Should an increased risk for colon cancer among young and middle-aged adults change screening recommendations?
A new study showing a dramatic rise in colorectal cancers in this non-traditional population — meaning those under the age of 50 — has many asking that question.
So far, though, screening guidelines remain the same, which has researchers pushing for people to know the warning signs, the risks of their lifestyle factors, and their genetic risks. Experts are searching for less invasive screening procedures as well.
The new study, led by the American Cancer Society, finds that those born after 1990 have double — yes, double — the risk for colon cancer and quadruple the risk for rectal cancers compared to those born around 1950. Researchers believe the underlying cause may be due to the ever-increasing weight of the nation, unhealthy diets, and sedentary lifestyles.
“Our finding that colorectal cancer risk for millennials has escalated back to the level of those born in the late 1800s is very sobering,” Rebecca Siegel, MPH, strategic director of Surveillance Information Services at the American Cancer Society, said in a press release.
“Educational campaigns are needed to alert clinicians and the general public about this increase to help reduce delays in diagnosis, which are so prevalent in young people, but also to encourage healthier eating and more active lifestyles to try to reverse this trend,” she added.
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Another large international study this week in the BMJ links obesity with cancers mainly of the digestive organs as well as hormone-related malignancies. Strong associations were found between a high body mass index (BMI) with risk of esophageal, bone marrow, and colon (in men), rectal (in men), biliary tract system, pancreatic, endometrial (in premenopausal women), and kidney cancers.
Weight gain was also associated with a higher risk of gall bladder, gastric cardia, and ovarian cancers, and mortality from multiple myeloma.
Only about 38 percent of those prescribed a colonoscopy actually comply.
Current recommendations call for most people to be screened for colorectal cancer starting at age 50, unless they have a family history of the disease. The study authors, however, are proposing that screening be considered before age 50, especially as those who are younger and who develop the disease are diagnosed late-stage — largely because they’ve not been thinking cancer is a risk and have brushed off the symptoms for years.
“This has been something that has been of concern in the screening and cancer prevention communities,” said Dr. Kisiel, a gastroenterologist at Mayo Clinic and assistant professor of medicine at Mayo Clinic College of Medicine. “Would patients under the age of 50 but of average risk — meaning, lacking a hereditary reason to be screened for colon cancer, benefit from screening at an earlier age?”
Kisiel told LifeZette that a “line in the sand” has been drawn around the age of 40: If screening begins then, would it make a meaningful dent in the course of the illness? “We’ve hypothesized that we would, but there really isn’t any data to support that decision-making. This study emphasizes that we need a higher level of research to determine if the benefit that we hope for will be realized.”
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The concern with screening too early is the cost versus the benefit. Procedures are often done that may not be necessary or do more harm than good to a patient. And screenings aren’t cheap — that is another consideration.
But we tend to avoid screenings anyway. We don’t like the process. Only about 38 percent of those prescribed a colonoscopy comply. And relying on patients to recognize the symptoms to catch a cancer early may be inadequate, said Kisiel.
It’s why he and the Mayo Clinic have worked with Exact Sciences to develop a less-invasive screening test, Cologuard. In June of 2016, the U.S. Preventive Services Task Force (USPSTF) issued an “A” rating to the newer screening option — a noninvasive at-home stool DNA test, as well as virtual colonoscopy (CT colonography). The hope is that more Americans will be open to getting these less invasive screenings.
Until then, Americans can take some very simple steps to reduce the risk of colorectal cancers: eat more vegetables, fruits, and whole grains; get regular exercise; watch your weight; avoid tobacco; limit your alcohol; and know the signs. Where colorectal cancers are concerned specifically, any unintended weight loss, weakness and fatigue, or a change in bowel habits or blood in your stool that lasts more than a few days are signs that need to be checked by a physician.