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home : columns : ask the doctors November 23, 2020

10/26/2020 8:00:00 AM
Early detection is key to colon cancer survival

Dear Doctors: My husband and I were shocked when our nephew was diagnosed with colon cancer. He's only 36 years old. Isn't that awfully young? It seems like we're hearing about a lot of younger people getting this kind of cancer. Why is this happening?

Dear Reader: Unfortunately, you're correct about the increase in the number of younger adults being diagnosed with colon cancer at this time. And with the recent death of actor Chadwick Boseman from the disease, the disturbing trend has entered the national consciousness. Excluding skin cancers, cancers of the colon and rectum -- collectively referred to as colorectal cancer -- are the third most commonly diagnosed types of cancers that occur in both men and women in the U.S. They account for more than 50,000 deaths each year.

Until recently, colon cancer was not prevalent among younger adults. This had been reflected in the screening guidelines put forth by the American Cancer Society, which had recommended that regular screenings for colon and rectal cancers begin at age 50. But statistics show that younger adults are increasingly affected by this type of cancer. Of the estimated 135,000 cases of colorectal cancer predicted for this year, at least 12% will be discovered in people younger than 50.

As a result, the screening guidelines have since been updated. It's now recommended that regular screenings should begin at age 45. Individuals living with inflammatory bowel disease, and those with a family history of it, are at increased risk of colorectal cancers. They may be advised to start screenings even earlier.

Screening for the disease includes colonoscopies, which are used to identify and, when possible, remove polyps and other growths. Fecal tests can be useful in identifying blood in the stool. Each of these can be indicators of cancer or a pre-cancerous condition. A study published last year found the updated age guidelines for colorectal cancer screenings can prevent about 30,000 potential cases each year and save 11,000 lives. Not all insurance companies are on board with the new guidelines, though, and some patients would have to pay for earlier screenings themselves.

As for why the disease is striking an ever-younger population, researchers still aren't sure. Some suspect changes to behavior, as well as environmental factors, and have launched studies to learn more. Others worry that younger adults are ignoring the physical symptoms that may indicate the presence of colorectal cancer. These include visible blood in the stool, particularly when it's bright red in color; rectal bleeding; persistent sensations of pressure within the bowel and abdomen that are not relieved by a bowel movement; ongoing abdominal pain and cramping; weakness or fatigue and unexplained weight loss. Another indicator is changes to bowel habits that last more than a few days, such as constipation, diarrhea or a change to the shape of the stool. If anyone experiences one or more of these symptoms, it's important to check in with your health care provider. The good news is that, when caught early, colorectal cancers are highly treatable.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu. Owing to the volume of mail, personal replies cannot be provided.





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