5 key facts: Rising cases of early-onset colorectal cancer in young adults

Nobody ever wants to hear they have cancer, but when it strikes a young person, the news is perhaps even more devastating because everything about the future they were imagining and working toward is thrown into question.

Unfortunately, early-onset cancer — disease in people younger than 50 years old — is being diagnosed more frequently, according to various studies. And among early-onset cancers, colorectal cancer hovers near the top of the list.

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“It was shocking to see that a young person — perfectly fit and healthy, no risk factors, no family history — could be diagnosed with Stage 4 disease. And then it just became more and more common, which is also distressing,” Dr. Kimmie Ng told CNN Chief Medical Correspondent Dr. Sanjay Gupta recently on his podcast, Chasing Life.

Ng, a gastrointestinal oncologist and associate professor of medicine at Harvard Medical School, has been treating patients for two decades at Boston’s Dana-Farber Cancer Institute, where she is the founding director of the Young-Onset Colorectal Cancer Center, one of the nation’s first centers that treat younger adults with the disease.

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The incidence of both colon and rectal cancer has been increasing by about 2 per cent per year in younger people since the mid-1990s, Ng said, noting that it’s happening to both men and women, not just across the United States but globally, too.

“It’s difficult to receive a cancer diagnosis no matter what age you are, but younger people face really different challenges,” Ng said. “Eighty per cent have children under the age of 18. They’re also caring for elderly parents. They’re in the midst of their careers. Some people are still getting education. Some people are still planning to expand their families.”

Early-onset colorectal cancer is already the leading cause of cancer-related death in the US in men younger than age 50, and if the trend continues, Ng said, it will become the leading cause of cancer death in women under 50 by 2030. (After breast cancer, colorectal cancer is the second leading cause in younger women now.)

She points out, however, that in absolute numbers, these cancer cases in younger people are “still quite small,” noting “it is still relatively rare to develop any of these cancers at a really young age.”

Screening is key

Across all ages, colorectal cancer cases and related deaths in the US have been declining for decades, Ng said, attributing that success to improvements in treatment and public health efforts to promote screening. “But that benefit has not been seen in people under the age of 50,” she said.

In 2021, the US Preventive Services Task Force, an independent board of medical experts, lowered the recommended age to start screening for colorectal cancer in asymptomatic people of average risk from 50 years old to 45.

But Ng doubts the panel will lower the age again soon, noting not only the relatively small absolute numbers but also other factors that go into implementing a successful screening program, such as cost and the risks associated with screening, including bleeding, sedation complications and false positives.

Instead, Ng believes the focus should be on figuring out why this surge in early-onset colorectal cancer is happening. “What are the risk factors?” she said. “Who is at risk, and can we tailor that high-risk 30-year-old for earlier screening?”

“There was this effort to get 80 per cent of the population screened in the United States, but we haven’t yet reached that goal,” Ng said. “And so it is really important that we continue public health efforts to really advocate that screening can be lifesaving, and it really needs to be done.”

Environmental factors may be fueling disease risk

With each generation, the risk has gone up, Ng observed.

“The increase in young-onset cancers is generational, with every generation after 1950 experiencing rising incidence,” she said.

“For example, someone born in 1990 now has >4x (greater than four times) the risk of developing rectal cancer and >2x (greater than two times) the risk of developing colon cancer compared to a similarly-aged person who was born in 1950.”

“When we see these … effects, what it usually suggests is that there’s some environmental exposure or exposures that have happened recently that are contributing to that rise,” Ng told Gupta on the podcast. “So, the big question now is what are these things that are actually leading to this increasing incidence in young people?”

Researchers have been trying to pinpoint the drivers of this unsettling trend.

Younger patients may have a harder time

If you have been diagnosed with any cancer, being young has its advantages, Ng said. Younger patients tend to be healthier, for one. They are more likely to withstand higher doses and more cycles of chemotherapy compared with older patients, and they can undergo surgery and radiation more often as well.

Nevertheless, Ng, said, “their survival is not necessarily better than that of an older patient with cancer.”

She noted that for colorectal cancer, “the very youngest patients” — those younger than age 35 — “seem to have shorter survival.”

Get screened

Ng reiterated the importance of screening at the appropriate age for your level of risk: 45 if you are of average risk, and earlier if you have a family history.

She also stressed how crucial it is to put embarrassment and stigma aside and to reach out to your doctor, and even a family member, if you are having unusual symptoms, like those mentioned above.

“It’s so important that we try to normalise these conversations,” she said.

She added she also would like to see physicians routinely and systematically ask their patients two questions: “‘Are you having blood in the stool? Are you having a change in your bowel habits?’ so that these symptoms can come to light.” Especially because many people are reluctant to bring them up themselves.