March is National Colorectal Cancer Awareness Month.
Colorectal cancer was once considered rare in young people, but today one in five diagnoses occurs in people under 55. These diagnoses, called “early-onset colorectal cancer” or “young-onset colorectal cancer,” refer to colorectal cancer that occurs in people under 50 years of age.
Rates are rising so quickly that first colonoscopies are now recommended at age 45, five years earlier than before.
We have with Dr. Laura Van Meter Baum, a medical oncologist at the Dana-Farber Cancer Institute, spoke to learn more about this worrying trend.
Do we know why colon cancer diagnoses are increasing among young people?
Since the 1950s, there has been an increase in colon cancer rates among young people worldwide. We have identified some risk factors, but they do not fully explain the increase. Several factors are likely at play, including lifestyle and dietary habits, as well as environmental and other factors that may affect your health. Because we know that lifestyle and dietary habits play a role in increasing your risk, it is important to remember that we can control these risks. Diets high in processed and highly processed foods and low in fiber, obesity, physical inactivity, smoking and alcohol consumption contribute to all types of health problems, including colon cancer.
Are there differences in symptoms and survival rate between early and advanced colorectal cancer?
There are not necessarily different symptoms of the cancer itself, but younger people are less likely to undergo colon cancer screening, so they are more likely to be symptomatic at the time of diagnosis. Symptoms such as abdominal pain, weight loss, iron deficiency anemia or changes in bowel habits can be signs of colon cancer. Additionally, younger people are at higher risk of developing cancer in the rectum or the left side of the colon. Therefore, they are also more likely to have bright red blood in their stool, which is more common in rectal and left-sided tumors. As far as survival rates go, this is surprisingly controversial. Patients with early colorectal cancer are more likely to have more advanced cancer and therefore have a higher mortality rate. About 7 in 10 younger people receive the diagnosis at an advanced stage, compared to 6 in 10 people who receive the diagnosis after age 50. At each stage, however, some recent studies suggest that survival rates are better for younger people than for those diagnosed late because they receive more intensive therapies. However, other studies show no difference or even worse survival rates. We find that very young patients, those under 30 or 35, generally do worse.
Do you see certain mutations more frequently in early-stage colon cancer?
While 10% of colorectal cancers diagnosed after age 50 are caused by inherited genetic mutations (also known as “germline mutations”), we have found that genes play a larger role in early-onset colorectal cancer. Approximately 15-30% of early-onset colorectal cancers are associated with inherited genetic mutations that cause familial cancer syndromes. Lynch syndrome is the most common of these, but there are other genetic syndromes that contribute to this risk. We are also finding more new mutations in tumors from people suffering from early-stage colon cancer. These mutations, called “somatic mutations,” are mutations in the tumor itself and not in the patient’s genetics. In general, patients with early-stage cancer have different types of mutations than older patients, which may affect their outcomes.
Watch: Understanding Lynch Syndrome: What Women Need to Know >>
What types of treatment are most commonly used for early-stage colon cancer?
Treatment usually includes a combination of surgery, chemotherapy and radiation. Another treatment option is immunotherapy, which fights cancer by targeting gene mutations if applicable to the diagnosis.
I said earlier that people who are diagnosed younger tend to receive more aggressive treatment, but that is not always the case. It also partly depends on the cancer, where it is located and how aggressive the cancer is. It also depends on how well the patient copes with the treatment.
Is there a difference in treatment between a 45-year-old and a 68-year-old person if both are otherwise healthy?
No. However, if the patient has other health problems or cannot cope with certain therapies, we adapt the treatment to the patient’s needs. In general, younger patients are more likely to tolerate and receive a range of treatments.
Can younger people do something to protect themselves from colon cancer?
A healthy lifestyle helps, but it’s important to remember that we don’t really have control over whether we get cancer. We have seen many younger patients who are triathletes and are doing everything right. I recommend eating a high-fiber, healthy diet, exercising, quitting smoking, and drinking less alcohol. I think awareness helps too.
It is important to know that colon cancer is not just a type of cancer that affects people over 50. Younger people should talk to their doctor if they have possible symptoms or changes in their bowel habits.
Super important point: When it comes to colon cancer, screening is actually a prevention tool. During a colonoscopy, the doctor not only examines cancer, but can also detect and remove polyps before they become cancerous.
Read: Your Guide to Colon Cancer Screening Tests >>
Are there additional considerations regarding side effects and treatment outcomes in younger adults with colorectal cancer?
Colorectal cancer is different in younger people, especially because they are at different stages of life before age 50. Treatment may need to consider fertility issues if the patient wants to become pregnant, especially if she requires radiation. If you have young children, you may face more stressful parenting issues during cancer treatment.
Relationship problems can be different for younger people. For example, if they need a permanent ostomy bag, they may be very emotional about it when dating or early in a relationship or marriage. Cancer impacts school and career and can have a major financial impact. Dealing with colon cancer at a young age can be a real setback: emotionally, physically and financially. Of course we try to help and support people.
The treatment is also getting better. Colon cancer is not easy, but the earlier it is diagnosed, the more options you have and the more likely you are to be cured.
This educational resource was created with support from Merck and Takeda.
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