In a study published by the American Society against Cancer in March, researchers estimated that, by 2023, 153,000 people will be diagnosed with colorectal cancer in the United States. Of these cases, around 13 percent would correspond to people under 50 years old, which represents an increase of 9 percent of cases in this age group since 2020.
While the new diagnoses of colorectal cancer have been decreasing among people over 50 years of age since their highest figure in 1985, the trends for the most young people are going in the opposite direction, says Steven Itzkowitz, professor of medicine and oncological sciences at the School Icahn de Medicina at the Monte Sinaí hospital in the city of New York.
In addition, the authors of the study reported that cancers diagnosed in people under 50 years old tend to be more aggressive.
“We live in a time when young people, in the flower of life, are contracting colon cancer”, said Itzkowitz. “And unless we are serious about this, we might not have the opportunity to get rid of this disease”.
What is colorectal cancer and who runs the most risk?
Colorectal cancer is the third most frequent type of cancer in the United States. It starts like a polyp, the abnormal growth, in the large intestine, which over time can become cancerous and spread to other parts of the body.
The risk of suffering from this disease is similar in men and women, and increases with age. For example, in the United States, only 5 out of every 100,000 people between 30 and 34 years old develop colon cancer, while 61 out of every 100,000 people between 50 and 54 years old suffer from it, as well as 136 out of every 100,000 people between 70 and 74 years old. People of black or Native American or Alaskan origin are the ones who run the greatest risk, something that many studies attribute to social inequalities and barriers to accessing medical care.
It is also known that the risk of suffering from it increases if you have certain health problems, such as obesity, or if certain foods or drinks are added to your diet (such as alcohol or red or processed meats, such as sausages, pepperoni or hot dogs), in addition to leading a sedentary lifestyle.
Should I be concerned if I am under 45 years old? What are the first symptoms of colorectal cancer?
In the first place, according to Nancy Baxter, colorectal surgeon and director of the Escuela de Población y Salud Global de la Universidad de Melbourne, the increase in the rates of colorectal cancer from early appearance is worrying, but the general risk that a person under 50 years old colon cancer continues to be incredibly low.
“I don’t want panic to spread among the people,” asserted Baxter. Less than 15 out of every 100,000 people between 20 and 49 years old were diagnosed with this disease between 1998 and 2019. “The age is still the most important factor in the personal risk of contracting colorectal cancer”, she added.
That said, you should still be on the lookout for the first warning signs, which can include rectal bleeding, anemia, changes in bowel habits (such as sudden and new squeezing) or any type of abdominal pain. Younger people suffer from rectal bleeding as a first symptom, which doctors believe is possibly due to the fact that their cancers are more likely to occur towards the end of the colon.
If you are under 45 years old and have worrying symptoms, consult a doctor immediately.
Why are cases increasing among younger people?
The investigators do not know it for sure, according to Itzkowitz, and are still working to answer this question, but some changes in risk factors have given some clues.
Itzkowitz asserted that the highest rates of obesity in children and adults could be a relevant factor, as an important study published in 2022 concluded that suffering from obesity at 20 or 30 years old can double with increases in the risk of early onset colorectal cancer.
It has also been suggested that excessive alcohol consumption —which is supposed to be defined as five or more cups for men in a span of two hours, and four or more for women—could be a determining factor. This practice has taken decades to increase among adults aged 30 years or less.
However, perhaps the situation is much more complex, Baxter asserted. Researchers still do not know how childhood risk factors (such as having been born by caesarean section, having taken antibiotics or being exposed to certain environmental factors) can influence the risk of early-onset colorectal cancer, nor what role can the microbiome play .
For example, the consumption of sugary drinks, which increased among adolescents in the 1980s and 1990s, has been linked to a greater risk of early onset of the disease, but it is not clear whether this is due to the sugary drinks themselves or to factors related, such as diabetes or the changes that sugary drinks cause in intestinal bacteria.
To understand why the rates of colorectal cancer among young people are increasing and to prevent this trend from continuing, Baxer said, we must answer these types of questions.
Why do colorectal cancers tend to be more aggressive in young people?
A prevailing theory is that because younger people are less likely to develop colorectal cancer than older people, it is less likely that they and their doctors will notice the first symptoms, which leads to late diagnoses.
