Doctors are starting to see too many people diagnosed with colon cancer before the usual first screening at the age of 50. Here's what you should know about colon cancer in young adults.
Joe Gransden was in the prime of his life. The Atlanta jazz musician’s career was blossoming. He was in good shape. He felt fine and, like many younger people, he wasn’t seeing a doctor regularly.
He was far from alone: Colon cancer is increasingly turning up among young adults. According to a study published in JAMA Surgery, more than one in 10 colon cancers, and nearly one in four rectal cancers, will be diagnosed in people younger than the usual first screening age of 50.
“This is an important moment in cancer prevention,” says principal investigator George J. Chang, MD, MS, an associate professor at the University of Texas MD Anderson Cancer Center. “We’re observing the potential real impact of CRC (colorectal cancer) among young people if no changes are made in public education and prevention efforts. This is the moment to reverse this alarming trend.”
The answer to why this is happening is more elusive, but the MD Anderson Cancer Center says a lack of screening among younger people and risk factors – including obesity, an unhealthy diet, and sloth – are “known contributors.” This trend is made more puzzling because, overall, rates of colon and rectal cancers have been dropping in the U.S. for years.
An increase in screening that really gained steam in the 1980s partly explains the overall decline. Also playing a role: public awareness campaigns – aimed at the middle aged and older – have taught us just how deadly colon cancer is when it’s not caught early.
Screenings find growths, called polyps, on the intestinal wall. They can be pre-cancerous. Doctors can remove polyps during colonoscopies. People 50 and over with average risk should have colon cancer tests every 5 and 10 years. People with a family history of colon cancer, and those who have had polyps, need screenings more often.
One of the reasons behind the increase in younger people, besides their relative lack of screening and awareness, may be that colorectal cancer is variable, Chang says. There are several types of colon cancer, and causes may be different in younger people. More research is needed to find better answers, he believes.
Like Gransden, Emily Collins was young, 31, when she was diagnosed with colon cancer in 2001. Doctors found a large tumor, which went against the grain of Collins’ self-report that she felt “perfectly healthy.” Despite how she felt, she had advanced-stage colon cancer, which made it more deadly than if she were diagnosed earlier – through a routine screening.
Colon cancer is often found in its late stages because it’s masked by symptoms that are mistaken for “other medical issues,” according to Charlie Fuchs, MD, MPH, director of the Gastrointestinal Cancer Center at the Dana-Farber Cancer Institute. What's worse, there often are no symptoms in the early stages of colon cancer. When they do appear, symptoms can include blood in your stool, changes in bowel habits, and abdominal discomfort.
“These symptoms can arise for reasons totally unrelated to cancer, so one shouldn’t conclude that if you have any of those symptoms that you have colon cancer,” Fuchs said. “But you should bring it to the attention of your primary physician, who can make an assessment and decide if any further evaluation is required.”
Collins underwent months of debilitating chemotherapy, radiation, and major surgery.
Like Collins, Gransden’s diagnosis was practically an accident. At 35, he wasn’t concerned about the few symptoms he did have. But his wife urged him to see a doctor. The end result was 18 hours of surgery for stage 2 colon cancer. He then underwent a round of chemotherapy as a precaution. Today, eight years later, he remains in remission.
Gransden’s lesson: take any symptoms, however small, seriously, and see a doctor as soon as you notice them. A simple colonoscopy could save your life. Besides, you’re virtually out like a light through the whole thing, and the type of anesthesia used during the procedure has a built-in memory wipe.
The bottom line, experts warn, is that people far younger than 50 should take better care of themselves because it’s almost certain that lifestyle – and, perhaps, environmental factors – play a role in the development of colon cancer.
March 30, 2020
Christopher Nystuen, MD, MBA