Screening: Young Adults and the Alarming Rise of Colorectal Cancer

Although colorectal cancer mortality rates have declined in people over 65 due to increased diagnoses and better screening options, a concerning trend has emerged. Since the 1990s, the rate of colorectal cancer has more than doubled among adults younger than 50. Alarmingly, more younger people are dying from the disease.

Anton Bilchik, M.D., professor of surgery and chief of gastrointestinal research program at the Providence Saint John's Cancer Institute, has been involved in cancer research for 25 years. "Tragically, we've seen a massive increase in people under 45 being diagnosed with colon cancer," he says. "There isn't any other cancer that's increasing at such an alarming rate in young people. So much so that screening guidelines were reduced in the last year from age 50 to age 45. However, we really should be screening high-risk groups such as African Americans at age 40."

Even more concerning is the fact that researchers are finding most of the young people diagnosed with the cancer don’t have the common risk factors: family history, obesity, diabetes and a sedentary lifestyle. "That's what is alarming to us in this field. Many of these people are healthy, eat well, don't smoke, and have no family history of colorectal cancer," says Dr. Bilchik.

Experts have hypothesized that a probable cause of colon cancer in young adults may have three interrelated factors: an unhealthy diet, bacteria in the gut and inflammation. "The two trillion bacteria in our gut (microbiome) control our immune system and protect us against diseases such as cardiovascular disease. Disrupting the balance of bacteria in the body could aid in the growth and spread of colorectal cancer," says Dr. Bilchik.

Most Colon Cancer is Preventable

Prevention needs to start at a young age, not in the 30s and 40s when bad habits have been established. Parents need to raise children with healthy diets. A diet high in processed foods and red meat has been directly linked to an increase in cancer. Dr. Bilchik highlights these prevention tips that can begin with toddlers:

• Fast food and processed foods should be eaten a couple times a month, not daily.
• Limit consumption of red meat.
• Avoid antibiotics, if possible. There may be link between unnecessary antibiotics, causing disruption of the microbiome and immune system and colorectal cancer. Pediatric patients often get sore throats and are automatically put on an antibiotic. That overuse may cause a disruption of the good bacteria in the body, which we need to protect us from getting sick.

Early Warning Signs

Dr. Bilchik encourages physicians to share this important information with their patients and encourages everyone to shed the notion that colorectal cancer is an old person’s disease.  Everyone should get used to looking at their stool and notice changes, including:

• Changes in bowel habits or stool character that last longer than a few days, such as constipation and diarrhea
• Rectal bleeding (bright red blood)
• Blood in stool
• Abdominal pain or cramping
• Persistent abdominal bloating and pain
• Unintentional weight loss
• Fatigue and weakness
• Persistent feeling that you need to have a bowel movement, even after using the restroom

A person should seek immediate medical attention if symptoms increase in frequency or if they experience several at the same time. "Awareness of symptoms and what they may represent is very important. Unfortunately, we see many people who have had concerning symptoms that were not addressed for months or even years before seeking medical attention."

Continuing research, such as the genomic program at Providence Saint John's Cancer Institute, will help define early-onset colorectal cancer's causes and risk factors. Which, in turn, will likely help inform approaches for prevention, screening and treatment, says Dr. Bilchik. "The work being done at Saint John's Cancer Center is very exciting. We're analyzing the tissue of young adults to see if we can identify changes at the genomic level and we already see some differences."

Helpful Tips for Your Patients

Current ACS guidelines recommend that people at average risk of colorectal cancer begin screening at age 45. However, for those younger than 45, tailoring colorectal cancer screening approaches to each person based on their risk factors (called precision screening) may improve the efficiency and cost-effectiveness of screening.

According to Dr. Bilchik, screening for colon cancer doesn't necessarily mean you have to undergo a colonoscopy, which generally requires sedation; stool-based tests such as Cologuard are also available. "I think it's really important that people know their options, because those who are put off by a colonoscopy might otherwise be convinced to do the stool test."

For older adults, in addition to regular screening and paying attention to possible symptoms:

• Stop smoking.
• Lose weight.
• Exercise 30 minutes, five days a week. It has an anti-inflammatory effect, an anti-cancer effect.
• Eat sensibly. Avoid processed foods. Enjoy your BBQ occasionally, but not often. There are carcinogens that cause colorectal cancer.
• Limit red meat consumption.

Dr. Bilchik currently shares a medical directorship for the Digestive Health Institute at Saint John’s and is on the Stand Up To Cancer dream team. He credits his untiring drive of eradicating colon cancer to actor Chadwick Boseman, with whom he formed a close bond after treating him for four years. Boseman died of colorectal cancer in August 2020. He was only 43 years old.