Colorectal cancer (cancers of the colon and rectum) is now the leading cause of cancer death in the United States for both men and women under the age of 50. In 2018, the American Cancer Society changed their screening recommendation from age 50 to 45 because of the alarming increase in early-onset colorectal cancer (affecting those under 50 years old).
A recent study published in the Journal of the American Medical Association (JAMA) reported that colorectal cancer mortality has risen 1 percent annually since 2005, an increase that has now placed colorectal cancer as the No. 1 cause of cancer mortality in young adults. Experts don’t know why more younger people are getting colorectal cancer, but it’s clear that early-onset colorectal cancer is an important public health issue.
Pascale White, MD, MBA, MS, FACG
In this Q&A, Pascale White, MD, MBA, MS, FACG, Director of Health Equity in Action for Liver and Digestive Diseases (HEALD), and Associate Professor of Medicine (Gastroenterology and Liver Disease), Icahn School of Medicine at Mount Sinai, discusses warning signs younger people should look out for and when to see a doctor.
Why are many people in their 20s and 30s going undiagnosed with colorectal cancer?
Many young people may not have primary care doctors or are ignoring their symptoms. They may go to an urgent care center for strep throat or the flu but may be too embarrassed to discuss symptoms like rectal bleeding and may not be thinking they could have colorectal cancer. Regardless of how old you are, you should never ignore symptoms and should seek medical attention. Having a primary care doctor who could start a timely workup of the symptoms and make a referral to a gastroenterologist is critical to making the diagnosis early. The earlier colorectal cancer is diagnosed, the greater your chances are for survival.
Unfortunately, we are seeing that younger patients are being diagnosed with advanced stage colorectal cancer (stages III and IV). A majority of cases are occurring in the rectum and the distal (left) colon, which can present as rectal bleeding. That is why it is important not to delay seeing the doctor.
What increases my risks as a younger person?
While scientists do not have the exact answers, lifestyle and environmental factors are being investigated. Some studies have linked risk factors for early-onset colorectal cancer to obesity and alcohol intake. Note that these are similar risk factors for older adults too. Other risk factors include having a family history of colorectal cancer or having a hereditary condition like Lynch syndrome; not getting enough physical activity; using tobacco and eating a low-fiber diet high in processed foods.
Are certain groups more at risk than others?
Early-onset colorectal cancer is increasing in both men and women, but racial disparities exist. Although incidence among non-Hispanic white patients has shown a consistent increase, Black patients still have the highest overall incidence and lowest survival rates.
What type of family history puts me at risk?
The majority of young people who are getting early-onset colorectal cancer don’t have a family history of cancer. That said, any family history of colorectal cancer could be relevant. Knowing first-degree family history (mom/dad/brother/sister) helps your doctor determine if there is a higher risk. However, second-degree family history (aunts/uncles/grandparents/grandchildren/half siblings/nieces and nephews) can help spot potential patterns that might put you at risk. Mount Sinai has genetic counselors that can help identify these patterns.
What symptoms indicate that younger people should see a doctor?
A majority of younger people who are coming to see the doctor with early-onset colorectal cancer are symptomatic, and the most common symptoms are blood in stool and abdominal pain. Other symptoms include iron deficiency anemia, unintentional weight loss, and a change in bowel habits. Young people need to understand seeing blood in the stool (whether it is bright red blood or black stool) should not be ignored. Bleeding could be caused by something benign like hemorrhoids or something malignant like colorectal cancer. If you experience these symptoms, see a doctor as soon as possible. If colorectal cancer is caught early, your chances of survival are higher.
How can I reduce my risk?
Some things may not be in your complete control. For example, we are investigating whether there are certain environmental exposures that put younger people at risk. That said, there are actions you can take regardless of age that reduce overall risk for colorectal cancer. These include eating a well-balanced diet of high-fiber foods (fruits, vegetables, nuts, legumes, and whole grains); reducing your intake of processed foods, especially processed meat; reducing alcohol intake; getting regular exercise; and monitoring any health conditions you have, such as diabetes and obesity.
What is a colonoscopy?
A colonoscopy is a safe and effective procedure where a doctor uses a camera to examine the lining of the colon and rectum for growths called polyps and/or other abnormalities, including colorectal cancer. During the examination, you are given some sedation to keep you comfortable. If polyps are found, they are removed and sent to a pathologist for evaluation. Some polyps are benign while others could be precancerous. The type of polyps removed will determine when the colonoscopy should be repeated in the future.
Will my insurance cover it?
Insurance companies cover colonoscopies for people who are 45 years and older for screening colonoscopies. A screening colonoscopy is what the procedure is called when it is being done on a patient who has no symptoms. If you are under age 45 but are experiencing symptoms, you would be sent for a diagnostic colonoscopy because the procedure is being done to find the diagnosis that would explain the symptoms. In either case, we encourage patients to communicate with their insurance company prior to procedures to ensure they will cover the cost.
How can I get a colonoscopy if I don’t have insurance?
Call your health provider to see what resources may be available for free or low-cost colonoscopies. They can help navigate patients to centers that accommodate people who do not have insurance.