“I’ve definitely seen younger people who’ve been moved from one emergency room to another until finally someone says, ‘Maybe this is something more serious,’” Baxter said.
A study published in 2017 in the journal Clinical Gastroenterology and Hepatology, for example, revealed that people younger than 50 years tended to wait a couple of months longer than people older than 50 to receive medical attention after noticing their symptoms for the first time. Baxter said that she believes that this period of time may represent an opportunity for the cancer to progress, although she indicated that once more young people seek medical attention, the treatment time is comparable to that of older adults.
However, added Baxter, the answer to why these cancers seem to grow faster could lie in fundamental biology. “It’s more likely that the cancers that affect younger people are inherently aggressive,” she said. Scientists have discovered that early-appearing colorectal cancers have different molecular, epigenetic and genetic characteristics than those diagnosed later in life. These differences could be contributing to the reason why these cancers are more advanced when they are diagnosed.
What can I do to reduce my risk of colorectal cancer?
Itzkowitz signaled that people under 45 years of age should have honest conversations with their family members about their family’s medical history.
“People don’t take the time necessary to find out their family background or their family members from the vergüenza talking about it, but it’s something simple that any person of any age can do”, he says.
If you have a first-grade relative (for example, one of your parents or a brother) with colorectal cancer diagnosed before the age of 60, or if you have first-grade relatives diagnosed at any age, your risk is greater.
Although it is obvious that you cannot change your family background, you can make some adjustments to your lifestyle to reduce risk, among them:
Take a healthy diet. It has been shown that diets abundant in processed meats (such as hot dogs, bacon and some cold meats) or red meats (such as tenderloin, pork and lamb) increase the risk of colorectal cancer, while diets abundant in fruits, vegetables and whole grains have been shown to be beneficial. Even small changes, such as choosing fiber-rich fruits and vegetables like tentempie instead of fried porridge, or incorporating “lunes without meat” into your weekly meal plan, can make the difference.
Quit smoking. It is known that more than 70 chemical substances present in cigarettes increase the risk of cancer and damage the DNA inside our cells. The patches, chewing gum and nicotine lozenges can help to curb the antojos, according to the Centers for the Control and Prevention of Diseases in the United States and many free applications for smart phones, such as the QuitSTART application, can offer advice, motivation and challenges to help you stop smoking.
Stay active. In a study of nearly 90,000 nurses published in 2018, researchers found that those who were sedentary and watched television more than 14 hours a week were significantly more likely to develop early colorectal cancer than those who watched television less than seven hours a week . Federal guidelines recommend that most adults engage in at least 150 minutes of moderate-intensity activity each week (such as cycling, swimming or gardening) and two days of muscle-strengthening activities (such as lifting weights or flexing).
Reduce alcohol consumption. Excessive alcohol consumption (14 or more drinks a week, according to a study published in 2012) can increase the risk of developing early-onset colorectal cancer. Federal guidelines in the United States recommend limiting consumption to no more than one drink a day for women and no more than two drinks a day for men.
Maintain a healthy weight. Although the body mass index is not a perfect measure of health, researchers have discovered that those with a BMI below 25 run less risk of developing early-onset colorectal cancer. If you have been having weight problems, it is recommended that you talk to your doctor. Currently, adults with obesity are recommended several approved medications to lose weight, such as phentermine or liraglutida.
Periodic reviews. Experts recommend that most people undergo a colonoscopy (or a similar procedure called flexible sigmoidoscopy) at 45 years of age. If you have a family history, or a genetic predisposition to cancer, as in the case of Lynch syndrome, or if you suffer from an intestinal inflammatory disease such as ulcerative colitis, your doctor could recommend that you only test it before the age of 45. In these cases, medical insurance should cover colonoscopies.
If you do not have these risk factors, you could safely cover the colonoscopy only if you have certain symptoms, such as rectal bleeding.
According to the recent study by the American Society against Cancer, four out of every 10 Americans over 45 years of age are not on the day with colorectal cancer detection tests in 2021, and among those who are between 45 and 49 years old, only 20 per cient was there for the day. “Some people say that this is the most preventable but least preventable cancer we are facing”, stated Itzkowitz.
Ultimately, the best detection test for the youngest people is the one that comes true, he sentenced. Speak with your doctor about the pros and cons of each one to make the most appropriate decision.
