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Topic: Colorectal cancer is on the rise in young adults: What Millennials and Gen Zs need to know

Summary

The rate of colorectal cancer among young adults in the US has been increasing since the 1990s. Scientists are trying to figure out why. (Posted 8/15/23)

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Colorectal cancer is on the rise in young adults:  What Millennials and Gen Zs need to know

RELEVANCE

Most relevant for: Young adults. It may also be relevant for:

  • previvors
  • people with a genetic mutation linked to cancer risk
  • healthy people with average cancer risk
  • people with a family history of cancer

Relevance: Medium-High

Relevance Rating Details


What is this topic about?

Colorectal cancer cases in the United States are decreasing, likely due to improved screening and prevention in older adults. However, the American Cancer Society (ACS) reported that the number of colorectal cancer cases among young adults in the US has more than doubled since 1995. The report estimates that about 150,000 people will be diagnosed with colorectal cancer in 2023; about 20,000 of these people will be younger than age 50. The factors driving this rise among young adults remain a mystery.

Wakeup call

Actor Chadwick Boseman, who played King T'Challa in Black Panther, died of colorectal cancer at age 43. Randy Gonzalez, the dad in the popular TikTok comedy duo Enkyboys, was 35 when he died of colorectal cancer. Astros first baseman and former Orioles baseball player Trey Mancini was diagnosed and treated for 3 colorectal cancer at age 28. These news stories emphasize the findings in the recent ACS report that colorectal cancer in young adults is rising.

Since the 1990s, colorectal cancer among young adults has increased by two to four percent per year and even more sharply in people under 30. Advanced colorectal cancer cases—in which cancer has spread to other parts of the body—also increased among young adults. Among younger adults, colorectal cancer is expected to become the leading cause of cancer-related deaths in the US by 2030.

Colorectal cancer cases rose among young adults in every racial and ethnic group in the United States from 2010 through 2019. Annual rates in young adults of different racial and ethnic groups increased by:

  • 0.2% among Black people
  • 1% among Asian American and Pacific Islanders people
  • 2% among non-Hispanic white people
  • 3% among Hispanic people
  • 3% among American Indians and Native Alaskan people

What factors are known to increase the risk of colorectal cancer?

Some factors are known to increase the risk of colorectal cancer, especially for older people. These include obesity, a sedentary (nonactive) lifestyle, a Western diet, and eating or drinking a lot of sugar. However, among young adults, these lifestyle habits alone do not seem to be the reason for the worrisome increase.

Inherited mutations can increase colorectal cancer risk

Colorectal cancer can also be due to an in a gene that increases risk, especially in young adults. This includes mutations in the following genes:

genes

Other genes linked to colorectal cancer risk

  • APC
  • MUTYH

Many people diagnosed with colorectal cancer at a young age may have an . However, because cases due to an have not been increasing among young adults, other factors are suspected of causing the rise in colorectal cancer in this population over the last two decades.

What factors are increasing colorectal cancer in young adults?

The ACS report suggests that the rise of colorectal cancer in young adults is likely due to environmental factors (for example, exposure to a chemical) and/or diet.

Specific causes of the rapid increase in colorectal cancer among young adults remain unknown. Experts are calling for more specialized research, particularly research that focuses on younger patients with colorectal cancer who are from more diverse populations.

Signs and symptoms of colorectal cancer

Symptoms of colorectal cancer are often blamed on other causes, especially at first. This can lead to a delay in diagnosis. 

Some symptoms of colorectal cancer are:

  • changes in bowel habits
  • blood in your stool
  • diarrhea, constipation or feeling that the bowel does not empty
  • persistent pain, aches or cramps in the abdominal (belly) area 
  • unexplained, unplanned weight loss

Among younger colorectal cancer patients, bleeding and abdominal pain are more common than among older patients. The ACS report points out that this is because younger patients are more likely to have left-sided tumors (colorectal cancer that begins on the left side of the colon).

