Incidence of Colorectal Cancer Rising in Young Adults

Colorectal cancer (CRC) is the second most common cause of cancer-related death in the United States and is the leading cause of death in men aged <50 years.¹ In recent years, the diagnosis of CRC has been shifting to a younger age and a more advanced stage.^1,2 In fact, 1 in 5 new cases of CRC occurs in people aged <50, and more individuals are diagnosed at an advanced stage now than in the mid-1990s before widespread screening.¹

Consensus is lacking as to why colorectal cancer is rising in younger adults,³ but contributing factors may include diet, gut bacteria, inflammation, environmental factors, and family history.^2-4 Research has shown that half of young adults with CRC have a chronic condition that causes inflammation in the gut, which can lead to mutations in DNA and promote cancer.² About 30% of patients with early onset CRC have a family history of CRC in ≥1 first-degree relative. Lynch syndrome is the most common hereditable forms of CRC and is often undiagnosed in affected people who are not aware that they are at a high risk for developing cancer.⁴ Most types of early-onset CRCs are sporadic and not attributable to germline alterations in cancer risk genes. Additional risk factors include sedentary lifestyle, being overweight or obese, smoking, and heavy alcohol use.³

In 2018, based on the increasing risk for CRC at younger ages, the American Cancer Society lowered the recommended age to begin screening in individuals with average risk from 50 to 45 years of age.^1,4 For individuals aged <45, colorectal cancer screening strategies are tailored based on their risk factors, an approach called precision screening.² Individuals with a family history of CRC are advised to begin screening by undergoing a colonoscopy at the age of 40 or at an age that is 10 years younger than the age of the family member with the earliest diagnosis.⁴

Various screening tests are available for detecting CRC, including stool tests such as fecal immunochemical testing (FIT) and multitarget DNA testing; visualization-based screenings include colonoscopy, sigmoidoscopy, and CT colonography.⁴ Individuals receiving a positive test result from a non-colonoscopy-based CRC screening test must receive a follow-up colonoscopy. Fecal occult blood testing has been replaced by FIT because it has a higher sensitivity for detecting CRC. This technique also only requires a single fecal sample, has a higher adherence rate, and does not require any dietary modifications or medication restrictions. Colonoscopy, however, still remains the most reliable method of screening for CRC.⁴

Standard treatments for CRC include surgery, chemotherapy, and radiotherapy, which can be used in combination depending on the location and progression of the cancer.⁵ Laparoscopic and transanal surgical approaches are frequently considered for localized cancer when the tumor location is easily accessible, allowing for a total mesorectal excision. Immunotherapy is a newer alternative therapy for cancer treatment that overcomes the issue of specificity, which is a major problem in chemotherapy and radiotherapy because these treatments affect normal cells along with cancer cells.⁵

An important consideration for the treatment of CRC is pain management. The first step to managing a patient’s pain is through the use of acetaminophen and nonsteroidal anti-inflammatory drugs; if those are ineffective, weak opioids such as tramadol, codeine, or dihydrocodeine are administered.⁶ If weak opioids are ineffective, stronger opioids such as morphine, methadone, or oxycodone are administered for severe cancer-associated pain.⁶

To help manage of CRC in younger patients, the following actions are recommended: discuss fertility preservation and risk for sexual dysfunction; provide information on financial support, online resources, and social networking communities; and educate patients on adjuvant and advanced disease treatment options, which do not differ by the patient’s age.⁴ Advocacy groups are a good resource that provide important information for younger patients with CRC and their friends and family and resource libraries with information on clinical trials, financial support, and insurance assistance. Some advocacy groups that have a strong media presence include COLONTOWN, the Colon Club, the Colon Cancer Coalition, Fight Colorectal Cancer, the Colon Cancer Foundation, Colorectal Cancer Alliance, and Michael’s mission.⁴

With CRC being diagnosed at a younger age, more awareness is needed regarding early warning signs of colon cancer in younger adults and the importance of universal Lynch testing and genetic counseling.² It is also important for individuals to become accustomed to observing their stool and noticing any changes. Younger adults and medical professionals must abandon the belief that CRC is solely a disease affecting older individuals.²

References

1. Siegel RL, Wagle NS, Cercek A, Smith RA, Jemal A. Colorectal cancer statistics, 2023. CA Cancer J Clin. 2023;73:233-254.
2. National Cancer Institute. Why is colorectal cancer rising rapidly among young adults? Accessed March 18, 2024. https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults
3. Katella K. Colorectal Cancer: What millennials and gen zers need to know. Yale Medicine. Accessed March 18, 2024, https://www.yalemedicine.org/news/colorectal-cancer-in-young-people
4. Asha Karippot AP. What’s driving the rise of colon cancer in young adults? ASCO Daily News. Accessed March 18, 2024, https://dailynews.ascopubs.org/do/s-driving-rise-colon-cancer-young-adults?intcmp=cc_ascodn_dn_jan2023_site_homepage_all__glob_011223_021023_expper__aware_image-text_jan2023
5. Johdi NA, Sukor NF. Colorectal cancer immunotherapy: options and strategies. Front Immunol. 2020;11:1624.
6. Zielińska A, Włodarczyk M, Makaro A, Sałaga M, Fichna J. Management of pain in colorectal cancer patients. Crit Rev Oncol Hematol. 2021;157:103122.