What you need to know about colorectal cancer screenings and symptom monitoring.
In recent years, the rate of people under age 50 being diagnosed with colorectal cancer has increased, prompting a change in screening guidelines — and a need for increased vigilance. Physicians are encouraging patients to have conversations about their risk factors and any unexplained symptoms with their primary care provider.
“I noticed the rise early in my career, about 20 years ago,” said Dr. Cathy Eng, a gastrointestinal oncologist at Vanderbilt-Ingram Cancer Center. “I was seeing several young patients with Stage 4 metastatic disease, or advanced disease at presentation.”
Colorectal cancer in young adults
The incidence of this cancer has decreased overall, by about 1% each year, according to the American Cancer Society. Rates are probably going down because of increases in screening for colorectal cancer.
“The majority of cases that we see do not have a family history of colorectal cancer, so these are spontaneous cases.”
However, the decreased number of colorectal cancer cases has largely been among adults over age 50. For people younger than 50, rates have increased by more than 2% each year from 2012-2021. In 2019, 1 in 5 people diagnosed with this type of cancer were under age 50, up from 1 in 10 in 1995.
Researchers are investigating why colorectal cancer is on the rise in younger people, but as of right now, they do not have definitive answers. The trend highlights the importance of getting recommended screenings, knowing your risk factors (things that make it more likely that you will get cancer), and monitoring yourself for symptoms.
The importance of screenings
“People often put off screenings,” Eng said, “because it takes a lot of time to prep.” In addition to prepping for a colonoscopy, people need to find transportation to and from their appointment because they cannot drive themselves. They also need time to recover from the anesthesia.
“There is no standard body type or appearance of a young patient with colorectal cancer.”
Screenings are important not only for early detection of any cancer, but also prevention. Colonoscopies and sigmoidoscopies find polyps (precancerous growths), which doctors can typically remove during the procedure.
“Historically, colorectal cancer starts from a non-cancerous polyp,” Dr. Eng said, “and the non-cancerous polyp takes five to 10 years to develop to become cancerous.”
Other screening options include stool-based testing and imaging, such as CT colonography.
Screening recommendations
In 2021, the U.S. Preventive Services Task Force (USPSTF) changed screening guidelines. Previously, the task force recommended that people at average risk for colon cancer get their first screening at age 50. The revised guidelines recommend that people of average risk now start screenings at age 45, with later screenings every 10 years.
Understanding risk factors
People who are of average risk do not have the following: a personal history of colorectal cancer or polyps, a family history of colorectal cancer, a personal history of inflammatory bowel disease, a confirmed or suspected hereditary cancer syndrome, or a personal history of abdominal radiation for a prior cancer treatment.
If you have one of these concerns or develop unexplained gastrointestinal symptoms, your doctor may recommend earlier screenings.
For example, Eng said, “If you have a first-degree relative who was diagnosed at age 45, then you should be screened at 35, so 10 years earlier than their diagnosis.”
Eng recommends talking to your doctor about your risk factors. However, risk factors are only part of the equation.
“The majority of cases that we see do not have a family history of colorectal cancer,” she added, “so these are spontaneous cases.”
Eng emphasized that while some lifestyle factors, such as tobacco use, may make it more likely for someone to get cancer, colorectal cancer also occurs in people who live healthy lifestyles. She provided the example of seeing marathon runners in her clinic who have advanced stages of colorectal cancer. “There is no standard body type or appearance of a young patient with colorectal cancer,” she said.
Colorectal cancer symptoms
Monitoring yourself for symptoms is just as important as getting recommended screenings. If you experience any of the following symptoms that do not go away on their own, talk to your doctor:
- Changes in bowel habits
- Blood in your stool
- Urgency or pain while having a bowel movement
- Persistent abdominal cramping or discomfort
- Persistent hemorrhoids
- Unexplained weight loss
- Incidental findings of iron deficiency anemia (not attributed to the menstrual cycle)
“It’s really important to emphasize that people need to recognize the signs and symptoms early on,” Eng said, “so patients can be diagnosed at an earlier stage, as early diagnosis increases survival rates.”
Early detection saves lives
Getting checked for colorectal cancer is so important, because this common type of cancer does not have symptoms at first. Screenings can help detect cancer in its earlier stages, when treatment is most successful. Talk to your doctor about when you should get your first colonoscopy.
