Colorectal cancer (cancers of the colon and rectum) is rising globally among people under 50 years old, prompting the American Cancer Society in 2018 to change their screening recommendation from age 50 to 45. While rates are also rising among those in their 20s and 30s, colorectal cancer is still less common among this age group.
Pascale White, MD, MBA, MS, FACG
Experts don’t know why more younger people are getting colorectal cancer, but it’s clear that early-onset colorectal cancer (affecting those under 50 years old) is becoming an important public health issue. In this Q&A, Pascale White, MD, MBA, MS, FACG, Director of the Gastroenterology Clinic, and Associate Professor of Medicine (Gastroenterology), 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 don’t have primary care doctors or are ignoring their symptoms until they already have late-stage colorectal cancer. They may go to an urgent care center for strep throat or the flu, but they are ignoring important symptoms like rectal bleeding. They think they are too young to have cancer or are embarrassed. Regardless of how old you are, you should have a relationship with a primary care doctor who knows you and your patterns, who will be able to tell if something is wrong.
What increases my risks as a younger person?
Some of the risk factors for younger people are the same as those who are older. These include having a family history of colorectal cancer or having a hereditary condition like Lynch syndrome; being obese; not getting enough physical activity; using alcohol and tobacco, which have both been shown to be independent risk factors for colorectal cancer; and eating a low-fiber diet high in processed meat.
Are certain groups more at risk than others?
Early-onset colorectal cancer is increasing in both men and women; the most significant increase is occurring among non-Hispanic white patients. However, there are racial disparities that exist in early-onset colorectal cancer. Studies have shown that young Black patients have overall worse 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 people who are coming to see the doctor with early-onset colorectal cancer are symptomatic, and a majority of symptoms are blood in stool and abdominal or rectal pain. Other symptoms include unintentional weight loss, changes in bowel habits, diarrhea, and iron deficiency anemia. 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; 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 the 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