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Marcella W. Bradway: Younger adults warned of unexplained rise in colorectal cancer

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Colon cancer can readily be prevented through screening, according to Dr. Marcella W. Bradway, director of surgery at Berkshire Medical Center. But many people still ignore or resist the recommendation to get screened. 

While the rate of colon and rectal cancer among adults 50 and over has declined steadily over the past three decades, thanks largely to a widespread increase in early detection colonoscopy screenings, the rate of colorectal cancer among people younger than 50 has been climbing steadily, by 1 to 2 percent a year, since the mid-1990s — for reasons that remain unknown.

The American Cancer Society recently reported that 20 percent of colorectal cancer diagnoses in 2019 were in patients under age 55 — about double the rate in 1995 — and that rates of advanced stage disease increased by about 3 percent annually in people younger than 50.

In response to this unexplained increase, the U.S. Preventive Services Task Force, a group that provides guidelines for avoiding colorectal and other cancers, now recommends that most Americans be screened for colorectal cancer at age 45 — five years earlier than previously recommended — and continue with colonoscopy screenings periodically until age 75.

Colorectal surgeons and gastroenterologists nationally are urging patients younger than 45, including college students, to talk to their doctors immediately if they’re experiencing any suspicious symptoms, particularly rectal bleeding, as well as unusual stools, constipation or other sudden changes in bowel movements.

No amount of rectal bleeding is normal and should always be checked. Many people mistakenly dismiss a little bleeding as “just a hemorrhoid,” only to find out it was cancer.

Meanwhile, cancer researchers are busily looking into possible explanations for the rise in colorectal cancer among younger patients. Among the usual suspects are sedentary lifestyle, obesity, smoking, heavy alcohol use and poor eating habits. Those behaviors really flared up during the pandemic, and we should all try to migrate back toward lifestyles that will benefit us in all aspects of our health.

Family history of colorectal cancer or polyps, and conditions such as inflammatory bowel disease are also possible triggers, as are environmental factors.

The population at all ages should take seriously the risk of colorectal cancer and follow the recommendations for colonoscopy screenings. Colon cancer can readily be prevented through screening. With a patient under sedation, the doctor inserts a flexible tube with a light and camera on the end through the rectum to examine the colon. The tube also allows a doctor to snip away any polyps that may be precancerous, preventing many cancers before they develop.

As common and tolerable as the procedure has become, many people still ignore or resist the recommendation to get screened. That’s why colon cancer remains the second most common cause of cancer death in men and the third in women. More than 50,000 people die from colon cancer annually in the U.S., and between 50 and 60 percent of those deaths could be prevented through screening.

For those below the age 45 recommendation for regular colonoscopies, a physical rectal exam in the doctor’s office for anyone with suspicious symptoms is advised. If that exam discovers a mass in the rectum or finds blood in the stool, the doctor can send the patient for a colonoscopy.

The goal is early detection. The earlier the cancer is caught — before a tumor can penetrate the walls of the colon and get access to surrounding lymph nodes and travel to other organs — the better the prognosis.

Finally, it’s important to be aware that some have no symptoms at all. In more than 50 percent of colon cancer cases, patients experience zero symptoms — no pain, no rectal bleeding, no change in bowel movements or other signs something is wrong. So, tell your doctor if colorectal cancer runs in your family. He or she may decide to recommend a colonoscopy before age 45.

Marcella W. Bradway, MD, FACS FASCRS, is a colon and rectal surgeon and chair of the department of surgery at Berkshire Medical Center.

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