June 3, 2020 -- Young adults are often not aware they can get colon cancer, and doctors are often late to diagnose it in younger patients, according to new research presented at the American Society of Clinical Oncology annual meeting.
Ronit Yarden, PhD, an adjunct associate professor of oncology at Georgetown University School of Medicine and former senior director of medical affairs, Colorectal Cancer Alliance, says this lack of awareness may be partly to blame for rising rates of colon cancer in adults under 55.
While the overall rates of colorectal colon cancer declined by 3.6% annually among adults 55 and older from 2007 to 2016, it increased by 2% annually in that time period among those under age 55, the American Cancer Society says. In 2020, the American Cancer Society estimates there will be nearly 108,000 cases of colorectal cancer diagnosed, with 53,200 deaths.
Yarden and her colleagues did an online survey, launched via social media channels. In all, 885 patients and survivors finished the questionnaire.
The median age at diagnosis was 42, which Yarden notes is lower than the American Cancer Society’s recommended age of 45 to start screening for average-risk people.
Most respondents, 63%, said they were not aware that colorectal cancer can affect people younger than 50. Yarden says that may explain why most waited more than 3 months after noticing symptoms to see their doctors. And 23% waited more than 12 months to seek help.
Once they did visit the doctor, the diagnosis was not rapid -- 75% said they visited two or more doctors before getting a diagnosis; 11% of those visited 10 or more doctors before hearing what was wrong.
Many patients replied that they felt the doctors they saw dismissed their symptoms.
"In fairness, some of the symptoms are kind of vague," says Yarden, who’s also former senior director of medical affairs for the Colorectal Cancer Alliance. But many had several symptoms, and the combination of them should have raised suspicion about colorectal cancer, she says. She didn't ask which symptoms were dismissed, but she notes that 68% of respondents reported blood in the stool and 49% had rectal bleeding. "Those are the ones that are more of a direct correlation," she says.
Seventy-seven percent of patients reported being diagnosed with advanced disease. As a result, they were treated with aggressive therapies and that affected their quality of life. They reported anxiety, depression, sexual issues, unemployment, financial problems, and nerve issues. Many of the youngest patients said their doctors did not discuss fertility preservation before treatment.
In all, 29% reported some family history of colorectal cancer, a risk factor that should raise awareness, Yarden says. And 6% were diagnosed with Lynch syndrome, a type of inherited cancer syndrome linked with a tendency to get colon cancer and certain other cancers.
"Increasing awareness of young-onset colorectal cancer is a first step toward improving their care," says Nancy You, MD, an associate professor of surgical oncology and associate medical director of the Clinical Cancer Genetics Program at the University of Texas MD Anderson Cancer Center, Houston. She reviewed the findings.
Many questions remain, she says. In most cases of young-onset colorectal cancer, the cause remains unknown. The absence of family history does not mean a young adult isn't at risk, she says.
It's also important to test any patients with symptoms that suggest colorectal cancer, she says, regardless of age.
While there is a trend in recent years of younger adults being diagnosed with colorectal cancer, it's important to remember that ''it's still a very uncommon diagnosis in younger people," says Richard Schilsky, MD, chief medical officer and executive vice president of the American Society of Clinical Oncology, who also reviewed the findings.
Even so, patients and doctors need to become more aware that colorectal cancer can happen at any age. "When a younger person shows up [with the symptoms], doctors tend to look for alternative causes, or they tend to think it's a self-limiting problem," Schilsky says. The message for patients is not to ignore symptoms or delay seeking medical help, he says. For doctors, it's to do the right testing if symptoms suggest colorectal cancer.
''Listen to your body," Yarden says. "If you have symptoms and don't feel right, go immediately to the doctor. Don't postpone it." Rectal bleeding, blood in the stool, a change in bowel habits or stool shape, belly pain or cramps, weight loss, and decreased appetite are among the symptoms.
And, as her survey suggests, you may need to see another doctor, or even several.
The American Cancer Society recommends people at average risk of colorectal cancer (such as those without a family history) start screening at age 45. It also says those with a family history or inherited conditions, such as Lynch syndrome, may need to start earlier.