Since the mid-1990s, rates of colon and rectal cancer have been rising in people under the age of 50, and the cause is still largely unknown. It’s now established that early-age onset colorectal cancer (EAO CRC) patients are more often diagnosed at an advanced stage compared to  those diagnosed over age 50, and face unique challenges such as family planning, financial strains, and career disruptions.

Fight Colorectal Cancer (Fight CRC) President, Anjee Davis, joined authors Dr. Nilo Azad, Rebecca Siegel, Dr. Christopher Jakubowski, and Dr. Stacey Fedewa in publishing a book chapter, Colorectal Cancer in the Young: Epidemiology, Prevention, Management in the American Society of Clinical Oncology (ASCO) Educational Book.

Our very own Anjee Davis will join Dr. Nilo Azad and Dr. Rebecca Siegel on August 8th, to dive into the unique challenges young people diagnosed with colon or rectal cancer face. This was initially planned to be a live session, but given current conditions of the COVID-19 pandemic, it will now be a virtual panel discussion.

The ASCO20 Education Program will be available in an all-virtual format – on-demand videos, slides, and meeting materials, scheduled broadcast sessions, virtual networking and exhibits – starting Saturday, August 8

Research Summary

To understand the key takeaways from the published manuscript, we reached out to authors Dr. Azad and Ms. Siegel. According to Dr. Azad, “the goal of the manuscript is to educate the oncology and other provider communities about the increasing incidence and special needs of early onset colorectal cancer.”

Several primary points from their manuscript include:

  • Screening for CRC in average-risk patients (no family history or predisposing conditions) is recommended by the American Cancer Society to begin at age 45.
  • Patients present with characteristic symptoms of abdominal pain, rectal bleeding, and changes in bowel habits, but diagnosis often is delayed.
  • Currently, patients with EAO CRC are treated in the adjuvant and metastatic setting, just as their older counterparts are.
  • Fertility, pregnancy, sexual health, financial toxicity, and long-term survivorship challenges are some of the unique issues in the management of EAO CRC.

Dr. Azad noted the “incidence is increasing especially for rectal cancer. Providers need to keep a higher index of suspicion for colorectal cancer conditions.” Ms. Siegel also stressed the importance of “destigmatizing the disease and symptoms to reduce the time before initial provider visit, which appears to account for much of the delayed diagnosis.”

Early last year, researchers from the University of Colorado Cancer Center presented results on prolonged rectal bleeding before diagnosis in early-age onset colorectal cancer patients. Of 211 EAO CRC patients, over half of the patients had rectal bleeding prior to diagnosis, and on average, it took 271.17 days to diagnose these cases with CRC. 

According to the manuscript authors, “this challenge can be addressed by working with national primary care groups to educate the provider community about the changing incidence of this entity. Primary care physicians and other clinicians can have a dramatic impact on the morbidity and mortality of EAO-CRC by ruling out serious causes of these symptoms in young patients (rectal bleeding, abdominal pain, change in bowel habits, and anemia).”

Anjee points out a need to empower young patients and was echoed by all the speakers on this panel. We can and should encourage patients to ask difficult questions about long-term survivorship issues from the beginning of their care, including those around the cost and impact on sexual health, fertility, and quality of life.


Next Steps

It is a reflection of progress that during ASCO’s Educational Program the voices of the EAO CRC community are being heard and presented.

Fight CRC’s research and advocacy team won’t stop there, as many questions still surround EAO CRC, such as:

  • Why is this increased incidence happening? 
  • How can we thread the needle about diagnosing EAO CRC at earlier stages without overly testing healthy young patients with benign issues?

Through Fight CRC’s EAO CRC working group, we aim to tackle these questions. Read more about the working group and how you can get involved.

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