Daniel Lavy, MD, a colorectal surgeon at Bridgeport Hospital and assistant professor of Surgery at Yale School of Medicine and Smilow Cancer Hospital, shares his insights on why colon and colorectal cancer is on the rise among younger people.
It used to be considered an “old person’s disease.” But today, younger individuals – both men and women under age 50 – are being diagnosed with colon or colorectal cancer. It’s a disturbing trend that is raising more questions than answers.
“Unfortunately, we are seeing more and more young patients with a diagnosis of colon and rectal cancer, not only in our practice but across the country as well,” said Daniel Lavy, MD, a colorectal surgeon at Bridgeport Hospital and assistant professor of Surgery at Yale School of Medicine and Smilow Cancer Hospital. “The ‘younger population’ are those individuals diagnosed under the age of 50.”
Today, the lifetime risk of developing colorectal cancer is 1 in 23 for men and 1 in 25 for women, so men in this younger population have a slightly higher incidence of mortality when compared with women in the same age group.
“We don’t know exactly why, but I think it is important to note that both sexes are at significant risk of developing colon and rectal cancer,” he said.
What’s changed?
“We think it’s a combination of not only genetics, but a component of diet and lifestyle,” Dr. Lavy said. “There are good studies to support that diets high in processed or smoked meats increase your risk for colon cancer. It’s some combination of genetics and our environmental factors.
“What’s interesting is that when you look at the overall mortality rate for colorectal cancer, it’s been declining in older populations,” Dr. Lavy said. “And despite this, there is an increase in mortality in younger individuals.”
Colorectal cancer death rates have risen about 1 percent annually in those under the age of 50 since 2005. “The rising mortality rate in the younger patients, I think, emphasizes the need for more awareness and potentially earlier screening interventions in this demographic,” he said.
“When you compare that to an older population that has experienced a decline in colorectal cancer mortality over the past few decades – and we attribute that to better screening programs – we’re recommending that everyone get colon cancer screening at the age of 45, and we are detecting things sooner.”
Symptoms to watch for
Malignancies start in the colon and rectum as a polyp, which is a growth on the inner-lining of the large intestine or the rectum and, over time, can transition to cancer.
Some polyps are completely benign and will never become cancerous.
Dr. Lavy said the youngest patient he has encountered is a 28-year-old, who had painless, rectal bleeding. A subsequent colonoscopy found an early cancer, and the patient was cured through surgery.
“The main advantage of a colonoscopy is to detect these polyps before they have a chance to transition to cancer,” Dr. Lavy said. “What’s nice about a colonoscopy is we can remove the polyp before it has a chance to progress. So, that’s why when we say a colonoscopy is lifesaving, it can really prevent cancer.”
Symptoms that should prompt an evaluation by a physician – either the primary care physician, gastroenterologist or colorectal surgeon – include:
- Any kind of rectal bleeding
- Unexplained abdominal pain
- Changes in bowel habits, like new onset diarrhea
- Any kind of unexplained weight loss
These are all warning signs, Dr. Lavy explained.
“It doesn’t necessarily mean that you need a colonoscopy and that you have cancer, but these symptoms should alert you to seek help and have a further workup,” he said.
Types of colonoscopies
“We do have national guidelines that recommend that everybody get screened for colon cancer at the age of 45, but we don’t routinely screen those younger than 45. That’s why it’s important for these younger patients to tell us if they’re having symptoms,” Dr. Lavy said.
Noninvasive options exist — which can be suitable for some patients — but all should be followed by a colonoscopy if they are positive.
“If you’re otherwise healthy and you can tolerate a minor procedure, there is no reason in my mind not to do a colonoscopy,” Dr. Lavy noted. “I think the hardest part of the procedure is the day before, when you have to do a bowel regimen. The day of the procedure, you go to the hospital, they give you an I.V., and some people describe it as the best nap they’ve ever had.”
Takeaways
Genetic testing should be considered in any young patient under age 50 diagnosed with a new colorectal cancer, Dr. Lavy advised.
But the most important takeaway? “Get your colonoscopy!” Dr. Lavy said. “If you are 45 or older and have not yet undergone the procedure, there is no reason to delay. If there are specific concerns preventing you from proceeding at this time, I encourage you to discuss these with your physician, who can also review alternative screening options based on your preferences, risk factors and medical history. Ultimately, the most effective screening test is the one that gets completed,” he said.
Learn more about colorectal surgery at Bridgeport Hospital.
