Colorectal Cancer in Young Adults
Research tells us that colorectal cancer is no longer a disease that only affects older populations.
While approximately 90% of colorectal cancer cases occur in people over the age of 50, since the mid-1990s, the number of new cases of colorectal cancer (CRC) has been increasing among adults under 55 years old.
Because screening doesn’t typically begin until age 45 due to evidence-based guidelines, many young adults are being overlooked.
A debate exists whether it’s worth it to begin screening at an earlier age, considering risk factors and barriers that come with medical procedures such as the risk of perforation, taking off work, etc.
While adjusting screening guidelines could help catch cases of CRC in earlier stages, large issues still exist; no one knows why the number of cases in young adults is on the rise.
How Can I Prevent Colorectal Cancer If I’m a Young Adult?
There are unique challenges facing the “under 50” community, but there are several ways to prevent colorectal cancer.
As advocates, we must be committed to education. Here’s what we mean:
- Educate providers and medical professionals of the rising incidence of colorectal cancer in the under 50 population (like this study).
- Educate family members around the importance of sharing personal and family history with relatives – including adenomatous polyps and cancer.
- Increase patient awareness to know when to be screened based on family history.
- Educate people not to ignore other risk factors.
- Don’t delay screening when it’s been recommended.
Genetic Testing and Family History
We know that 20-30% of all colorectal cancer patients have a family history of CRC and 3-5% of patients have an inherited genetic syndrome.
Some genetic syndromes may include Lynch syndrome, familial adenomatous polyposis (FAP), MUTYH-associated polyposis, certain hamartomatous polyposis conditions or others.
In 2017, Medical Advisory Board member Heather Hampel of Ohio State worked on a study that found 16% (one out of every six) of CRC patients diagnosed under the age of 50 carried an inherited susceptibility. Read more about the study and implications.
Researchers concluded that due to this high percentage, genetic counseling and multigene panel testing should be considered for ALL patients with early-onset CRC.
Learn more about hereditary CRC.
Get help finding a genetic counselor.
The United States Preventive Services Task Force (USPSTF) makes colorectal cancer screening recommendations for average-risk patients.
(Some of the same tests used to screen for colorectal cancer are used for diagnostic procedures for patients presenting with symptoms.)
But how do those guidelines get set?
Those who set the screening guidelines identify potential risks for screening. Sometimes these risks may outweigh the benefits for preventive screening for an entire population (like all people under age 50).
At the core of the guidelines is the answer to this question, “at what age do we reduce screening to provide optimal benefit and minimal risk*?”
This is a question we must keep asking.
As advocates at Fight CRC, here’s how we’re continuing to stay engaged:
- We comment when the USPSTF solicits public feedback on guideline revisions.
- We support further research that will provide a body of evidence needed to make any guideline changes.
In the case of screening guidelines, we have to stay vigilant.
And we’ve seen it work:
In May 2018, the American Cancer Society (ACS) updated their screening guidelines for average-risk adults to begin at age 45 rather than 50. Read more about the guideline change here.
* In 2016 the USPSTF concluded there is insufficient evidence to reduce the average-risk screening age. Changing the screening guidelines must be grounded in published research and research takes time and funding. We can’t pick an arbitrary age to reduce to; read our response to the 2016 recommendations
In addition to USPSTF and ACS, there are other organizations that create screening guidelines based on a variety of risk, methods, approaches, and timelines:
What Should I Do if I’m Under Age 50?
It is extremely important to talk to your healthcare provider about signs and symptoms, such as (but not limited) to:
- Blood in the stool
- Abdominal pain
- Unintentional weight loss
If you feel like your provider is not taking you seriously about signs or symptoms, advocate for yourself and if needed, find another provider.
It is important to remember that you need to follow-up and have a colonoscopy if it’s recommended. Studies note almost half of patients did not follow up on a colonoscopy when recommended and signs and symptoms were present!
So… The Screening Age is Now 45?
The American Cancer Society (ACS) updated their screening guidelines for average-risk adults. They recommend screening begin at age 45 rather than age 50. Read more about the guideline change here.
We were involved in this research and we know there are many questions about this change. See below for some of the common questions and our responses:
Why Reduce the Age to 45 and Not 40, 35 or Younger?
The modeling studies suggested there would be benefit in finding and preventing cancer at age 45, but the studies didn’t show reduction of incidence for ages lower than that.
It’s important to remember the age is set for the average-risk population (not those at increased or high-risk, or those who have signs or symptoms).
Will Insurance Start Covering Colonoscopy at Age 45?
Some insurance plans may follow the ACS screening guidelines, but many follow USPSTF guidelines.
It’s important to have a conversation with your healthcare provider to understand when screening is recommended for you, and to call your provider and ask what your plan covers and which screening guidelines the insurance carrier follows.
Is the “Get Screened at 50” Recommendation Gone, or Does it Still Apply?
The ACS recommends the average-risk screening age starts at age 45, but USPSTF and many others have not updated, so different guidelines will follow different strategies.
It Was Previously Recommended That African Americans Get Screened at 45; Does This Mean They Should Get Screened at 40 Now?
The USPSTF guidelines recommend African Americans begin screening at age 45. Although the ACS’ new recommendations suggest 45 for average-risk populations, African Americans should continue to follow the recommended screening guidelines and speak to their doctors if they have any concerns or signs and symptoms.
Does This Apply to All Screening Options?
The new guidelines allow for FIT/FOBT annually, sDNA every three years, colonoscopy every 10 years, CT colonography every five years, and flex sig every five years. Read more about screening options.
Cologuard is Only for Those 50+…is That Still the Case or Will it Be Lowered Too?
Cologuard, or sDNA, is listed as one of the approved screening modalities.
I Have a Genetic Syndrome and Qualify as High Risk – How Does This Change Impact Me?
The ACS guidelines are for the average-risk population. Those who are at increased risk or high risk based on genetic and family history will have different guidelines for prevention.
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