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Colorectal cancer, traditionally considered a disease of the elderly, is increasingly being diagnosed in patients aged 20-54 years. Physicians and patients alike should be aware of this disturbing trend.
When researchers reported that the incidence of colorectal cancer among adults in their twenties and thirties had risen, the scientific world was skeptical about the revelations. It was suggested that the obtained results would inform not so much about the actual increase in the number of cases, but rather about earlier diagnosis, which would be more beneficial for patients.
Now, however, a new study has dispelled the doubts on this point: it’s not that young Americans are simply being diagnosed with colorectal cancer earlier. They actually die from this type of cancer a little more often than in previous decades, and no one really knows why.
There will be more and more sick people
“It’s a fact,” emphasizes Rebecca L. Siegel, an epidemiologist at the American Cancer Association and lead author of the study, published in the Journal of the American Medical Association (JAMA), and an earlier report. – We are talking about a slight increase, but this trend, which has only emerged in the last decade, does not look temporary in my opinion. The disease begins to hit younger and younger people.
A recent study found that while the risk of dying from colorectal cancer or rectal cancer decreased in the population as a whole, mortality in the 20-54 age group slightly increased: 4,3 deaths per 100. people in 2014, compared to 3,9 deaths per 100 thousand. people in 2004.
“It’s not a matter of diagnosing a few smaller cancers,” said Thomas Weber, a colorectal cancer specialist not involved in the latest study. – Something else is happening and it is of great importance.
This is all our fault?
Nobody knows what lifestyle, environmental or genetic factors may contribute to the increase in morbidity. If the cancer associated with the human papillomavirus, HPV, has been diagnosed more frequently in recent years, it would be mainly caused by cancers of the cervix, back wall of the throat, and anus – scientists do not believe that sexual behavior or HPV would increase the incidence of colorectal cancer (cancer rectum and anus are two different diseases).
Obesity, a diet high in red or processed meat, and lack of physical activity are among the factors that increase the risk of developing the disease, but researchers are looking for other possible causes of this type of cancer. For example, it has recently been shown that prolonged administration of antibiotics in adulthood is associated with an increased risk of developing precancerous polyps, possibly because antibiotics can alter the composition of the gut microbiome.
The researchers would also like to see if the cases of colorectal cancer in younger adults are significantly different from the cases of the disease in older adults, and whether they can be detected and treated with the same methods. Some evidence suggests that juveniles are more likely to have precancerous polyps that are more difficult to detect and remove during colonoscopy because of their location in the gut and because they are flat rather than cylindrical, explains Otis Brawley, chief physician of the American Cancer Association.
- Read more: Gastric and duodenal polyps
First of all, prevention
The latest findings urge the search for reliable methods for the early detection of colorectal cancer in young people. For years, most medical communities have recommended routine screening for people in their 50s, unless they have specific risk factors, such as a family history or a disease such as inflammatory bowel disease, which is known to increase the risk of cancer. One overseas organization, the American College of Gastroenterology, recommends that you begin screening African Americans in their 45s early, as it has been shown that this ethnic group is more at risk than whites.
The ideas of extending the screening program to the entire population are both controversial and expensive, given that the vast majority of colorectal cancer deaths still occur in the elderly. “I don’t think we should routinely order colonoscopy on twentysomethings because of this modest increase in mortality,” admits Michael Potter, professor of family and social medicine at the University of California, San Francisco. (…) – Undoubtedly, it is worthwhile to conduct further research in this area and check whether lowering the age of routine screening tests would bring more benefits or losses. Because we are talking about research that is itself associated with some risk.
Screening tests are also expensive, but it’s not the price that is the most important thing. Searching for colon cancer in cubs is like looking for a needle in a haystack: you would have to test a lot of people to find a handful of cancer patients or precancerous polyps. Most young people would therefore undergo testing for no good reason, and some of them might still suffer. Complications with colonoscopy, considered the primary test for colorectal cancer, are quite common. A study involving over 300 healthy Medicare patients who underwent colonoscopy showed that two percent. of them had to return to hospital or to the emergency room within a week of medical intervention due to complications such as a break in the bowel or rectal wall, which could be life-threatening.
If not a colonoscopy, then what?
But while some medical organizations insist on colonoscopy as their preferred screening method, experts from the US Preventive Services Task Force advocate using other tests as cheaper and less invasive, although they may not be as effective in cancer detection and prevention. For example, examination of stools for microscopic amounts of blood or changes in DNA may suggest the presence of a tumor or polyp, but such analyzes should be performed more often, and later, if the result is positive, supplemented with colonoscopy.
All of these research methods have their pros and cons. Some of them may give a false-positive result, forcing someone to continue testing unnecessarily, or a false-negative result, putting the patient to sleep. However, according to Brawley, we have a scientific basis to claim that stool analysis can save lives and that some patients would be better served by such non-invasive methods. – In the USA, we are all leaning towards technologically advanced solutions, forgetting about old methods that are still very good – he assessed.
Regardless of the screening guidelines, people who are concerned about developing colorectal cancer should tell their doctor, no matter what their age, said Douglas Owens, of the Preventive Services Task Force. – There may always be circumstances in which decisions should be made on an individual basis – he emphasized.
However, many doctors might object to referring young adults to colonoscopy because colorectal cancer is rare in this age group, Weber admits. In his opinion, it is necessary to increase the awareness of the risk among doctors and patients. “We should be vigilant beforehand, investigate symptoms and rule out cancer,” he advises.
Rectal bleeding, bloody stools, unreasonable weight loss, fatigue, digestive problems, and changes in bowel movements can be warning signs of colorectal cancer. Anemia in men may also indicate a developing cancer, as well as anemia in premenopausal women, in whom anemia is too often included in menstruation – when female anemia is accompanied by any other disturbing symptoms, the patient should be immediately referred for bowel cancer tests thick.
It is worth making sure that we know the medical history of our loved ones well – it is important to know not only about relatives who have cancer, but also about those with benign polyps. Tell your doctor about all your health conditions, including inflammatory bowel disease, which may increase your risk of getting sickness. You can reduce this risk yourself by maintaining a proper body weight, exercising a lot, eating properly, not smoking or abusing alcohol.