Colorectal Cancer Screening

Colorectal cancer screening is improving. A colonoscopy is considered to be the best screening test because it allows your doctor to look directly at the inside of your colon and then remove any before they turn into cancer. This test uses a long, thin and flexible lighted tube to check for or cancer inside the rectum and the entire colon. Other tests can detect colorectal cancer but are not appropriate for everyone, especially those at higher risk. These include:

  • Home tests that look for cancer and/or blood in the stool
  • CT colonography, also called ”virtual colonoscopy”
    • CT colonography uses X-rays and computers to image the entire colon.
  • Flexible sigmoidoscopy
    • For this test, the doctor inserts a short, thin and flexible lighted tube into the rectum. This test only views the rectum and lower third of the colon.

Colonoscopy is used as a follow-up procedure if anything unusual is found during one of these other screening tests.

Currently, experts recommend that people at average risk start screening for colorectal cancer at age 45. However, if you have any of the following risk factors, you should talk with your healthcare provider about when to begin screening and how often to screen.

  • family history of colorectal cancer
  • personal history of colon
  • or another gene mutation linked to colorectal cancer 
  • an inflammatory bowel disease like Crohn’s disease or ulcerative colitis

What does this mean for me?

If you have any of these symptoms of colorectal cancer, don’t wait—let your doctor know right away. If your symptoms persist, seek out a (GI doctor) for follow-up.  

  • changes in bowel habits
  • blood in your stool
  • diarrhea, constipation or feeling that the bowel does not empty
  • persistent pain, aches or cramps in the abdominal (belly) area 
  • unexplained, unplanned weight loss

If you have any of the following risks, ask your doctor when and how often you should be screened for colorectal cancer:

  • family history of colorectal cancer
  • personal history of colon
  • or another gene mutation linked to colorectal cancer 
  • an inflammatory bowel disease like Crohn’s disease or ulcerative colitis

If you are age 45 or older and have not yet had colorectal cancer screening, ask your doctor about starting regular screening. 

Reference

Siegel, RL, Wagle, NS, Cercek, A, et al. Colorectal cancer statistics, 2023. CA a Cancer Journal for Clinicians. 2023; 73( 3): 233-254.

Disclosure: FORCE receives funding from industry sponsors, including companies that manufacture cancer drugs, tests and devices. All XRAYS articles are written independently of any sponsor and are reviewed by members of our Scientific Advisory Board prior to publication to assure scientific integrity.

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posted 8/15/23

Questions To Ask Your Doctor
Questions To Ask Your Doctor

  • What is my colorectal cancer risk?
  • When and how often should I be screened for colorectal cancer?
  • Will my health insurance cover the cost of colorectal cancer screening?
  • What colorectal cancer screening method is best for me?

Open clinical trials
Open clinical trials

The following are studies looking at colorectal cancer screening or prevention.  ​​​​​

Other colorectal cancer screening and prevention studies may be found here.

Updated: 07/18/2023

Finding experts
Finding experts

The following resources can help you locate an expert near you.

Finding gastroenterologists


Other ways to find experts

  • The National Cancer Institute (NCI)-designated comprehensive cancer centers deliver cutting-edge cancer care to patients in communities across the United States. Most centers have specialized screening and prevention centers for high-risk people. Find a center near you and learn about its specific research capabilities, programs, and initiatives.
  • Register for the FORCE Message Boards to get referrals from other members. Once you register, you can post on the Find a Specialist board to connect with other people who share your situation.

Updated: 04/08/2023

Expert Guidelines
Expert Guidelines

The U.S. government and many health organizations have recommendations for colorectal cancer screening and other preventative measures. Below are the recommendations from the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN) and the U.S. Preventive Services Task Force ().


Screening Recommendations

 

ACS

NCCN

Recommended age to begin routine colorectal cancer screening for people at average risk for the disease

Age 45

Age 45

Age 45 -49
(Grade B)

Age 50 
(Grade A)

Recommended age to discontinue routine screening for those at average risk

Age 75

Age 75

Age 75

Recommends that screening for adults ages 76 to 85 be based on patient preferences, health status, and prior screening history.

Yes

Yes

Yes (Grade C)

Advises against colorectal cancer screening beyond 85 years of age

Yes

-

-

Recommended age to begin routine colorectal cancer screening for people at high risk* for the disease

Before age 45: specific age depends on risk factor

Before age 45: specific age depends on risk factor

-


*People with any of the following are considered high risk: 1) personal history of colorectal cancer or certain types of , 2) family history of colorectal cancer, 3) personal history of inflammatory bowel disease, or 4) a confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or .


