The share of colorectal cancer diagnoses among people under 55 has nearly doubled in the past three decades, a report says, a shift in disease burden that doctors are working to understand and detect earlier.
The American Cancer Society said Wednesday that about 20% of new colorectal cancer diagnoses were in patients younger than 55 in 2019, up from 11% in 1995. Some 60% of new colorectal cancers in 2019 were diagnosed in advanced stages, the research and advocacy group says, up from 52% in the mid-2000s and 57% in 1995, before screening became widespread.
Colorectal cancer cases and death rates have continued their overall decline for decades thanks to screening, better treatments and reductions in risk factors such as smoking, the ACS report authors said. . But shifting the burden to young people and diagnoses at more advanced stages oncologists on alert.
“The improvements have slowed down, and they have slowed down because of this opposite trend that we see in younger people,” said Kimmie Ng, director of the Young-Onset Colorectal Cancer Center at the Dana-Farber Cancer Institute in Boston. “More and more people are being diagnosed with cancer that may not be curable.”
Colorectal cancer is one of the most common types of cancer in the United States and the second deadliest behind lung cancer. Some 153,000 diagnoses are expected in 2023, the ACS estimates, including some 19,500 cases in people under 50. The cancer is most common in people between the ages of 65 and 74, but the rate of cases in those under 50 has been rising rapidly. The 2020 death of actor Chadwick Boseman from colon cancer at age 43 brought more attention to the trend.
Researchers don’t know why rates among young people are increasing. Changes in known risk factors, including unhealthy diets, alcohol consumption and physical inactivity, could contribute but do not fully explain the trend, the oncologists said. Some believe that environmental changes could reshape the composition of microorganisms in people’s bodies, called the microbiome, putting them at risk.
“I see so many young patients who lead really healthy lives who are diagnosed with metastatic colon cancer,” Dr. Ng said. “There are other environmental exposures that need to be looked at.”
The drivers of the shift to later-stage diagnoses are also unclear, doctors said, but plateauing screening rates are likely contributing. Younger patients also tend to be diagnosed at later stages, in part because doctors may confuse symptoms such as abdominal pain, blood in the stool and unintended weight loss with something else in these cohorts of patients. age.
The ACS and a US government-backed panel in recent years have lowered their recommended threshold for screening to 45 from 50 in light of the trends.
Justin Kelly, 46, said he didn’t realize he was eligible for testing until it happened during a medical checkup last spring. He had no symptoms and considered himself at low risk. His stool-based screening test came back positive and a colonoscopy revealed he had stage three cancer. He receives treatment at Dana-Farber.
Mr. Kelly learned after his diagnosis that he had Lynch Syndrome, a genetic condition that increases the risk of certain cancers. He said a doctor told him that if he hadn’t come and his tumor hadn’t been detected, he probably wouldn’t have lived to be 50.
“It’s quite shocking when you hear something like that,” said Mr. Kelly, who works for a medical device company and lives in Portsmouth, NH. “I have a lot of friends who rushed to plan their colonoscopies after hearing my news.”
About 43% of diagnoses under age 50 are in people between the ages of 45 and 49, the ACS said in its report published in CA: A Cancer Journal for Clinicians.
“There’s a good chunk that’s still under 45,” said Jordan Kharofa, a radiation oncologist at the University of Cincinnati Cancer Center, who was not involved in the study.
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People with a family history of colorectal cancer or other risk factors should speak with their healthcare provider before age 45, said ACS executive director Karen Knudsen. There are also screening gaps among eligible people, Dr Knudsen said. Among people aged 45 to 49, the rate of participation in screening is about 20%, according to the report. Adoption is also low among people without health insurance.
Alaska Natives, American Indians, and Blacks have higher colorectal cancer incidence and death rates than other groups, and men have higher case rates than women. There are also stark geographic disparities, with higher case and death rates in Appalachia and parts of the South and Midwest.
The disparities could reflect differences in risk factors and in access to testing and treatment, the oncologists said. Endoscopy services are limited in much of Alaska, for example, the ACS said, leading to lower screening rates and contributing to a higher disease burden among Alaska Natives. .
Write to Brianna Abbott at email@example.com
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