Many were stunned to learn of the recent death from colon cancer of Chadwick Boseman, star of the 2018 film “Black Panther.” Boseman was just 43, and many think of colon cancer as a disease of older people. That is a misconception that can prove deadly, according to Mark Hanna, M.D., a colorectal surgeon at City of Hope.
Unfortunately, Boseman’s case is no aberration. While colon cancer rates among older adults have been declining due to screening, they have been increasing alarmingly over the last five to 10 years in those under age 50, according to Hanna.
According to the American Cancer Society (ACS), about 104,000 cases of colon cancer will be diagnosed this year. Another 43,000 cases of rectal cancer will be detected. Around 12%, or 18,000 cases, will be found in people under age 50. Because of this, just three years ago, the ACS amended its colon cancer guidelines to recommend beginning screening at age 45 instead of age 50 for those of average risk. “And we may be heading to screening even earlier,” Hanna said.
Why Are Young People Getting Colorectal Cancer?
No one is really sure what accounts for the increased incidence among the young, although it is a hot topic for study. “I think genetics contributes to some degree, but I think there are other factors involved that we haven’t identified yet,” said Andreas M. Kaiser, M.D., clinical professor and chief of colorectal surgery at City of Hope and clinical professor in the Department of Surgery. “It’s likely a combination of genes and environment. There must be some genes that we simply don’t know about yet — we see patients where the known gene mutations are not there.”
Some have linked obesity to the issue. “The increasing obesity pandemic, especially among younger adults, may be contributing to some of this,” Hanna said.
Race is also a factor. African Americans and Hispanics are at a higher risk for colorectal cancer, Hanna said, and when they are diagnosed it is typically at later stages than Caucasian patients. “Genetically it seems likely they are at higher risk, but there is also probably a socioeconomic dynamic here,” Hanna said. “Usually patients who are minorities are of lower socioeconomic status, so they have decreased access to timely care and screenings. Unfortunately, we see that very frequently in the population that we treat.”
Delays in Detection
A serious problem is that younger people often don’t go to the doctor when they have symptoms, or when they do, signs of colon cancer are dismissed because of their age. “Just this morning I had a 23-year-old patient,” Kaiser said. “With these young folks, there is often a delay in diagnosis because even if they have symptoms like bleeding, they think it can’t be because they have cancer.”
In addition to taking your symptoms seriously yourself, don't let your doctor brush off your symptoms. A survey conducted by Colorectal Cancer Alliance earlier this year found that 75% of colorectal patients said they had visited two or more doctors before getting their diagnosis.
Kaiser said he has seen colon cancer patients as young as their teens. “It’s heartbreaking. It’s heartbreaking at any age, but in someone with their whole life and dreams ahead of them, it’s really heartbreaking.”
And unfortunately, colon cancer tends to be more aggressive in young people. “When we have somebody who is 60 or 70, those tumors probably evolved over five or 10 years. It’s a slow process,” Kaiser said. “In somebody who’s young, all of these changes happen much faster. It’s more like two to three years, or even less than that.”
Don’t Ignore These Symptoms
That is why early detection is key to survival, especially in the young. Usually the first symptom that most patients will experience is vague abdominal pain that persists for more than three months, Hanna said. Painless rectal bleeding or blood in the stool is another “classic sign.”
“Those are the two earliest signs you’ll see. As patients get more advanced disease, they’ll have severe abdominal pain, change in their stool caliber (the size of the stool becomes smaller as the cancer grows because it blocks the movement of the colon), and unintentional weight loss.”
If you are having any of what Hanna calls the “five red-flag symptoms,” go get an evaluation by your primary-care physician— no matter what age you are, Hanna said. “Don’t ignore your symptoms — even if you think they’re mild, even if you think they’re probably nothing, even if you know you have hemorrhoids. If the symptoms persist, there is no downside to getting checked. Colon cancer is one of the very few cancers that we have where we have a very good, effective screening test. Colonoscopy has been shown to decrease the incidence of cancer and the mortality from cancer, and it’s a very well-tolerated test. Do not be afraid to get a colonoscopy if you need it. It can save your life. “
The five signs are:
- Rectal bleeding
- Change in bowel habits
- Unintentional weight loss of 10 pounds or more
- Blood in the stool
- Abdominal cramping or pain
What’s on the Horizon
Kaiser said treatment innovations for colorectal cancer are constantly evolving. “Surgery has made tremendous changes. There have also been absolutely unthinkable developments in terms of chemotherapy,” he said. “If somebody had a metastatic tumor 30 years ago, the average life expectancy would have been maybe six months. And now we sometimes have patients who live for many years with metastatic cancer.” He said that City of Hope is at the forefront of immunotherapies for colon cancer as well.
He added that City of Hope has been performing genomic sequencing on patients’ colon cancer tumors for years now. “We were one of the first places to do it, and I think it’s much more advanced here than at many other places. Figuring out which treatments might work better or less well — we try to find that information in the genes.”
While colon cancer among young people is a troubling trend, “The important thing to know is that there will most often be symptoms in the early stages,” Hanna said. “As long as you get checked in an appropriate, timely manner, colon cancer is very treatable.”