March is colorectal cancer awareness month. Many people under 55 don’t have colonoscopies or rectal exams on their radar. The truth is, they should. Doctors across the U.S. have reported seeing younger patients with advanced colorectal cancer more often. According to the American Cancer Society’s latest colorectal cancer report, 1 in 5 new cases are among those in their early 50s or younger. The report also revealed that colorectal cases among adults under 55 increased from 11% in 1995 to 20% in 2019. These numbers have caused researchers at Yale University to encourage people as young as 20 to be aware of the warning signs and to talk to their doctor if they recognize changes in their bowel movements or other suspicious symptoms. There’s a shift occurring in colorectal cancer diagnoses. The question is, are patients and providers aware of the shift?
While the recommendation has always been to begin colonoscopies at age 50, advanced colorectal cases have been on the rise in younger adults: Chadwick Boseman, known for his role in Black Panther, died from colon cancer in 2020 at age 43; Broadway actor Quentin Oliver Lee died from Stage IV colon cancer in 2022. The bottom line is that colorectal cancer depends largely on a patient’s family history and demographics. Incidences of colorectal cancer don’t magically spike once people hit their 50th birthday. Despite large-scale efforts to educate the public on the importance of colorectal cancer screenings, many people still express anxiety about the screening procedure.
Anxieties about Colorectal Cancer Screenings
Many people express the following three anxieties as their reason for not getting a screening:
- I have no family history of colorectal cancer. The American Cancer Society (ACS) recommends that all individuals (regardless of risk) get screened for colorectal cancer. The National Foundation for Cancer Research states, "Unlike many other forms of cancer, only a very small percentage of colorectal cancers are associated with inherited genes.” Colorectal cancer can affect anyone, regardless of family history.
- I can’t afford the procedure. Most insurance companies should cover screening for people aged 50 and older. People under 45 considering colorectal cancer screening under the new ACS guidelines should talk with their doctor and insurer to discuss test coverage. If uninsured, a preventive screening will prevent a patient from developing colorectal cancer later in life. Cancer treatment is much more expensive than screening, and providers have worked to ensure that screenings are cost-effective.
- I heard that colonoscopies are the only way to get screened. Colonoscopies hurt. While screening is typically done via a colonoscopy, alternative screening methods exist. Providers should discuss alternative methods with patients who are anxious about a colonoscopy. While a colonoscopy may sound painful to some individuals, using a thin tube to check for polyps in the colon is usually relatively painless. Almost all colonoscopies in the United States are performed with patients under a level of sedation or anesthesia that prevents them from feeling anything. The procedure is often completed before the patient is even aware it has been conducted.
A colonoscopy is the most common colorectal cancer screening procedure. When appropriate, providers should talk about alternative screening methods with patients who are nervous about getting a colonoscopy.
Encouraging Patients Under 50 to Be Alert and Screen
While incidences of colorectal cancer in individuals over 65 are declining, some providers are still recommending that these individuals continue screening until 75. Colorectal cancer is the second most common cause of cancer death in the United States, and it is the leading cause of cancer-related deaths in men under 50. ACS researchers analyzed data from the National Cancer Institute and the US Centers for Disease Control and Prevention on cancer screenings, cases, and deaths. Researchers found that from 2011 through 2019, colorectal cancer rates increased by 1.9% each year in people younger than 55. Though colorectal cancer death rates fell by 57% between 1970 and 2020, among people younger than 50, death rates have continued to climb by 1% annually since 2004, an overall increase of 19%.
Colorectal cancer is the second most common cause of cancer death in the United States, and it is the leading cause of cancer-related deaths in men under 50.
Since 1995, rates of advanced disease have increased by about 3% annually in people under 50. In 2023, it’s predicted that 19,550 diagnoses and 3,550 deaths from colorectal cancer will occur in people under 50, according to an early 2023 ACS report. A larger uptake in colorectal cancer diagnoses, screenings, and deaths among patients under 50, caused the US Preventive Services Task Force and the US Multisociety Task Force on Colorectal Cancer, both of which provide preventive guidelines, to recommend in 2021 that the age for colorectal cancer screenings be reduced to age 45. They also recommended that screenings continue periodically until age 75. This change in screening guidelines represents a passion and dedication among providers to educate people on colorectal cancer symptoms and treatment at a younger age so that cancers are detected earlier when they are more treatable.
While it’s hard to find an exact reason for the rise of colorectal cancer incidences in younger adults, various lifestyle factors can affect a person’s risk. A sedentary lifestyle, obesity, smoking, heavy alcohol use, and even low-fiber/high-fat diets increase a patient’s risk of colorectal cancer. Providers who encounter patients with a family history of colorectal cancer are encouraged to move the screening age from 45 to 40 (or, as the ACS recommends, 10 years before the age a patient’s family member was diagnosed with colorectal cancer).
Regardless of when a patient starts screening, though, it’s important that providers educate them on the warning signs and symptoms. Providers whose patients experience the following symptoms should recommend a follow-up appointment:
- Rectal bleeding
- Unusual stools
- Low energy or tiredness
- Changes in bowel movements
Being proactive is key in preventing colorectal cancer. It is a good idea for providers to advise patients not to assume they are healthy. If they notice anything unusual, they should schedule an appointment.
For more useful information on colorectal cancer, visit the CDC’s colorectal cancer resource page.
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