Concerns Increase Over Rising Colorectal Cancer Cases Among Younger People

The recent passing of actor James Van Der Beek at 48 has once again brought attention to the alarming rise of colorectal cancer in younger individuals.

While overall cancer death rates for those under 50 have seen a 44% decline since 1990, colorectal cancer has emerged as the leading cancer killer for that age group. This type of cancer can develop in the colon or rectum.

Van Karlyle Morris, who heads colorectal cancer at MD Anderson Center in Houston, mentioned, “We expect this trend to continue.”

Current federal screening guidelines, backed by the American Cancer Society, suggest that those at average risk should start screening at 45, typically through a colonoscopy every decade or a stool test every one to three years. Insurance companies often use these guidelines to determine coverage.

Though the majority of colon cancer cases affect individuals over 50, there has been a notable increase in diagnoses among those in their 20s, 30s, and 40s in recent years.

Why Start Screening at 45?

Colon cancer generally develops slowly, often beginning with adenomas or polyps that may later progress to cancer.

Morris commented, “The persistent rise in colorectal cancer rates among younger individuals certainly raises the need for discussions about possibly lowering the screening age.”

In 2021, the U.S. Preventive Services Task Force revised its guidelines, reducing the recommended screening age from 50 to 45. The American Cancer Society had already been advising adults to start screening at 45 since 2018, though this idea faced skepticism in the medical community.

Rebecca Siegel, a senior scientific director at the American Cancer Society, recalled that there was considerable resistance initially, with many thinking it was premature. “Even today, not everyone agrees,” she said.

Siegel emphasized the complexity of developing cancer screening guidelines, where experts analyze research to balance the benefits against risks, which can include factors as minor as missing work.

The risk of colorectal cancer for individuals aged 40-44 stands at about 21 per 100,000, while it more than doubles to 47 per 100,000 once they reach 45, at which point routine screening is recommended, she noted.

About 10% of colorectal cancer cases involve patients under 50, according to the Mayo Clinic.

“While colorectal cancer rates are on the rise for younger people, overall occurrence remains low,” Dr. Andrew Chan, a gastroenterologist in Boston, explained.

Resource allocation also plays a role in determining screening guidelines, Siegel added. The limited number of gastroenterologists makes it challenging to conduct routine screenings effectively.

Morris pointed out that under the current recommendations, scheduling a colonoscopy can take several months.

Currently, the uptake of screenings for individuals at average risk is fairly low, with only about 20% of those aged 44 to 49 up to date on screenings, according to the American Cancer Society.

“Younger populations, particularly those below 45, are likely to have even lower uptake,” Chan said.

Should I Consider Earlier Screening?

If an individual has a family or personal history of colorectal cancer or polyps, they should begin screenings before age 45, Siegel advised.

She noted that conversations with family members are crucial. For instance, having had a non-cancerous polyp at 40 may mean an earlier screening is warranted.

Once symptoms surface, a colonoscopy shifts from being a screening tool to a diagnostic test, and insurance should then cover it, according to Siegel.

What Are Initial Symptoms of Colon Cancer?

In a recent interview, Van Der Beek discussed his first symptoms, which emerged as changes in bowel movements in the summer of 2023, when he was 46. Initially attributing the changes to coffee consumption, he sought a colonoscopy after the symptoms persisted, leading to a Stage 3 colon cancer diagnosis.

Research outlines four potential symptoms that could appear up to two years before a diagnosis:

• Abdominal pain.
• Rectal bleeding.
• Persistent diarrhea.
• Iron deficiency anemia, often detected in routine blood tests.

“Recognizing these warning signs is vital,” Siegel remarked, highlighting that many colorectal cancer symptoms may be mistaken for less severe gastrointestinal issues.

“If symptoms persist, especially multiple symptoms, it’s critical to take action,” she added. Morris suggested that individuals with unexplained anemia or low red blood cell counts should also consider screening promptly.

Though the FDA has approved noninvasive stool and blood tests as initial screening tools, if there are signs of cancer, such as blood in stool, a follow-up colonoscopy is necessary.

Studies show that Cologuard, a home stool test, identifies about 92% of colorectal cancers while Shield, a blood test, detects around 83%. However, both tests are less effective in finding precancerous polyps.

What About the Cost of a Colonoscopy Without Insurance?

Even as noninvasive stool tests like Cologuard make access to screening easier, colonoscopies are still the definitive method for detecting colorectal cancer.

“Insurance typically covers colonoscopies and tests like Cologuard only from age 45 onward, except for those at higher risk,” Chan noted.

Those at average risk wishing to undergo a colonoscopy before 45 may need referrals, as stated by Morris.

The out-of-pocket price for a colonoscopy can vary widely, from about $1,250 up to over $4,000, according to a price comparison website.

How Can I Lower My Risk of Colon Cancer?

As colorectal cancer rates among young people rise, the reasons remain unclear.

Some research indicates that factors like increasing obesity rates, reduced physical activity, alterations in the gut microbiome, and diets high in ultraprocessed foods since the 1980s might contribute significantly. Additionally, early findings suggest antibiotics and certain gut bacteria may play a role.

Chan emphasized the importance of screening but also advised focusing on diet and regular exercise. These lifestyle changes have been shown to notably decrease colorectal cancer risk.

“These types of measures could offer benefits that extend beyond just screening,” he suggested. “While screening is essential, we shouldn’t disregard these other factors.”