The rate of colorectal cancer diagnosis in people under age 50 has doubled since the mid-1990s to 2020, according to the National Institutes of Health.
This is occurring even as the overall rate of colon cancer diagnoses over the past five years has decreased 46%, due in part to an increase in colonoscopies, which can prevent cancer from occurring through removal of precancerous polyps.
This earlier diagnosis is one reason it’s now recommended people start screening at age 45, instead of age 50. Those five years can be important, particularly since colorectal cancer in people under 50 appears to be more aggressive.
“It’s concerning because we don’t know why it’s happening,” said Heidi McKean, MD, Avera medical oncologist specializing in gastrointestinal and colorectal cancer.
Changing Colon Screening Guidelines
Over the years, experts in the field of oncology and gastroenterology noticed the following trends. According to the American Cancer Society: An increase of more than 10% of colorectal cancers in people ages 20 to 39.
- Colon cancer in people under age 50 is increasing about 2% every year.
- About one in five colorectal cancer diagnoses are now in people 54 and younger.
Changing the screening guideline to start at age 45 will help get people in sooner, but not everyone is taking advantage of it.
McKean explained one case of someone just under age 50 diagnosed with a stage 4 cancer that had already spread to another body part.
That’s a person who qualified for a colon screening and didn’t get one.
Typically, between ages 50 and 65 the cancer is slower growing, one reason that colonoscopies can happen every 10 years if no polyps are found. But in people who are under age 50, colon cancer tends to be more aggressive and found at more advanced stages, when it’s harder to treat.
“That’s our concern, is that we keep finding these patients that have really aggressive types of cancer,” she said. “Young patients are increasingly diagnosed with advanced stages of cancer that’s already spread to the lymph nodes or other body parts,” she said. The liver and lungs are common sites where colorectal cancer spreads.
People under age 45 who do not qualify for the recommended screening would need a referral from a doctor, if they are showing symptoms or have a strong family history. A screening wouldn’t be covered 100% by insurance but with coinsurance or co-pay. (Talk to your insurance company about your specific plan coverage.)
How to Protect Yourself at Any Age
This may feel like a helpless situation, but you have options at every age. The key is to take action.
Stop Colon Cancer
If you have a family history or are 45 years old take the steps to lower your risk for colorectal cancer.
Get Screened
If you’re age 45, get a colon screening and follow your doctor’s recommendations based on findings.
Colonoscopy is widely considered the best exam to stop this cancer. Doctors can not only detect colon cancer early, they can stop it from developing altogether by removing precancerous polyps.
Don’t Ignore Symptoms
Don’t assume everything is OK if you are under the magic number of 45. The most concerning symptoms include:
- Rectal bleeding (black stools)
- Change in bowel habits like new or worsening diarrhea and constipation
- Change in stool caliber (very skinny or flat) indicating an obstruction
Other symptoms include:
- Fatigue
- Unintentional weight loss
- Constant gas, cramps or bloating
It’s worth noting that stool tests, such as Cologuard® are for people at average risk who are not having symptoms. If you are having these symptoms and further screening is recommended, a stool test would not the best option.
Consider Genetic Counseling
If a first-degree family member has had colon cancer, talk to your provider about early screening and consider genetic counseling. You may be recommended for genetic testing. There are certain types of genetic mutations, including Lynch syndrome, that can put you at higher risk for colon cancer before age 50.
Knowing these risk factors can allow your care team to create a personalized screening plan.
How to Prevent Colon Cancer
While studies haven’t determined the reason for younger diagnosis of this deadly cancer, potential causes point to lifestyle and environmental factors.
These include:
- Smoking and alcohol use
- Increased rates of obesity and sedentary lifestyles
- High fat, low fiber diets
That makes healthy lifestyle choices even more important, whether you have a family history or not.
Things to do that can lower your risk:
- Exercise regularly
- Maintain a healthy weight
- Follow a diet low in fat and high in fiber
- See your provider at least annually
Simply put: If you’re 45, have a family history or are experiencing symptoms, talk to your provider about colon cancer.
