Lately, everyone is speculating about the rising incidence of colon cancer. Speaking as a gastroenterologist, it's true that the alarm is on in our field.
But what exactly do we mean when we say the disease is on the rise, and why?
The past few decades have seen astonishing progress, but the reality is emerging that this progress is becoming more and more disparate across age groups. Incidence and mortality is declining in adults over 65, but more people under 65 are being diagnosed with and dying from colorectal cancer. It's the second most common cause of cancer death in all age groups, but it is the most common cause of cancer death for people under 50.
We're finding that, unlike most other diseases, youth isn't on your side when it comes to assessing your risk.
If you were born in the 1990s, your overall risk for colorectal cancer is 50% higher than people who were born before that time—regardless of hereditary and genetic factors. Rates of colon cancer among people aged 20 to 39 are projected to increase by 90% percent by 2030.
This trend is not well understood, even among doctors and researchers. Diet, environmental factors, activity level, alcohol and tobacco use, and other factors have all been linked to colon cancer, but do not explain the uptick in younger people while older people face better prospects than ever before.
What we do understand is that there are layers of protection we possess in the fight against colon cancer mortality, and we need to be using them fully. One thing that can partially explain why older people may face better outcomes is their eligibility and stronger adherence to regular screening, when you're most likely to catch it at an early or even precancerous stage. Among those diagnosed under age 50, roughly three-quarters are diagnosed when the disease reaches a late stage.
In response to this health crisis, the American Cancer Society and the U.S. Preventive Services Task Force recommends that adults with no additional risk factors should begin receiving regular screenings at age 45. During a colonoscopy, doctors check for abnormalities in colon and rectal tissue; they can also identify polyps in a precancerous state, the main cause of colon cancer. With regular screening, many cases of colorectal cancer are preventable, and can be caught before reaching even Stage 1.
It's true the preparation is not the most pleasant experience, but once you're in for the procedure, it's over before you know it. For eligible patients, stool DNA tests are a reliable first line of defense that offer a little less intimidation.
Unfortunately, greater rates of colon cancer in young people, while still rare, may be the new norm. So as we move ahead, we have to ensure that public health measures to combat the effects of this trend are also the new norm.
Start getting tested regularly at 45. If you are aware of a relative who was diagnosed with colorectal cancer, especially before age 65, talk to your doctor about whether you need to begin screening at a younger age. If you have a positive stool test, get a timely colonoscopy to receive more definitive results.
Decrease your risk by minimizing alcohol consumption, ceasing tobacco use, maintaining a healthy BMI, exercising regularly, consuming minimal processed and red meats, and eating a diet rich in fruits, vegetables, and high-fiber foods.
Know the signs that could indicate colorectal cancer: abdominal pain, changes in bowel movements, blood in the stool, unexplained weight loss, iron-deficiency anemia and fatigue.
And if you've been diagnosed or fear you could have colon cancer, don't panic. Cancer treatments are more advanced than ever, and the majority of patients with this disease survive it. When caught at an early stage and with appropriate treatment, the survival rate is over 90%. Let's spread knowledge rather than fear, and make sure everyone is taking the steps needed to prevent colon cancer and catch it early.
Julie Yang, MD, FASGE, FACG, NYSGEF, is the director of Comprehensive Gastrointestinal Cancer Program at Maimonides Medical Center.
