Increasing concern about colorectal cancer risk in young adults

Historically, colorectal cancer (CRC) Mainly affected the elderly. But in the 1990s, a mysterious new trend began. The incidence has declined in people over the age of 50 and has increased fairly rapidly in young adults.

This trend is still declining today, and researchers are deciding whether factors such as diet and sedentary lifestyle play a role, or whether a unique new subtype of the disease is affecting young adults. Working to Questions also arise about the best ways to diagnose and treat CRC in this young population.

Dr Zsofia K. Stadler, an oncologist at the Memorial Sloan Kettering Cancer Center in New York City and co-director of the annual Early-onset Colorectal Cancer Summit sponsored by the Patient Advocacy Organization, the Colorectal Cancer Foundation, sits at CURE®. I lowered it. Let’s dig into those issues.

cure®: What is the increase in colorectal cancer in young adults?

Stadler: Since the 1990s, there have been guidelines for colonoscopy in patients over the age of 50. In fact, the population over age 50 has a gradual but steady decrease in the risk of colon cancer. This is because colonoscopies detect and remove premalignant polyps to prevent cancer.

But what is very impressive is that since the 1990s, the incidence of colorectal cancer in the population under the age of 50, who usually does not undergo colonoscopies, has increased by about 1-2 percent each year. To increase. And the increase is even more profound in very young patients. The annual growth rate for people aged 20 to 29 is about 4%.

Another trend is that young adults get diagnosed later. why?

I don’t know the answer exactly. One hypothesis is that perhaps the biology of some of these cancers is more aggressive, but most of the data presented
Do not prove it. Later diagnosis may also be due to patients presenting later in life because they have not undergone regular screening.

Some interesting studies suggest that later diagnosis is due to both donor and patient behavior. For example, patients with early-onset colorectal cancer are known to wait up to one year after symptoms appear before seeing a doctor. In addition, the average number of providers that early-onset colon cancer patients see before diagnosis is three, because the symptoms often resolve as hemorrhoids or hemorrhoidal bleeding. Very common.

What are the other possible signs of CRC?

Other symptoms include rectal bleeding, changes in bowel habits (either diarrhea or constipation), and abdominal pain. All of these are symptoms that either develop over time or become progressively worse.

Is there a difference between colorectal cancer in young adults and disease in the elderly?

In young adults, we know that many colon cancers are hereditary, that is, hereditary genetic variants cause the predisposition. The most common inherited cause is Lynch syndrome, which accounts for approximately 3% of CRC cases overall. However, young patients younger than 50 years account for about 10% of all colon cancer diagnoses.

Approximately 80% to 85% of colon cancer in young adults are not genetically related and the rest are unexplained. Many studies have examined the epidemiological factors that may be associated with increased risk, but, interestingly, we know many risk factors that increase average-onset colorectal cancer, Western diet, obesity, diabetes, smoking, excessive alcohol consumption-they do not seem to cause the rise. Therefore, we are investigating the cause of this dramatic change.

Due to the increasing illness in young adults, the American Cancer Society currently recommends early screening for CRC. What are its recommendations?

The American Cancer Society has done a modeling study showing that the average age at which we start screening needs to be reduced from 50 to 45. In fact, for African Americans, for example, this has been recommended for some time.

Studies seem to suggest picking up more cases in this way with expanded screening, but the most dramatic increase in colon cancer in younger patients is actually between 20 and 29 years old. Because it is a group, it is always the group with the most dramatic increase in risk.

How can we keep the disease from rising if we do not screen the youngest adults at risk?

Many families also have polyps that increase the risk of colorectal cancer. Also, many families lack knowledge of polyp population, age, and polyp pathology. This can be very important in determining the risk faced by a particular patient.

One of the most important predictive aspects is that 15% to 25% of patients have a family history of illness, which increases their risk. Therefore, the US Preventive Services Task Force has issued a recommendation that first-degree relatives with colorectal cancer under the age of 60 should undergo colonoscopies from age 40. However, we don’t always follow these guidelines, and patients may not be aware that earlier screening is recommended.

Primary care physicians may not start talking about the risk of colorectal cancer until age 50, when they usually start screening for colonoscopies, but the primary care physician, who had a family history, said It is possible that the inspection started earlier.

As such, patients need to know that their primary care physician should be notified if a family has a new diagnosis. But at the same time, primary care physicians occasionally need to ask the patient. “Are there any new things in your family? Has anyone been diagnosed with cancer?” Sometimes, these family histories change and you may discover a genetic predisposition syndrome ..

If someone develops colorectal cancer, it is routine for a doctor to identify a mutation in the tumor. Some of them show the presence of syndromes that predispose patients to colorectal cancer and other cancers. With this information, healthy relatives can carefully screen for cancer over time, so that any illness can be detected and treated early.

You mentioned colonoscopy. Are there other screening types suitable for young adults?

There are other types of screening, but none is better than colonoscopy. There is a sigmoidoscopy, which screens only the left side of the colon and lacks the entire right side. A blood or guaiac test, which looks for blood in the stool, is better than nothing, but a colonoscopy is recommended if you have symptoms of rectal bleeding.

What is your most important advice for young adults facing a CRC diagnosis?

It is important to know that they are not alone as patients, they are not alone in the field of studying this. Gastroenterologists, primary care physicians, oncologists, and surgeons are increasingly aware of an increase in early-onset colon cancer. In fact, many large cancer centers have early-onset colon cancer centers, and these patients must address specific issues such as social and psychological concerns, fertility, and genetics. I can. There are resources for these patients.