible sigmoidoscopy for better effectiveness.
Ultimately, it's important to follow up on any colorectal cancer screening available. If you know you have a family history of colorectal cancer, this can provide you with the tools and insight to recognize what to look for. Just because you have a family member with cancer does not mean you are doomed to get cancer too. If you know you have a close relative who had colorectal cancer, it is highly recommended that you see a genetic counselor and undergo genetic testing. Genetic testing can determine if you have an inherited gene mutation or any hereditary colorectal cancer syndrome. According to an article from the National Cancer Institute, "Young-onset colorectal cancer", 20% of people under 35 with colorectal cancer have a genetic predisposition for this disease. Predisposed individuals can get screening earlier than others and may be eligible for preventative surgery, such as a colectomy, to prevent colorectal cancer. Besides the genetic component, there are lifestyle changes you can make to help lower your chances of getting colorectal cancer, such as maintaining a healthy weight, avoiding smoking, and limiting alcohol use, to name a few. I always tell my patients, "You know your body better than anyone; trust your intuition if something doesn't feel right." You can learn the signs to look out for, get screened, and remember that your voice matters in your healthcare journey.