Marc Sonenshine, M.D.
Board Certified, Internal Medicine and Gastroenterology
Atlanta Gastroenterology Associates, affiliated with Northside Hospital in Atlanta, GA
Many of us, think of colorectal cancer as an older person’s problem, but the recent data that is out about colorectal cancer is alarming. Incidences of colorectal cancer have been decreasing by about 1 percent a year since the mid 1980s, but incidences among people under 50 — the recommended screening age — has been increasing sharply, and these younger patients are more likely to present with advanced disease.
The study, published in JAMA Surgery, used a national database of 400,000 patients with colon or rectal cancer. Incidences decreased by about 1 percent a year over all but rose among people 20 to 34, with the largest increase — 1.8 percent a year — in disease that had already progressed to other organs.
Incidence rates today, per 100,000 people, are 3 for ages 20 to 34; 17 for ages 35 to 49; and 300 for people over 50. But by 2030, the researchers estimate, one in 10 colon cancers and one in four rectal cancers will be in people under 50, and rates among those over 50 will be 175 per 100,000.
LiveLiving: What do you think is causing this increase of colorectal cancer among young people?
Sonenshine: There is no scientific data explaining the increase in colorectal cancer among young adults. However, I suspect lifestyle choices play a key role – lack of a well-balanced diet, a sedentary lifestyle, and tobacco use.
Screening is one way to prevent and detect this disease. But it is usually recommended at age 50. Should screening begin earlier then?
Although the JAMA article demonstrates an increase in colorectal cancer for patients under 50, I would not recommend changing the recommended screening age. Of all colorectal cancer diagnoses, the majority of cases are still seen arise in patients over 50. Initial screening occurs in patients with or without symptoms. But with the increase seen in younger adults, any patient with symptoms should be evaluated by a gastroenterologist. Those symptoms include rectal bleeding, change in bowel habits, abdominal pain, unexplained weight loss, and low blood counts (anemia). Finally, patients with a family history should be monitored more closely with screening considered at an earlier age.
LiveLiving: Are there risks involved in beginning screening before 50?
Sonenshine: The risks to an individual for screening before 50 simply pertains to the procedure itself, the associated anesthesia, and the cost. Overall, those risks are extremely low. On a broader, societal level, where economics of healthcare remain a challenge, the cost to expand screening — especially via colonoscopy to a younger population – would not create value nor save enough lives for the expanded use of limited resources.
LiveLiving: What are the symptoms of colorectal cancer that one should look out for?
Sonenshine: Screening is performed in patients that are asymptomatic, and that is why it is so important because early cancers can be found before they spread and cause symptoms. The common symptoms for colorectal cancer are rectal bleeding, change in bowel habits (i.e. increased constipation, change in caliber of stools), abdominal pain, weight loss, and low blood counts (anemia).
LiveLiving: Is there a connection with HPV (human papilloma virus) in rectal cancer?
Sonenshine: The JAMA article describes the increased incidence of adenocarcinoma of the colon and rectum (colorectal cancer) in young adults but an overall decrease when all ages of society are factored. There is no link between HPV and adenocarcinoma of colorectal cancer. However, squamous cell cancer of the anus is related to HPV, and, with new recommendations for vaccinating young people for HPV, hopefully we will see a decrease in the already rare squamous cell cancer of the anus.
LiveLiving: What other solutions would you recommend in preventing this disease?
Sonenshine: I believe the best way to prevent colorectal cancer is screening appropriate adults. Only 60% of eligible adults over 50 (45 for African Americans) actually get screened. So, if we could increase that rate to 100%, we would markedly reduce the number of colorectal cancers. Further, we must be more aggressive in screening patients with a family history of colorectal cancer while also evaluating patients with any symptoms of rectal bleeding, change in bowel habits, ongoing abdominal pain, and low blood counts (anemia).