Colorectal cancer screening tests

Stool‐based tests are tests performed on a stool (feces) sample to help diagnose conditions affecting the digestive tract, including colorectal cancer. Like most screening diagnostics, the frequency of stool tests varies. Stool tests include:

Stool Test

Recommended frequency

Fecal protein test (FIT)

Once per year

Fecal blood test (gFOBT)

Once per year

Fecal test (FIT-DNA)

Once every 1 or 3 years

 

Structural (visual) examinations look inside the colon and rectum for areas that might be cancerous or have . These include:

Structural examinations

Recommended frequency

Colonoscopy

Once per 10 years

CT colonography

Once per 5 years

Flexible sigmoidoscopy

Once per 5 years

Flexible sigmoidoscopy with FIT

Flexible Sigmoidoscopy every 10 years plus FIT every year


Importantly, of all the screenings available, colonoscopy can prevent many cases of colorectal cancer by finding and removing abnormalities before they can become cancer. Although sigmoidoscopy can also find and remove , this procedure uses a shorter scope that doesn’t examine the entire colon. 

Insurance coverage for screening

Colorectal cancer screenings such as stool-based tests (see descriptions below) beginning at age 45 have been given a grade "A" or "B" by the U.S. Preventive Services Task Force (). This means that these services have shown effectiveness in detecting or preventing the disease. 

  • The Patient Protection and Affordable Care Act (ACA) requires that most health plans cover 100 percent of one colorectal cancer screening at its recommended frequency (see Colorectal cancer screening tests table below) with no out-of-pocket costs to patients who are age 45 and older—no matter their risk. 
  • Medicare beneficiaries—no matter their age—are allowed one colonoscopy covered at 100 percent every six years for those at average risk and one colonoscopy per 24 months for those at high risk.
  • Medicaid coverage of colorectal cancer screening varies by state. Individuals who qualify based on their state’s decision to expand Medicaid under the ACA are entitled to the same screening and preventive services as those who are covered by private insurance.

For individuals at increased risk, certain states require insurance coverage of colonoscopy beyond that required under the ACA. Check with your state insurance commission to determine if you live in one of these states.

Updated: 01/30/2024

Expert Guidelines
Expert Guidelines

The National Comprehensive Cancer Network (NCCN) provides risk management guidelines for people with  mutations.

Colorectal cancer 

  • Colonoscopy every 1-2 years. Speak with your doctor about whether you should be screened yearly or every two years. Men, people over age 40 and individuals with a personal history of colon cancer or colon may benefit most from yearly screenings. 
    • For people with , or EPCAM:
      • beginning between ages 20-25 (or 2-5 years before the earliest age of colon cancer in the family, if diagnosed before age 25).
    • For people with or PMS2: 
      • beginning between ages 30-35 (or 2-5 years before the earliest age of colon cancer in the family, if diagnosed before age 35).
  • Daily aspirin can decrease the risk of colorectal cancer. The best dose and timing for aspirin are unknown. Speak with your doctor about the benefits, risks, best timing and dose.

Endometrial and ovarian cancer

  • Be aware of endometrial and ovarian cancer symptoms.
  • Consider endometrial biopsy every 1-2 years beginning between ages 30-35.
  • Discuss the benefits and risks of oral contraceptives.
  • Consider risk-reducing hysterectomy; discuss risk-reducing removal of ovaries and with your doctor (, , and gene mutations).

Other cancers

  • Consider annual cancer screening with testing and digital rectal exam.
  • For people with a family history of urothelial cancer and men with an mutation:
    • Consider annual urinalysis beginning between ages 30-35.
  • Consider baseline esophagogastroduodenoscopy with random stomach biopsy at age 40. 
    • consider continuing this surveillance every 3-5 years for people in a high-risk category for gastric cancer. 
  • Consider testing for H. pylori and treating if the test is positive. 
  • For people with a family history of pancreatic cancer:
    • Consider annual cholangiopancreatography (MRCP) and/or endoscopic (EUS) beginning at age 50. 
    • Consider participating in a pancreatic cancer screening study. 

Consider annual physical and neurological exams. 

  •  

Updated: 03/09/2023

Peer Support
Peer Support

The following organizations offer peer support services for people with or at high risk for colorectal cancer:

Updated: 02/10/2023

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