Data shows colorectal cancer rate up 60% for people under 50

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The colorectal cancer rate for people under 50 rose more than 60% between 1990 and 2018, which is the latest data available, while the rate for those 50 and older fell nearly 50% during the same time period, according to the National Cancer Institute’s surveillance, epidemiology and end results program. The trend led to a recommendation that colorectal cancer screenings begin at age 45, instead of 50, as had been the case for years.

In younger adults, risk increases with age, so someone in their 40s is at higher risk than someone in their 20s. And it is still much more common in adults 50 and over.

About 10% of cases today are in people under 50, said Michael Sapienza, chief executive of the Washington, D.C.-based Colorectal Cancer Alliance. Nearly 3,600 people under 50 died of colorectal cancer in 2019, compared with 2,676 in 1990, a much bigger percentage increase than the rise in population, according to institute statistics.

Dr. Christopher DiMaio, chairman of gastroenterology at St. Francis Hospital & Heart Center in Flower Hill, said “14, 15, 16 years ago, when I was still in training, it wasn’t a common occurrence” to see someone under 50 with colon cancer.

“It’s not unusual now,” he said.

The increasing number of older Americans getting colonoscopies and other colorectal screenings is the biggest reason the incidence of colorectal cancer has fallen so sharply among older Americans, said Dr. Arif Kamal, chief patient officer for the American Cancer Society.

That is a reflection of how people under 50 are much less likely to be screened, Kamal said. Rising obesity rates and environmental factors, such as soil contamination, are other possible reasons, he said.

DiMaio said when he sees people under 50 with colorectal cancer, the cancer tends to be more advanced. That’s in part because of the lack of screenings — the cancer is detected when people like Canale come in with abdominal pains, or with other symptoms, such as rectal bleeding or a change in bowel movements, he said.

In addition, he said, in younger adults, “These cancers have a different genetic fingerprint compared to the cancers that a typical 65-year-old would get. There is something biologically different. We don’t know what’s driving that.”

Overall, Black Americans have the highest rate of colorectal cancer, more than 15% greater than for whites, federal data shows.

But the sharpest increase in cases in adults under 50 is among non-Hispanic whites and Native Americans, and the young-adult rate for whites equaled that of Blacks by 2016, a 2020 cancer society report says.

One barrier to younger adults getting screenings is that many insurance companies don’t cover colonoscopies and other screenings for people under 50, said Michael Davoli, senior government relations director, New York, for the American Cancer Society Cancer Action Network.

Actor Chadwick Boseman’s 2020 death from colon cancer at age 43 helped highlight how younger people can get colorectal cancer, Sapienza said.

But it’s still often seen as an older person’s disease. That means many adults under 50 never think of getting a screening, and doctors may not look for signs of colorectal cancer in younger patients, Sapienza said. An alliance survey found that more than half of colorectal cancer survivors under 50 said they had been misdiagnosed.

Canale said when she saw two doctors for constipation in early December, the first doctor put her on laxatives and the second a high-fiber diet. By Christmas, her abdominal pain “became unbearable,” and she couldn’t eat or even sit down. That’s when her husband pushed her to go to the emergency room, where a CT scan revealed a large mass.

“It was a very big mass, the size of that orange,” she said, gesturing to a large orange in a fruit basket.

Chemotherapy shrunk the size of the mass by 70%, but the cancer had spread to her liver. Doctors hope to implant a pump to target chemotherapy directly at the liver, which her oncologist told her has a 50% chance of success of leaving her liver cancer-free.

But doctors now fear the cancer may have spread to the uterus. A CT scan on Thursday detected a new mass, but it’s unclear whether it’s in the colon or next to the colon in the uterus. Canale is awaiting MRI results.

COLORECTAL CANCER HIGH RISK FACTORS
Older age
Family history of colorectal cancer
Certain gene mutations
Type 2 diabetes
Being overweight or obese
Lack of physical activity
Smoking tobacco
Moderate to heavy alcohol use
Diets high in red and processed meats

It says Americans, does that mean I don't need to worry?

Sorry, couldn't resist. I know this is nothing to joke about, and it is worrying. My mum died of bowel cancer and I have an agonising phobia of colonoscopies so I'll probably die of bowel cancer.