Sunday, March 12, 2023 | 3 a.m.
A new report from the American Cancer Society points to an alarming increase in colon cancers among younger people.
Unraveling the cause will take years of research. In the meantime, more needs to be done to prevent some of these advanced cancers — and to better address the needs of younger patients.
The report highlighted several worrisome trends for the second-leading cause of cancer deaths. People younger than 55 accounted for 20% of colon cancers in 2019, up from just 11% in 1995. Oncologists have been keeping an eye on the steady increase in younger patients, but the report shows the age of onset continues to skew younger.
That matches what specialists are seeing in their practices. “We’re seeing more and more patients in their 30s as opposed to their 40s — and I feel like that just happened in the last five years,” said Nancy You, director of MD Anderson’s Young-Onset Colorectal Cancer Program.
Worse, two-thirds of young people are coming in with cancers that have spread to other parts of their body. The trend is occurring across all racial and ethnic groups.
The data surprised even oncologists who have been treating younger colon cancer patients. “The problem is so prevalent now that it has actually been changing the epidemiology of colorectal cancer,” said Kimmie Ng, director of the Young-Onset Colorectal Cancer Center at Dana-Farber/Brigham and Women’s Cancer Center.
Researchers are trying to determine what’s behind the shift. Among the questions: Is there something biologically different about these early onset tumors? Is something in our diet, like processed meats and sugary drinks, to blame? Could this be linked to the rise in obesity?
Understanding the precise factor or combination of factors contributing to this rise will take time — epidemiological studies that will take years, in fact. To speed that up, hospitals seeing these younger patients should be working together to collect as much data as possible on as many people as possible.
While that work is pursued, many concrete things can be done to lower the number of colorectal cancers among young people and ensure they are detected before they have metastasized to other organs.
The first step is awareness. Maybe that sounds flip, but it’s needed desperately. Younger people don’t always recognize the signs of colorectal cancer and so don’t seek help until it has progressed. The ACS report noted that young people are most often presenting with cancers in distinct regions, the rectum and the distal colon. The location of these tumors means many more young patients — 41% of them — show up at their doctors complaining of rectal bleeding that is more typical for patients older than 50.
The issue needs to be driven home to health care providers, too. While the increase in early onset colon cancers has been on the radars of gastroenterologists and oncologists for years, the news hasn’t trickled down to the people most likely to see younger patients — primary care physicians, gynecologists, emergency room physicians or health care workers in urgent care facilities. Too often patients’ early symptoms aren’t taken seriously, or they embark on a diagnostic odyssey that takes them through multiple doctors. One study found that younger patients had their symptoms for twice as long as older patients, and it took 40% longer to get a correct diagnosis.
Screening could be vastly improved. The report points out that just 20% of people ages 45-49, the youngest group in which routine screening is recommended, have been tested. It might help if patients were more commonly offered noninvasive alternatives to colonoscopies. Anyone who has had a colonoscopy can attest to the layers of challenges: finding an appointment, taking a day off to complete the preparation and procedure, and getting someone to accompany you to and from the medical center. Adherence to screening might improve if average-risk patients were given options like stool-based tests, which can be completed at home.
Of course, screening can only help the group being tested — and that in theory doesn’t capture many of those affected by younger-onset cancers. But in practice, it could: Although the current recommendation is that average-risk people get their first colonoscopy or other screen at age 45, “many, many people are not at average risk and they don’t realize it,” said Rebecca Siegel, a cancer epidemiologist and senior scientific director of surveillance research at the American Cancer Society. A family history of colon cancer increases a younger person’s risk, but so does advanced polyps, said Siegel, who wrote the recent report.
“Everyone should talk to their doctor in their 30s about their family history,” she added.
Last, these younger patients deserve better care than they might be finding at diagnosis. They are navigating much different life challenges than the older patients whom physicians would have typically seen in the past. They are just getting started in life, meaning they are likely to be relying on an employer rather than Medicare for insurance coverage, are still taking care of children — or maybe even haven’t started to have them yet and might be managing their parents’ health in addition to their own.
Too few hospitals have a comprehensive care team that can address issues unique to younger patients, like the need for financial support, fertility and sexual health concerns and other long-term challenges associated with undergoing cancer treatment.
Answers about the cause of the rise in early-onset might be years off, but the tools to address it exist now. More urgency needs to be put behind deploying them.
Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry.
