By: George Beauregard, DO, Chief Populational Health Officer
Cancer is primarily a disease of aging.
The average age of men discovered to have colorectal cancer (CRC) is 72; for women it’s 68. Factors that place individuals at high risk for developing CRC include having a family history of colon cancer, the presence of adenomatous polyps, and familial polyposis syndromes. People having those circumstances should screen sooner than the currently recommended starting age of 45.
But over the past few decades, a shift in the epidemiology of colon cancer has happened. While colorectal cancer rates in people 50 years or older have declined, rates in people under 50 have risen at a persistently stubborn rate of 2.2 percent per year. The grim pace appears to be increasing. The rates of cases of new under-50 CRC have increased considerably since 1995. It’s projected that by 2030, one-third of all cases of CRC will occur in people younger than 50. What’s particularly frightening is that in most of these cases, there are no signs or symptoms that herald the presence of the disease.
Since the late 90s, colorectal cancer has risen from being the fourth-leading cause of cancer death in men younger than 50 to being the first. In women younger than 50, it now trails only breast cancer. It’s rise to supplanting that as the lead cancer in women under 50 within a few years is a well justified concern.
The causes of this general increase are being investigated, with (Westernized) diet, obesity, sleep disruptions, the gut microbiome, breast feeding, environmental pollution and overuse of antibiotics in newborns, children, and adolescents among possible culprits. Also of note is the finding that younger generations (so-called “birth cohorts”) such as Millennials and GenXers have seen larger increases in certain prime cancers compared to previous generations, suggesting that high incidence rates may persist for decades. It begs the question: what changes in environmental substances and/or new epigenetic or immune system susceptibilities have emerged since the 1990s? Microplastics and energy drink consumption come to mind.
So, stories of younger adults with colorectal cancer are starting to appear more frequently than they should. Previously healthy people under 50, who have little to no signs or symptoms of colon cancer, are typically found to have advanced stage disease, which is less responsive to treatments. Common signs of colon cancer include abdominal pain, blood in the stool, anemia, and diarrhea. The presence of one of these signs increases the risk of CRC 2-fold; having four signs increases the risk 6-fold. These common signs are often dismissed by people having them—and by physicians evaluating those individuals.
It’s known that screening rates for colorectal cancer fall well below the national goal of 80 percent.
In 2021, the Centers for Medicare and Medicaid (CMS) concluded that there was sufficient evidence to support the coverage of a blood-based biomarker test as a suitable screening option for asymptomatic individuals at average risk. This test, which requires approval by the Food and Drug Administration (FDA), may be administered once every three years.
The newer blood-based tests may improve CRC screening rates in people who decline having a colonoscopy or a stool-based test. If not cost prohibitive, they might serve to democratize screening, particularly in populations with limited access to health care providers and services,
While colonoscopy remains the gold standard for screening for colorectal cancer—followed by at home stool-based tests—newer tests, like Exact Sciences Cologuard Plus, and blood-based tests (so-called “liquid biopsies”) like Guardant’s SHIELD, and GRAILs Galleri test—which tests for as many as 50 cancer types—have emerged and show promise for early detection. (Cologuard Plus and the SHIELD test are FDA approved; while the Galleri test isn’t yet.)
In principle, the central idea of early disease detection and treatment is simple. Early detection leads to a higher likelihood of potential cure or improved survival.
Speak with your primary care provider about getting screened and what the current testing options are.
At the end of the day, the best screening test is the one that gets done. Don’t be complacent, get screened…and spread the word.
