Colorectal cancer rising in young adults? Physician offers perspective
November 6, 2014 | by Denise Heady
A new study suggests that the colorectal cancer outlook is more grim than many thought, with the number of cases among young adults actually rising. But the study, which made headlines around the country, might not have the obvious message many consumers think.
Donald David, M.D., chief of gastroenterology at City of Hope, says some of the statistics might be linked to detection bias.
First, some context: Colorectal cancer cases and related deaths have been steadily declining in the United States for the past couple of decades. Chalk that up to improvements in prevention, screening and treatment. But the new research found that not only is colorectal cancer rising in young adults, it will probably continue to rise over the next 15 years.
The study, from the University of Texas MD Anderson Cancer Center, estimated that, by 2030, the incidence rates of colon cancer and rectal cancer will increase by 90 percent and 124.2 percent, respectively, for patients aged 20 to 34 years old.
Incidence rates for adults 50 years old or older are expected to continue to decline, with the largest decrease expected for patients older than 75 years.
The study, published online Nov. 5 in JAMA Surgery, analyzed data on nearly 400,000 colon cancer patients from a U.S. database of cancer cases between 1975 and 2010.
The researchers found that overall colon cancer rates are decreasing in the population as a whole, but increasing among people age 30 to 49. In fact, during the years studied, colon cancer rates rose by nearly 2 percent among people age 20 to 34. Further, among young colorectal patients — as with young breast cancer patients — the disease was more likely to be diagnosed at a more advanced stage.
These predictions may seem alarming, but David urges consumers and doctors to consider the bigger picture.
“We are screening more people and generally screening earlier than we used to,” said David. “We are also more cognizant about the importance of family history and rare familial cancer syndromes that emerge earlier in life.”
Although the study highlights the importance of screening tailored to a person's particular family history and risk factors, it should not prompt people in their 30s to run out and get a colonoscopy.
“It’s a very individual sort of thing,” David told Reuters Health in an interview about the study. “There is a national prescription for most people, but there are individual circumstances that only you and your doctors are going to be able to figure out.”
The U.S. Preventive Services Task Force currently recommends regular screening for colon cancer, beginning at age 50, by using fecal occult blood testing, sigmoidoscopy or colonoscopy. Screening should continue until age 74, and the interval between screenings should depend on the method, the task force says.
“The basic screening guidelines have not changed,” said David. “Fifty years old for most, 10 years earlier if there is a family history of colon cancer in a first-degree relative and earlier than that based on special familial situations which are addressed in guidelines."
Cancer risk, and cancer itself, is about the individual.
Learn more about colorectal cancer research and treatment at City of Hope.
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