The face of colorectal cancer is getting younger by the day. Meanwhile, researchers are potentially years away from understanding why.
Just weeks after actor James Van Der Beek died of colorectal cancer at 48, new data published Monday by the American Cancer Society features grim statistics about the rise of colon and rectal cancers, which are now the third most commonly diagnosed and second most deadly cancers in the US.
For some demographics, however, the findings contain reason to celebrate: Mortality rates among adults 65 and older have fallen by 2.3% annually since 2012.
But for everyone else, colorectal cancer diagnoses and deaths are increasingly common. And as younger generations age, researchers are warning that their colorectal cancer burden will “swell like a tsunami.”
In the US this year, there will be an estimated 108,860 new cases of colon tumors and 49,990 cases of rectal tumors, according to the new data. Nearly half of those new diagnoses will be in individuals younger than 65.
That disparity is almost 30% higher than it was in 1995. And it’s estimated that nearly a third of those who die from colorectal cancers this year will be younger than 65.
While the overall rate of colorectal cancer diagnoses has been in decline since its peak in 1985 — reflecting changes to things like smoking habits and increased preventative screenings for older people — the researchers behind this data say those numbers “mask” a disturbing trend in younger generations.
They clarify, that colorectal cancer risk is more closely associated with generation rather than age. Colorectal cancer “incidence is not increasing in young adults per se but, rather, in every generation born after circa 1950 in the United States,” according to the study.
This “birth-cohort effect” may provide some answers about why certain demographics are encountering this disease with more frequency.
One hypothesis blames the drastic changes in carcinogen exposure that happened in the 1950s, including the mass manufacturing of plastics and other synthetic materials, as well as highly processed foods.
It’s possible that some of those changes are associated with inflammatory bowel disease, a risk factor for colorectal cancer, which has been increasingly observed in younger patients.
But the true effects of things like ultraprocessed foods, microplastics and antibiotics on gut health remains unknown.
Young people are diagnosed later than older people
Three in four colorectal cancer patients younger than 50 are diagnosed with advanced disease, compared to less than a quarter of older patients, thanks in part to diagnostic delays.
It can sometimes take up to 40% longer for a younger person to start treatment for reasons that range from misdiagnosis to health insurance–related hold-ups.
These delays are even more common among different races and ethnic groups — which face a number of barriers to screenings and preventative care — and can have deadly consequences. The later the stage at diagnosis, the less likely the patient will survive.
Despite higher rates of diagnosis, however, younger patients have similar survival rates to older patients. Researchers think this is due to overall health at the time of diagnosis, plus an ability to tolerate more aggressive treatments and remain active in the period following treatment.
Treatment has different implications for younger people
But more intensive treatment isn’t always the right choice — and overtreatment of early onset disease “is an increasing concern” and “the focus of ongoing clinical trials,” according to the study.
Treatment of rectal tumors in particular can have serious implications on fertility, which will be an increasing concern for colorectal cancer patients as they skew younger and younger.
Knowing risk factors and symptoms is life or death
Early screenings and colonoscopies can reduce mortality by close to 60%, detecting precancerous lesions and polyps and identifying asymptomatic early stage cancer, which is significantly easier to treat.
For anyone with an average risk of colorectal cancer, the recommended age to begin screening has recently been lowered from 50 to 45 years. But for those with a family history of colorectal cancers or those with inflammatory bowel disease, screening should start earlier, or with the onset of any symptoms.
The American Cancer Society identified “red flag” symptoms as rectal bleeding, abdominal pain, diarrhea and iron-deficiency anemia.
Other risk factors include obesity, Type-2 diabetes, smoking and very heavy consumption of processed meat or alcohol (more than three drinks per day).
Research suggests that regular physical activity and a diet rich with whole grains, fiber and dairy can potentially lower overall risk. But experts are stressing the urgent need for more thorough investigation into the causes and potential treatments for this increasingly common disease.
