Increasing risk of colon cancer is a wakeup call for younger adults

Once thought to be just an older person’s concern, colorectal cancer has morphed into an age-blind condition. Waiting rooms for that periodical colonoscopy exam are now dotted with 20-, 30-, and 40-year-olds, a troubling development that’s challenged cancer experts to find a cause for this disturbing uptick.

This cancer rise in younger adults might have first appeared on many people’s radar with the publicity surrounding the death of Chadwick Boseman, the “Black Panther” actor who died of colorectal cancer in 2020 at age 43.

That wasn’t an isolated incident. According to the American Cancer Society, colorectal cancer has become the leading cause of cancer deaths in the U.S. for men under 50 and the No. 2 cause among women of the same age. Early-onset colorectal cancer rates have increased by 1% to 2% annually.

And while colorectal cancer remains most frequently diagnosed in people over 65, incidence in that group has declined; in fact, older people are less likely than people younger than 50 to be diagnosed with advanced stages of the disease.

The U.S. Preventive Services Task Force (USPSTF) and the U.S. Multisociety Task Force on Colorectal Cancer, two groups that provide preventive guidelines, recommend that most Americans get screened for colorectal cancer at age 45 — five years earlier than previously recommended — and continue with screenings periodically until 75.

Even that age change may not be low enough, given the alarming statistics pointing to earlier instances of this cancer.

Those at a higher risk of colorectal cancer might need to start screening before 45. This includes people with a family history of colorectal cancer or certain types of polyps; a personal history of inflammatory bowel disease; or a genetic syndrome, such as familial adenomatous polyposis or hereditary non-polyposis colorectal cancer.

That’s why Yale Medicine surgeons have urged people younger than 45 — even college

This cancer rise in younger adults might have first appeared on many people’s radar with the publicity surrounding the death of Chadwick Boseman, the “Black Panther” actor who died of colorectal cancer in 2020 at age 43.

students — to talk to their doctors about any suspicious symptoms, such as constipation, rectal bleeding, or sudden changes in bowel movements.

Yale Medicine physicians have reported seeing young patients with a diagnosis of colorectal cancer more often.

For example, those Yale doctors indicated they diagnosed colon cancer in a father of four in his 30s who thought for months that his rectal bleeding was caused by hemorrhoids.

And there was one week when all seven of the patients the practice saw were diagnosed with rectal cancer, the oldest being 35.

The youngest colorectal cancer patient diagnosed at this location in recent months was 18.

Given all this updated information on this disease’s increasing impact on previously low-risk age groups, it’s up to those individuals — and their doctors — to be aware of this possibility.

A global team of researchers, known as PROSPECT, is now investigating the rapid rise in young-adult cases of colorectal cancer, in which cells in the colon or rectum grow out of control.

The team, which includes researchers from nine institutions in five different countries, was recently awarded a grant of up to $25 million over five years to study early-onset colorectal cancer. They hope that, with time, they can understand the pathways, risk factors and molecules involved in the cancer’s development.

“Research suggests that this risk is increasing with each new generation,” Andrew Chan, the director of epidemiology for the Mass General Cancer Center and a gastroenterologist focused on cancer prevention among families at high risk of gastrointestinal cancer, told the Boston Herald.

The research team has uncovered contributing causes to this rise in early-onset cases, including overweight/obesity, physical inactivity, poor diet, and alterations in the gut microbiome.

Those factors reflect the increasingly sedentary lifestyle especially associated with a generation that’s grown up in the digital age.

That lack of physical activity has already been identified as a risk factor for cardiovascular disease, high blood pressure and Type 2 diabetes.

“Despite this progress, these factors do not completely explain the rapid rise in cases, and many unanswered questions remain about the mechanisms responsible for the rise in cases,” Chan said.

The research team will try to unequivocally identify these risk factors and develop prevention measures.

“This work will offer opportunities for preventive interventions that can benefit younger generations,” Chan added. “In addition to colorectal cancer, there is a rising incidence of multiple cancer types in young adults. The research can serve as a model for the study of other early-onset cancers.”

Those who’ve undergone a colonoscopy can vouch that it’s not an especially pleasurable experience, particularly the at-home preparation required for the procedure.

However, that inconvenience is a small price to pay for potentially catching this cancer before it does irreparable harm.