Colorectal Cancer is on the Rise in Young Adults

colorectal cancer © Sebastian Kaulitzki - stock.adobe.com

Colorectal cancer is a common and often deadly disease of the colon and rectum. Despite the stabilization of cases in adults over the age of 50, rates are on the rise in people under the age of 50 and have been increasing by 1% annually since the year 2000, according to Aparna Parikh, M.D., an oncologist at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School. It is now the deadliest cancer for men and the second deadliest cancer for women, second only to breast cancer. About 55,010 people will die from it this year, the American Cancer Society estimates.

“I think these younger patients have really unique challenges,” Parikh said in an interview with Managed Healthcare Executive. “Many of my patients have young children. We see a lot of 20- and 30-year-olds who are just starting to get their lives going and in the prime of their life in terms of earning potential.”

Researchers from the International Agency for Research on Cancer, which is part of the World Health Organization, reported global cancer statistics this week in the CA: A Cancer Journal for Clinicians. According to their report, in 2022, there were an estimated 1.9 million new cases of colorectal cancer and 904,000 deaths.

These types of cases are not just occurring in the United States.

“We’re definitely seeing this trend described now across the world - certainly in Europe, certain parts of South America and even in smaller parts of Africa and India,” Parikh said.

The disease’s increasing incidence among younger people is leaving professionals baffled.

Experts aren’t sure exactly why it develops, but there a variety of risk factors that include excessive drinking, smoking, obesity and poor diet, the CDC reports.

“We know red meat and a heavy diet certainly are risk factors for colorectal cancer,” Parikh said. “Plant-based Mediterranean diets generally seem to be protective on gut health.”

Upward case trends in developing countries like Southeast Asia and Eastern Europe may be attributed to the lack of access and cost of screening options, the report in CA: A Cancer Journal for Physicians reads.

A family history of colorectal cancer is also a risk factor. About 1 in 3 those diagnosed with colorectal cancer have a family member who has had the disease. Now, though, more cases are occurring in people with no family history of colorectal cancer.

“Primary care doctors don’t think of colorectal cancer in younger patients who are commonly diagnosed instead with inflammatory bowel disease,” UC Davis Comprehensive Cancer Center oncologist Rashmi Verma, said in a story published by UC Davis Health in March. “If an at-home test is prescribed and results come back negative, but symptoms continue, tell your doctor you want a colonoscopy.”

One thing is certain: Most colorectal cancer comes on slowly. It develops over years, starting as a polyp, sometimes taking up to a decade to turn into cancer.

According to Parikh’s research, there are several signs to look out for, with varying degrees of prevalence:

• A change in bowel habits (74%)
• Rectal bleeding combined with bowel habit change (71%)
• Rectal mass (24.5%)

The influx of younger and younger patients has caused the American Cancer Society to change their recommended screening age to 45. If someone has a first-degree family member with a diagnosis, the recommended screening age is 10 years prior to their diagnosis, Parikh said. Standard screening can include a blood test or a yearly stool sample test.

“If you're having any change in bowel symptoms or blood in your stool, that's no longer a screening. Those are symptoms and you go straight to the colonoscopy,” Parikh said. “But if you're having no symptoms that are consistent — no weight loss, no changes in your stool patterns, no abdominal pain and no blood in your stools — then you're eligible for a standard screening.”

After a cancer diagnosis, particularly in a young person, Parikh and her colleagues work with a team of social workers that specialize in working with families with young children. Financial planners are also involved in helping the patients plan for the costs of their care and end-of-life expenses. Patients who had planned on having children before their diagnosis may be connected to an IVF specialist to preserve their eggs, due to the potential damage caused to their reproductive organs during radiation treatment.

“It's not just the disease, it's all the things that the disease impacts,” Parikh said.