Colorectal cancer, once largely considered a disease of older adults, is increasingly affecting younger individuals, now representing the leading cause of cancer deaths in those under 50. This concerning trend is prompting medical professionals to re-evaluate screening guidelines and investigate potential contributing factors.
The recent deaths of actor James Van Der Beek, at age 48, and Chadwick Boseman, at 43, have brought this issue into sharper focus, highlighting the vulnerability of younger adults to this disease. As Dr. John Marshall of Georgetown University’s Lombardi Comprehensive Cancer Center notes, “We’re now starting to see more and more people in the 20-, 30-, and 40-year-old range developing colon cancer. At the beginning of my career, nobody that age had colorectal cancer.” This shift is described by Marshall as “shaking us all, to be blunt.”
Understanding Colorectal Cancer and Its Prevalence
Colorectal cancer develops in the colon or rectum, affecting the soft tissues of the digestive system. In the United States, We see the third most commonly diagnosed cancer and the third leading cause of cancer-related deaths for both men and women. The American Cancer Society estimates that approximately 158,000 new cases will be diagnosed in the U.S. This year. While it remains the second leading cause of cancer death behind lung cancer, it has surpassed other cancers as the deadliest for those under 50.
Historically, the incidence and mortality rates of colorectal cancer have been declining largely due to increased screening efforts. These screenings allow for the early detection of tumors, when treatment is most effective, or even the removal of precancerous growths before they develop into cancer. However, this positive trend is not being observed in younger adults.
The Rising Incidence in Younger Adults
Since the early 2000s, diagnoses of colorectal cancer have been steadily increasing among individuals under the age of 50. Data from the American Cancer Society reveals that in 2019, 20% of diagnoses were in patients under 55, roughly double the rate observed in 1995. Advanced-stage disease is increasing at an annual rate of approximately 3% in this younger demographic. Mortality rates in this age group have also risen, increasing by 1.1% each year since 2005, making colorectal cancer the leading cause of cancer death for Americans under 50.
Risk Factors and Lifestyle Considerations
While the majority of colorectal cancer cases and deaths still occur in individuals 50 and older, the increasing incidence in younger adults raises questions about potential risk factors. Established risk factors include obesity, a lack of physical activity, a diet high in red or processed meats and low in fruits and vegetables, smoking, heavy alcohol consumption, and a history of inflammatory bowel disease or a family history of colorectal cancer.
Experts emphasize the importance of lifestyle modifications. Dr. Marshall recommends a diet rich in fruits, vegetables, and whole grains, while moderating red meat consumption. Research also suggests a link between physical activity and improved outcomes. A recent study demonstrated that a three-year exercise program improved survival rates and reduced cancer recurrence in colon cancer patients.
Recognizing the Symptoms
Early detection is crucial for successful treatment. Individuals should be aware of potential symptoms, which include blood in the stool or rectal bleeding, changes in bowel habits (diarrhea, constipation, or narrowing of the stool) lasting more than a few days, unexplained weight loss, and abdominal cramps or pain. “Don’t ignore symptoms. Get it checked,” urges Dr. Marshall, emphasizing that early diagnosis significantly improves survival rates.
Screening Recommendations and Emerging Research
Current medical guidelines generally recommend initiating colorectal cancer screening at age 45. However, this may be too late for some younger adults at higher risk. Individuals with a family history of the disease or other predisposing factors should discuss earlier screening options with their healthcare provider.
Various screening methods are available, including annual stool-based tests and colonoscopies, which may be performed every 10 years if no abnormalities are detected. A newer blood test is also available for adults aged 45 and older. The optimal screening strategy should be determined in consultation with a physician.
Unraveling the Cause of the Increase
The underlying causes of the rising incidence of colorectal cancer in younger adults remain unclear. Many young patients diagnosed with the disease do not exhibit traditional risk factors. Researchers are exploring various possibilities, including changes in the gut microbiome – the community of microorganisms living in the digestive tract. The location of tumors within the colon appears to differ between younger and older patients, suggesting potential variations in the disease’s development and progression.
As Dr. Marshall notes, the situation is complex and requires further investigation to understand the factors driving this concerning trend and to develop more effective prevention and screening strategies for younger adults.
