Colorectal cancer incidence is rising among young adults

April 12, 2022

In 2020, the death of Hollywood’s rising star, Chadwick Boseman from colon cancer at the age of 43 shocked the world. We learned that he was diagnosed with stage 3 colon cancer when he was just 39 years old, and the cancer progressed to stage 4, eventually.

Since 1994, the incidence of colorectal cancer (cancer of colon and rectum) in young adults has steadily been rising, and as of 2016, colorectal cancer has become the leading cause of cancer death in the people under 50. On the other hand, the incidence of colorectal cancer in people over 50 has been rapidly decreased thanks to the regular colonoscopy. For this reason, many medical organizations now recommend starting the screening of colorectal cancer at age 45 instead of 50.

Recently, researchers at the Icahn School of Medicine at Mount Sinai published the first large-scale, nation-wide study to confirm the rising incidence of colorectal cancer and precancerous polyps in patients under age 50 (1). The team analyzed the colonoscopy data collected from 131,000 patients ages 40 - 49 between January 2014 and February 2021. These patients represent different ethnic/racial groups who received colonoscopy at 123 different ambulatory endoscopy centers across 29 states in the US. About 32% of the patients aged 45 - 49 had precancerous and cancerous lesions or polyps. Almost 8 % of them had advanced premalignant lesions or polyps (APLs), about 0.58% of them had colorectal cancer. These rates are similar to those who are over age 50, but the rate of colorectal cancer is even higher in the patients aged 45-49 compared to that of people aged 50 or older.

These results confirm the urgency of beginning colorectal cancer screening before age 50.

The cause of the rise of colorectal cancer incidence in young adults is unknown. However, given that obesity, sedentary lifestyle and smoking are the main causes of colorectal cancer in people over 50, the high rate of overweight and obesity in young adults might be one of the causes of rising early-onset colorectal cancer. Others have suggested that unhealthy diet, changes in gut bacteria (microbiome) (perhaps due to unhealthy diet), inflammation or pollution might be the causes of the early-onset disease.

It is alarming to see the rise of colorectal cancer incidence and death rate, but colorectal cancer is one of the most preventable cancers. Awareness of risks of colorectal cancer and routine and timely screening at any age will be the keys to prevent colorectal cancer. If you experience one or more symptoms such as changes in bowel habits, blood in stool (maroon colored or black stool), rectal bleeding, abdominal pain, fatigue, or unexplained weight loss (2), please make an appointment with your doctor as soon as possible!

Sources

Trivedi, P.D. et al., Prevalence and Predictors of Young-Onset Colorectal Neoplasia: Insights from a Nationally Representative Colonoscopy Registry., Gastroenterology, 162:1136-46, 2022
www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669