What Young Adults Need to Know About Colorectal Cancer
Colorectal cancer is on the decline. Experts chalk that up to more people getting their regular colonoscopies, which can actually prevent precancerous polyps from becoming cancer.
But the disease is rising sharply in people ages 18 to 35, a population that is years away from getting their first screening colonoscopy. Colorectal cancer screening isn’t recommended until age 45 for most people.
“If the current trends continue, by 2030, colon cancer cases are projected to increase by 90% in patients under age 35, and rectal cancer cases are expected to increase by 124% in patients that age,” says Y. Nancy You, M.D. “In addition, about 60% of these young patients are diagnosed with stage III and IV colorectal cancer. That means their cancer is being found later when it’s harder to treat.”
We spoke to You about the rise in colorectal cancer cases in younger patients and what young people should know about their risk.
Why is colorectal cancer on the rise among young adults?
Unfortunately, we don’t know exactly why so many people under age 35 are being diagnosed with colorectal cancer.
What we do know is that nearly a third of colorectal cancer patients in that age group have an inherited genetic mutation that caused their cancer, compared to 3% to 5% of all patients. About 15% to 20% of colorectal cancer patients under age 35 have a family history of colorectal cancer or other cancers that indicate they may be at higher risk, compared to about 12% to 15% of all colorectal cancer patients.
So, we know that family history and genetics play a role in causing a good portion of colorectal cancers in these young adults, but we do not yet know exactly what is causing the disease in the remainder of the group.
What should everyone know about their family cancer history?
Knowing your family’s cancer history can provide you with very important clues about your own risk for colorectal cancer. Trace out three generations if possible. You want to know who had cancer and how you are related, what type or types of cancer they had and what age each person was diagnosed. Tracing all first- and second-degree relatives is best.
First-degree relatives are your birth parents, siblings and children. Second-degree relatives are aunts and uncles, nephews and nieces and grandparents.
Having a family history of cancer doesn’t mean you will get cancer. But this information lets you know if you should start screening early. The earlier cancer is detected, the easier it is to treat. And in the case of colonoscopy, we can actually prevent cancer by removing precancerous polyps or lesions before they become cancer.
What should younger colorectal cancer patients know about genetic counseling and testing?
Genetic counseling and testing are critical for any young person diagnosed with colorectal cancer. If a patient is diagnosed with an inheritable gene mutation or a hereditary cancer syndrome, like *Lynch syndrome, that gives us an explanation for why they developed colorectal cancer. That can help us tailor our treatment. It also helps us to look for and to prevent other cancers that the patient may be at risk for as a part of the same cancer syndrome.
And knowing if you have a genetic mutation is a signal to your family members that they should be tested as well. This is vital information for the whole family.
What colorectal cancer symptoms should people of all ages watch for?
Regardless of whether you have a family history of cancer, you should be familiar with your body and watch for colorectal cancer symptoms. Some symptoms may be subtle in younger patients.
Some of the symptoms to watch out for include:
Rectal bleeding with or without pain
Blood in the stool or toilet with or after a bowel movement
A change in bowel pattern
Bloating or full feeling or cramping
A change in the size or shape of stool
A new need for straining to evacuate stool
Weight loss without dieting
Fatigue or reduced exercise stamina compared to usual
Talking about some of these symptoms may feel embarrassing. If you have any of these symptoms or think you may have an inherited risk of colorectal cancer, have a conversation with your doctor about getting tested. Talk about poop. It’s OK!
How can people reduce their risk of colorectal cancer at any age?
It is never too early to start making healthy lifestyle choices to reduce your risk of colorectal and several other cancers. Here are some basics to get started:
Be physically active. Aim for at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week.
Limit red meat and avoid processed meat.
Eat a plant-based diet. Start by filling at least two-thirds of your plate with non-starchy vegetables and fruits. Filling the remaining one-third with lean animal protein or plant-based protein.
Limit alcohol.
If you smoke, stop. If you don’t smoke, don’t start.
Recommended colorectal cancer screening tests:
Finally, if your doctor thinks you should get a colonoscopy to screen for colorectal cancer, do it. It’s a very safe procedure. Men and women at average risk for colorectal cancer should get a screening colonoscopy every 10 years beginning at age 45.
While the colonoscopy prep is unpleasant for some patients, the good news is there are many varieties of prep now.
Getting a colonoscopy has huge benefits. It prevents cancer, and it prevents death. Research proves it.
Stool-based tests:
Highly sensitive fecal immunochemical test (FIT) every year
Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year
Multi-targeted stool DNA test (MT-sDNA) every 3 years
Visual exams:
Colonoscopy every 10 years
CT colonography (virtual colonoscopy) every 5 years
Flexible sigmoidoscopy (FSIG) every 5 years
It’s important that everyone talk to their health care provider about which tests might be good options. You should also check your insurance about payment for each test option.
These screening tests must be done at recommended time points to be effective. If you choose a test other than a colonoscopy, any abnormal test result must be followed up with a colonoscopy to see whether you have cancer.
*Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC), is the most common cause of hereditary colorectal (colon) cancer. People with Lynch syndrome are more likely to get colorectal cancer and other cancers, and at a younger age (before 50), including.