Colon and rectal cancer are among the leading cause of cancer deaths in men and women in the US, with cases on the rise in young adults.Actor Chadwick Boseman died of colon cancer Friday at age 43 after battling the disease for years. Medical experts have said colorectal cancer cases among younger people are going up — with cases among those under 50 increasing since the 1990s, according to a March report by the American Cancer Society. Half of all new diagnoses are in people age 66 and younger, the report said.The American Cancer Society recommends regular screening for colon and rectal cancer starts at age 45. Other health organizations in the United States still recommend routine screening starting at age 50.
The median age is going down
In the report, the American Cancer Society found that the median age for people diagnosed with colorectal cancer was 72 in 1989. It stayed that way until the early 2000s and then fell to 66 by 2016.ACS researchers found that the rate at which people are diagnosed with colorectal cancer in the United States is dropping among those 65 and older but rising in younger adults.Scientists knew cases of colorectal cancer was going up in younger age groups. “But we were surprised by how fast it is happening,” said Rebecca Siegel, study co-author and scientific director of surveillance research at the American Cancer Society in Atlanta.”This report is very important because it not only provides a snapshot of the current colorectal cancer burden, but also a window to the future,” she said, adding that if the increases in younger adults continue, “doctors should be aware of the unique challenges in this patient population — such as the need for the preservation of fertility and sexual function, as well as the risk of long-term treatment effects because of their extended life expectancy.”
The obesity epidemic could be a factor
The report included data on colorectal cancer cases and deaths from the National Cancer Institute and the US Centers for Disease Control and Prevention, among others.
Based on an analysis of the data, researchers found colorectal cancer cases among people younger than 50 have been increasing since the mid-1990s. From 2012 to 2016, incidence rates among that age group rose by 2.2% annually and included tumors found in both the colon and the rectum, the study found. Among adults ages 50 to 64, researchers found that colorectal cancer incidence declined during the 2000s, then reversed course and rose by 1% annually between 2011 and 2016. Among adults ages 65 and older, the study found that a rapid decline in colorectal cancer incidence persisted during the 2000s and that rates fell by 3.3% annually from 2011 to 2016.
“Much of the decline in incidence in older aged adults is because of increased screening, but the cause for rising incidence in younger age groups is still unknown,” Siegel said. “The obesity epidemic is probably contributing, but doesn’t seem to be the sole cause,” she said. “Diet has a large influence on colorectal cancer risk and there is a lot of research going on looking at how different things we consume, including drugs such as antibiotics, influence gut health, specifically their role in determining the microorganisms that make up our microbiome.”
Doctors should follow up with younger patients
The review also revealed trends in colorectal cancer deaths and determined future projections for the disease. Except for several types of skin cancer, colorectal cancer is the third leading cause of cancer death among men and women in the United States.The analysis found from 2008-2017 colorectal cancer death rates dropped by 3% annually in adults 65 and older and by 0.6% annually in adults ages 50 to 64 — but the rates jumped by 1.3% a year in adults younger than 50. The report also found that “striking disparities” by race and geography persist, with mortality rates among Alaska Natives almost three times higher than those in whites and about double those in blacks. As for incidence, during 2012 through 2016, rates ranged from 30 cases per 100,000 people among Asian/Pacific Islanders and 38.6 in Whites to 45.7 in Blacks and 89 in Alaska Natives, according to the data.
There were limitations in the research and scientists were unable to determine exactly why certain declines or increases in colorectal cancer occurred among various age groups.Yet researchers were able to make some projections in future trends, predicting an estimated 53,200 colorectal cancer deaths in 2020 with an estimated 7%, or 3,640 deaths, in adults younger than 50.The analysis also projected 147,950 newly diagnosed cases of colorectal cancer in the US this year with about 12%, or 17,930 cases, diagnosed in adults younger than 50.The analysis may “build more consensus for beginning to screen before age 50,” Siegel said.”In addition, this should be a wake-up call for clinicians to be better about timely follow-up of younger patients who present with symptoms” of colorectal cancer, she said.