While colon and rectal cancer rates are decreasing for adults 55 and older, they are rising sharply for adults in their 20s and 30s, according to a new study by the American Cancer Society, raising questions about whether screening should start earlier.
The study found that between the mid-1980s and 2013, colon cancer rates increased around 1.5 percent per year and rectal cancer rates rose 3 percent per year for those in their 20s and 30s. Rates also rose for those aged 40 to 54, but at a slower pace.
This translates to three in ten new cases of rectal cancer being diagnosed in people younger than 55 -- double the proportion in 1990 (1). Millennials in their 20s are twice as likely to develop colon cancer and four times as likely to develop rectal cancer, compared to 20 year olds in the 1970s.
Rebecca Siegel, who led the study, stated that the rates of the increase “was very shocking”. In response to the study, the American Cancer Society is reviewing its screening guidelines. Right now, adults are advised to get screened starting at age 50 (unless they have a family history of colorectal diseases) and repeating every 5-10 years depending on the results.
Colorectal cancer begins in the large intestine, or colon. It has been and will be one of the leading causes of death among cancers in United States, according to the American Cancer Society 2017 estimate: second highest for men and third highest for women.
There are no symptoms early on while the cancerous tumor is still small, so early detection is important to reduce risk. In light of the new data, following up on and getting a second opinion should symptoms appear, such as a persistent change in bowel habits and blood in stool, is all the more vital.
When that happens, the doctor may recommend getting tested. Recent technological advances have made this screening process more smooth and less invasive than the traditional colonoscopy. For example, Capsovision, a company founded in 2006, allows for non-invasive imaging of the gastrointestinal tract with a 360-imaging pill. Genetic testing can also determine one’s predisposition to colorectal cancers by comparing your genes with your family’s, searching for genes and syndromes, such as Lynch syndrome.
When one is tested positive, the patient then decides on treatment through surgery, radiation, chemotherapy, and/or medication. Surgery is most common in early stages, removing parts of the colon, fat, and lymph nodes; radiation therapy and chemotherapy are regular treatments used before, during, or after surgery or if surgery is not possible. Participating in a clinical trial may also provide effective treatment.
Some novel target therapy drugs are used as a complementary way to treat advanced colorectal cancer, typically when first and second-line treatments are no longer helpful. Lonsurf, an oral medication approved by FDA on September 2015, treats metastatic colorectal cancer, cancers that have spread to more than one organ. During the clinical trial, patients that took Lonsurf lived a median of 1.8 months longer. Treatment options such as these have helped make colon and rectal cancers less foreboding.
While the study confirms many doctors’ observations that they are treating younger and younger patients, the incidence of colorectal cancer in young adults remains very low -- 1 in 100,000 people in their 20s, compared to 50 in 100,000 in their early 60s (1). Still, doctors recommend patients to “push their doctors” -- as Dr. Nilofer Azad, an oncologist at Johns Hopkins Medical Center put it -- if symptoms persist.
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