Colorectal Cancer in Younger Adults

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UnityPoint Health - John Stoddard Cancer Center

Colorectal Cancer in Younger Adults

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Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer deaths in the United States for men and women combined. Although the overall incidence of colorectal cancer has decreased over the past decades, the incidence in adults younger than 50 has increased according to data in the National Cancer Institutes Surveillance, Epidemiology and End Results (SEER) program. 

A study just published in the journal Cancer used data from the National Cancer Data Base from 2004-2015 looking at the number of persons diagnosed with colorectal cancer ages 50 and older and those diagnosed at less than 50 years old. The journal found that over this time period the proportion of the total number of patients diagnosed with colorectal cancer at an age less than 50 rose from 10.0% in 2004 to 12.2% in 2015. They also found that younger patients had more advanced disease (stage 3 or 4 in 51.6% of those younger than 50 vs. 40% in those 50 and older). 

Based on the SEER data, the American Cancer Society in 2018 updated their guidelines to include a “qualified recommendation” that colorectal cancer screening begin at age 45. The reason that the recommendation was qualified is that it was based on computer modeling and not evidence from clinical trials. Qualified recommendations indicate less certainty about the benefits vs. harms of screening. At this time other major organizations including the US Preventative Services Task Force and major US gastroenterology associations have not changed their recommendations, which is to start screening at age 50. 

Many colorectal cancers are associated with lifestyle factors that can be modified or changed. With the trend of younger persons being diagnosed with colorectal cancer it is important to understand what lifestyle changes can influence your risk of developing colorectal cancer. 

Lifestyle factors linked to colorectal cancer include: 

- Being overweight or obese, especially having a large waistline, raises the risk of colon and rectal cancer in both men and women but seems to have a stronger link in men.

Physical inactivity has been linked to having a greater chance of developing colorectal cancer. Being more active can help lower your risk.

-Diets high in processed and red meats and low in vegetables and fruits may raise your risk of colorectal cancer. 

- Smoking raises your risk of developing colorectal cancer and also increases your risk of dying from the disease. 

- Moderate to heavy alcohol use (more than 2 drinks per day for men and 1 drink per day for women) can increase your risk for colorectal cancer. 

Cancer risk reduction strategies do not just apply to colorectal cancer but are similar for many cancers. In order to fully leverage lifestyle strategies for cancer risk reduction, I advocate the following: maintain a normal body weight and eat a mainly plant based diet avoiding processed and fast foods, learn to manage stress through breathing exercises or meditation, get 7-9 hours of quality sleep every night, exercise daily for at least 30 minutes, get outside everyday and enjoy nature, be compassionate to yourself and love yourself, enjoy energetic and nurturing social relationships, cultivate a spiritual practice, limit alcohol consumption and if you use tobacco products, quit. 

- Dr. Andrew Nish, Medical Director, John Stoddard Cancer Center