Better Care Needed to Stem Increase in Early Onset Colorectal Cancer

Better Care Needed to Stem Increase in Early Onset Colorectal Cancer

NEW YORK (Reuters Health) – Comprehensive strategies are needed to stem the increasing worldwide incidence of colorectal cancer in adults under 50, researchers report.

“Patients who are too young for standard screening are often presenting with more advanced disease,” lead author Dr. Cathy Eng of Vanderbilt University Medical Center in Nashville, Tennessee, told Reuters Health. “We need to diagnose our patients earlier so we can save more lives.”

Colorectal cancer has long been considered a disease of older people, the study authors write, but early-onset colorectal cancer with no definitive cause is now a global concern.

Dr. Eng and her colleagues reviewed almost eighteen years of medical literature for information on colorectal cancer published in English that included adults younger than 50 years of age, and they summarized their findings in The Lancet Oncology.

Colorectal cancer incidence in young people is rising, they found. In all ages, it remains the fifth leading cause of cancer worldwide and the fourth most common cancer in the United States.

Over the last two decades, the incidence of colorectal cancer has increased consistently in adults 20 to 54. By 2030, 11% of colon cancers and 23% of rectal cancers are predicted to occur in people under 50.

For average-risk patients, colorectal cancer is often attributed to lack of screening. In 2020, only around 72% of all people between ages 50 and 75 were estimated to have been appropriately screened. Patients younger than 50 were ineligible for screening, so they would present with active disease.

Worldwide guidelines vary, and the U.S. Preventive Services Task Force recently updated its colorectal cancer screening in average-risk patients to begin at age 45.

Preferred screening methods include colonoscopy, flexible sigmoidoscopy, guaiac-based fecal occult blood testing, fecal immunochemical testing, and stool DNA.

Abdominal pain (55%), rectal bleeding (46%), weight loss (35%), and change in bowel habits (32%) were the most common presenting early-onset colorectal cancer symptoms, the study found. Painless bleeding sometimes preceded other symptoms by 2 to 3 years.

Patients with early-onset colorectal cancer often presented with left-sided tumors. Within three months of primary tumor diagnosis, the younger patients were more likely to develop a second tumor. Symptomatic patients waited up to 6 months before seeking care.

Early-onset colorectal cancer is linked with risk factors. Patients have elevated rates of the hereditary condition Lynch syndrome. And tumors in patients under 50 are more likely to have BRAF wild-type genes, absence of methylation, and evidence of chromosomal instability.

“The number of patients with early-onset colorectal cancer I see in clinic has steadily increased over the last 5 years,” co-author Dr. Christina Bailey, also of Vanderbilt University Medical Center, told Reuters Health by email. “We hope these findings heighten the index of suspicion in healthcare providers so they refer young patients with symptoms concerning for colorectal cancer for timely endoscopic evaluation.”

“The new screening age is 45 years,” Dr. Eng noted. “We need to encourage insurance providers to cover the cost of all patients who are 45 years old without risk factors, and younger if they have family history or persistent symptoms.”

The paper did not declare commercial funding. Dr. Eng has involvements with Merck, Pfizer, and Roche. The other authors declare no conflicts of interest.

SOURCE: The Lancet Oncology, online January 22, 2022.

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