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Incidence Rises for Individuals Under Age 50

Colorectal cancer is being detected more often in individuals younger than age 50. Cancers of the colon and rectum combined rank as the second most common cause of cancer death in the United States among men and women in total, according to the American Cancer Society.

The incidence of colon and rectal cancer in people under age 50 has climbed 2% each year since 2011, with rates also climbing for those ages 50-64, according to data released in CA: A Cancer Journal for Clinicians, a bi-monthly, peer-reviewed medical journal published for the American Cancer Society. The organization estimates that in the U.S., 151,030 colorectal cancer cases (106,180 colon, 44,850 rectal) will be diagnosed in 2022, with an anticipated 52,580 deaths.

The need for colorectal screening is more important than ever, according to John Rabine, M.D., medical director and division head of Gastroenterology for Sinai Hospital of Baltimore. Regular screening for colorectal cancer, as well as precancerous lesions called polyps, help detect the disease in early stages or before it even develops. In the past few years, the American Cancer Society and multiple gastroenterology societies have lowered the recommended age for colorectal cancer screening to 45 years.

Testing for Colorectal Cancer

Several methods are used for screening for colorectal cancer.

Colonoscopy – Considered the gold standard, the primary test for colorectal screening is a colonoscopy. This test, administered while patients are sedated, evaluates the large intestine (colon) and rectum for signs of precancerous lesions. Polyps may be removed during the procedure, eliminating their potential to develop into cancer. During the 15-minute procedure, physicians also may choose to biopsy questionable lesions. If cancer is detected, most often it is early stage and treatable.

Unlike other cancer screening exams that detect cancer, like mammograms, pap smears and rectal exams, the colonoscopy also is used to prevent cancer, according to Dr. Rabine. “The phrase colon cancer screening is a bit of a misnomer. It’s really colon cancer prevention, or colon polyp screening.,” he says. “Whereas a prostate exam or a mammogram is meant to find a bump early when it’s only a stage one or two cancer, the purpose of a colonoscopy is to find precancerous polyps and remove them so that they can never grow into a cancer in the first place.”

The colonoscopy is repeated every 10 years for patients with average-risk and covered by insurance. It is performed more frequently when precancerous polyps are identified and for patients with risk factors for colorectal cancer.

Stool Tests – The fecal immunochemical test (FIT) uses antibodies to detect blood in the stool. Another stool test, Cologuard, also evaluates DNA found in the stool for genetic changes that could indicate colon cancer or precancerous conditions. These tests are administered at home and mailed away for evaluation. FIT and Cologuard tests are repeated more often, every one to three years. Insurance coverage varies for these tests.

The stool test is best used in between colonoscopies. Some patients, however, choose this method instead of undergoing a medical procedure. The colonoscopy requires a “prep,” which cleans out the colon prior to the procedure so they physician can have the best view. This involves consuming a drink that induces diarrhea and may be unpleasant.

“I tell patients that it’s much easier than the stomach flu or food poisoning, which can last a day or two or even longer,” says Dr. Rabine. “Colonoscopy prep is just bad diarrhea that only lasts four to six hours. A few hours of diarrhea to lower your risk of a leading cause of cancer is a small price to pay.”

Reasons for Testing

Age is not the only indicator for a colorectal cancer screening. As the disease often goes undetected without signs or symptoms, individuals in their 20s and 30s with risk factors should be screened.

Family history – If relatives have had colon cancer, the risk increases.

Personal history – Patients who previously battled colorectal cancer or had polyps removed, or had prior belly or pelvis radiation treatments, should test earlier than age 45 and more often.

Anemia – Iron deficiency can be a sign of colorectal cancer.

Bloody stool or rectal bleeding – Bleeding can indicate hemorrhoids or a more serious condition like colorectal cancer.

“It’s important for patients to realize that 45 is when you should get looked at if you have no symptoms. But even if you’re younger and seeing blood in the stool, you want to go ahead and get a colonoscopy early,” Dr. Rabine says. “It also pays to know your family history and realize that you may benefit from being evaluated at an unusually young age.”

Be Proactive – Schedule a Screening

The majority of colorectal cancer diagnoses come in patients over age 50, according to Dr. Rabine. Often, the patient has delayed testing.

“You don’t want to be the one who you could have prevented it,” Dr. Rabine says. “It’s a sad thing to end up with cancer because you didn’t make time for screening.”

Call 410-601-WELL to schedule a screening or to learn more about all other services offered by LifeBridge Health, including specialty care and community events.