Colorectal Cancer Death Rates Rising In Younger People – 3 Key Takeaways

Written By:Sandy McDowell

Editor's Note May 30, 2018:

The American Cancer Society lowered our colorectal cancer screening recommended starting age to 45 for people of average risk. The guideline was changed, based in part, on new data showing rates of colorectal cancer are increasing in younger populations. The update was made to save more lives by finding colorectal cancer early, or preventing it from even happening. The updated guideline differs from the previous guideline in the starting age, the type of tests for screening, and recommendation about age-specific recommendations for stopping screening.

If you’re younger than 50, it’s possible you haven’t thought much about getting colorectal cancer. But emerging evidence shows that you should start paying attention. A new study from American Cancer Society researchers reveals that the death rate for colorectal cancer among adults ages 20 to 54 has been increasing since the mid-2000s. This is a new trend. In the 1980s and 1990s, colorectal cancer death rates in this age group had been going down.

The study was published August 8 in the Journal of the American Medical Association. The findings follow a February 2017 study from the same researchers. That study found that young and middle-aged adults were being diagnosed with colorectal cancer at an increasing rate as far back as the 1980s for the youngest age groups (20 to 39 years). The reasons for the trend are still not answered. To provide more clues, Rebecca Siegel, MPH, and her colleagues analyzed cancer death rates from 1970 to 2014. Their dive into the death rate data generated 3 major findings.

Major Finding #1: The death rate for colorectal cancer in adults ages 20 to 54 increased by 1% each year from 2004 to 2014. Before then, from the mid-1970s through the 1990s, the death rate had been decreasing by almost 2% each year.  

The details: Some experts saw the prior reports about the increase in colorectal cancer in young age groups as positive news. They believed the increase in diagnoses was from improved detection through screening, such as with colonoscopy, instead of an increase in diagnoses from more disease. The new study strengthens the evidence that the rise in incidence is not a result of screening alone. “Finding colorectal cancers earlier through screening wouldn’t be expected to increase the death rate,” Siegel explains. “If the increased incidence was only because of earlier detection, if anything we might see a decrease in death rates. Instead, the death rates are increasing in this age group.”

The takeaway: The 5-year survival rate for colorectal cancer when it’s diagnosed at an early stage is 90%, but diagnosis in younger people is often delayed. “People don’t think about colorectal cancer in young people,” Siegel says. “So patients may delay seeing their doctors for symptoms, like rectal bleeding or persistent abdominal cramping. And primary care doctors often attribute persistent symptoms to more common problems like hemorrhoids or constipation.” That delay can allow cancers to grow, so they’re not found until the cancer is larger or has spread, at a later stage when the survival rate is not as high.

Younger people and their doctors also need to know and act on screening guidelines for people at an increased risk for colon or rectal cancer. People who are at increased risk for the disease, such as those who have a first-degree relative (a parent, sister, brother, or child) with colon cancer, rectal cancer, or who had precancerous polyps (called adenomatous polyps) should talk with their doctor about starting screening early, before age 50. The timing of the first screening varies based on medical and family history.

Your health insurance may not cover colonoscopy or other tests to screen for cancer if you’re younger than 50 unless you fall into a category of people who need early screening. But if you have a colonoscopy to evaluate symptoms, the tests help with diagnosis and your health insurance most likely will cover them, regardless of your age. 

Major Finding #2: The death rate for colorectal cancer among those ages 20 to 54 increased in white people by 1.4% each year since 2004. In contrast, the death rate slowly decreased in Black people throughout the 45 years studied. 

The details: The difference between races is perplexing, says Siegel. “This is in contrast with trends for major risk factors, which are similar in Blacks and whites,” she says. These risk factors include being overweight or obese, smoking, drinking too much alcohol, and getting too little exercise and activity. “Although the trend in death rates is consistent with the cancer incidence rate, we don’t know why the increase in disease in this age group is only in the white population.”

The takeaway: Siegel says the racial differences in disease trends are surprising because of the similarities in risk factors. “To understand why this is happening, more research is needed on what causes colorectal tumors.” 

Major Finding #3: The death rate is also increasing among adults in the screening population – people in their early 50s. 

The details: When Siegel looked within the 20- to 54-year-old segment, she found that death rates for colorectal cancer were increasing even among those 50- to 54-years old – people who should be getting screened for these cancers. 

The takeaway: This finding provides an opportunity to highlight that people often delay getting their first colorectal cancer screening test, says Siegel. Screening for colorectal cancer should start at age 50 for people of average risk, according to guidelines from the American Cancer Society, the U.S. Preventive Services Task Force, and the American College of Gastroenterology. Average risk means you don’t have a personal or family history or other high-risk factors. “In 2015, only 46% of adults ages 50 to 54 were up to date with their screening,” Siegel says, “compared to 67% of those 55 and older, according to the National Center for Health Statistics.”  

It’s still common to hear people claim they don’t need a colonoscopy because they don’t have any problem with their digestion or bowel movements. “There’s a need to increase awareness that screening is for people without symptoms,” Siegel says. “And that’s where public health messages and health care providers can help.”

Plus, many people automatically respond negatively to the suggestion of screening, saying, “I don’t want to know if anything’s wrong,” or “I’m afraid of what I’ll find out.” “We need to educate and re-emphasize that screening for colorectal cancer with recommended tests can save lives not only by finding cancer earlier, when treatment is usually more successful but also by preventing cancer entirely by removing precancerous polyps,” Siegel says.

“When it’s time to update colorectal screening guidelines, this evidence, along with evidence from other recent research, should be considered, especially since other studies show it might be more helpful to start screening at age 45 instead of age 50” Siegel says.

In future studies, Siegel’s team will look at the rise in colorectal cancer in those younger than age 55 from different angles to try to learn more about this disturbing trend.

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