Although recommendations on when to begin screening for colorectal cancer vary, one thing is clear: Regular screening is the key to preventing colorectal cancer, the second leading cause of cancer-related death in the U.S.
With more young people being diagnosed with the disease, consistent screening is important, experts say. Researchers suspect that lifestyle choices are contributing to the increase in the younger occurrence. Sedentary lifestyles, smoking, alcohol and diets high in red meat all could play a role.
“I’ve always been attuned to younger people getting colorectal cancer,” says Dana M. Hayden, MD, who specializes in colorectal surgery at Rush University Medical Center in Chicago. “It’s hitting all ages, but we’re definitely seeing more people under 50 and even in their 20s and 30s.”
A new guidance statement from the American College of Physicians issued in November, which analyzes recommendations from six other organizations, recommends that people with an average risk of colorectal cancer begin screening at 50.
But some organizations recommend starting earlier, based on an uptick in younger people diagnosed with the disease. Last year, the American Cancer Society’s updated screening guidelines recommended that adults at average risk of the disease begin getting tested at age 45.
While experts differ on whether to start screening at 45 or 50, neither is a magic number, says Rebecca Siegel, MPH, scientific director for surveillance research at the American Cancer Society.
“It’s somewhat arbitrary,” Siegel says. “Risk of colon cancer increases with age. That [age 50] has worked. But now risk in young people has increased.”
While the majority of cases occur in older age groups, there is evidence that colorectal cancer among young people is increasing. In adults younger than 50, colorectal cancer incidence rates increased by 1.6% per year from 2009 to 2013, while the rates decreased for those age 50 and older. Also, death rates from colorectal cancer in adults younger than 50 increased by about 1% per year from 2005 to 2014, while mortality decreased for those age 50 and older, according to the American Cancer Society.
Who needs early testing — and when
People with a greater than average risk of colorectal cancer should talk with their doctors about getting earlier or more frequent screenings.
Anyone with a first-degree relative — meaning a parent, sibling or child — diagnosed with colorectal cancer may need earlier screening, according to the American Society of Colon and Rectal Surgeons.
The American College of Gastroenterology recommends that African-Americans start routine screening at age 45 because they tend to be diagnosed with colorectal cancer at a younger age and with decreased survival rates as compared to other ethnic groups.
People are considered at higher risk for colorectal cancer if they have:
- Personal history of colorectal cancer or certain types of polyps.
- Family history of colorectal cancer.
- Personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease).
- Family history of a hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome.
- Personal history of getting radiation to the abdomen or pelvic area to treat a prior cancer.
While screenings in older adults have contributed to the overall decline of colorectal cancer, it’s still the fourth most commonly diagnosed cancer among adults in the U.S., according to the National Cancer Institute.
The screening options outlined by the American Cancer Society are either a visual exam, such as a colonoscopy, or a high-sensitivity stool-based test. All types of screening tests are effective at finding colorectal cancer, the organization says, and the best test is the one that patients do on time.
The American Cancer Society recommends choosing from the following screening options, based on a conversation with a physician:
- Colonoscopy every 10 years.
- CT colonography every five years.
- Flexible sigmoidoscopy every five years.
- Fecal immunochemical test (FIT) every year.
- High‐sensitivity, guaiac‐based fecal occult blood test every year.
- Multitarget stool DNA test every three years.
Know the warning signs
In addition to getting tested, Hayden believes that people need to be more aware of the symptoms of colorectal cancer.
According to the American Cancer Society, colorectal cancer symptoms include:
- Rectal bleeding.
- Blood in stool.
- Sudden, unexplained weight loss.
- Persistent abdominal pain.
- The urge to empty your bowels but nothing passes.
- Narrow stools.
Hayden encourages patients with symptoms that continue over several weeks to be evaluated by their physician and get a colonoscopy.
“Pay attention to symptoms and seek advice,” she says. “If the symptoms are persistent and you feel that they weren’t evaluated, then see a gastroenterologist or a colorectal surgeon and get a colonoscopy. You have to be an advocate for yourself.”
While rising colorectal cancer rates in young people are a concern, Ena Mahapatra, MD, director of the colon cancer screening clinic at John H. Stroger Jr. Hospital in Chicago, says the disease is more prevalent among older people.
Of the nearly 2,000 patients Stroger Hospital treated for colorectal cancer between 2000 and 2018, 75% of patients were age 50 to 75, while 9% were age 75 to 90, 8% were age 45 to 49, 7% were age 30 to 44, and 1% were age 15 to 29.
“We should be focusing on getting the population that has substantial risk of colon cancer and death screened,” Mahapatra says.
While researchers investigate what might be leading to an increase in colorectal cancer among young people, physicians recommend trying to live as healthy and active a lifestyle as possible.
“Pay attention to symptoms,” Hayden adds, “and seek advice.”