Colon Cancer Increasing in Younger People: "Not an Old Person's Disease"

Colon cancer continues to rise among younger U.S. adults, with the American Cancer Society reporting a doubling of cases in people younger than 55 in about 25 years.

Also, significantly more Americans are being diagnosed with advanced stages of the disease, the cancer society says.

As of 2019, 20 percent of colon cancer cases occurred in adults under age 55 -- up from just 11 percent in 1995, according to the new report.

Moreover, researchers found that the proportion of people diagnosed with advanced-stage cancer reached 60 percent in 2019, up from 52 percent in the mid‐2000s. The rate of advanced disease was 57 percent in 1995 before widespread screening was available.

Cancer experts are baffled, especially since numbers are declining in the overall population.

What's driving the increase?

"We don't know what is driving the increase in colorectal cancer among young people," says senior researcher Dr. Ahmedin Jemal, senior vice president for surveillance and health equity science at the cancer society.

"There is a lot of research going on. Some people say it's probably obesity or changes in diet over the past decades that might be a reason, but really, we don't know exactly what causes this rapid rise in colorectal cancer incidence rates," he says.

This year more than 153,000 Americans will be diagnosed with colon cancer and 52,550 will die from the disease, the researchers note.

Screening against colon cancer

Screening is the best protection against colon cancer, Jemal adds.

The cancer society recommends that screening start at age 45 for people at average risk. But Jemal said only 4 in 10 adults are being screened.

"If we were to raise colorectal cancer screening up to 80 percent, we estimated tens of thousands of cases could be averted, and thousands of lives could be saved," he shares.

Your doctor can provide you with a fecal blood test or refer you for colonoscopy screening, Jemal says. The advantage of the colonoscopy is that it needs to be done only every 10 years, while the other should be done yearly.

Barriers to screening include being uninsured and not getting a recommendation for screening from a primary doctor, he says.

Can we expect a lower age for screening?

Even though younger adults are developing colon cancer, Jemal doesn't anticipate the recommended age for screening will get lower.

"It is very unlikely because there will be a cost-benefit analysis and among all colorectal cancer cases that occur under age 50, 43 percent occur in ages 45 to 49. So it is very unlikely that it would have any benefit if we were to go to a younger age," Jemal notes.

Dr. John Ricci, chief of colorectal surgery at Long Island Jewish Medical Center in Great Neck, N.Y., says he treats many younger colon cancer patients nowadays.

"Where it used to be almost unheard of to see somebody in their 30s with colon cancer, now we're seeing it fairly frequently, unfortunately," Ricci shares.

Being aware of your family history

Patients have to be aware of their family history, Ricci says.

"It's not only cancers in your family history, it's also high-risk polyps," he adds. If close family members have had more than three polyps or big polyps, you would qualify for an early colonoscopy, Ricci notes. Polyps can turn into cancers if they are not removed.

Changes in bowel habits and bleeding -- symptoms of colon cancer -- are reasons to be evaluated by your gastroenterologist. "When you have symptomatic cancer, it's usually further along," Ricci shares.

Doctors need to recommend screening and patients need to be proactive and ask their doctor about screening, he adds.

"You just have to be cognizant that colorectal cancer is not an old person's disease anymore," Ricci says. "It's a middle-aged people's disease now. And it seems not enough people are getting screened."

For the report, Jemal's team used data available through 2019 from 50 states and the District of Columbia from the U.S. National Cancer Institute and the U.S. Centers for Disease Control and Prevention.

They found that the incidence of colon cancer and related deaths declined from three to four percent a year during the early 2000s to one percent a year and two percent a year, respectively, in the past decade.

Colon cancer rates were 33 percent higher in men (41.5 per 100,000) than in women (31 per 100,000) from 2015 to 2019, likely due to differences in risk factors, such as excess body weight, eating processed meats and smoking, the researchers note.

Rates of colon cancer have declined for those 65 and older and have stabilized for people 50 to 64, but have increased by two percent yearly in people younger than 50 and those 50 to 54.

Moreover, deaths from colon cancer have increased since about 2005 by one percent a year in people younger than 50 and by nearly one percent in people 50 to 54, the researchers say.

The highest rates of colon cancer are among Alaska Natives (88.5 per 100,000), American Indians (46 per 100,000) and Black people (41.7 per 100,000). Among white people, the incidence is 35.7 per 100,000. Death patterns are similar, with the highest among Alaska Natives, American Indians and Black people.

Colon cancer is easiest to treat when caught early. If you spot any of the following persistent symptoms, it's time to schedule a doctor's appointment:

A persistent change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
Rectal bleeding or blood in your stool
Persistent abdominal discomfort, such as cramps, gas or pain
A feeling that your bowel doesn't empty completely
Weakness or fatigue
Unexplained weight loss

By Jessica Daniels, BDO Staff Writer | Published March 2, 2023