A new study in the found colorectal cancer is now the leading cause of cancer deaths in people under 50, and is the only condition in the top five to show a steady rise in mortality in the past two decades.
Dr. Li Li, who chairs the University of Virginia Department of Family Medicine and co-directs the Cancer Prevention and Population Health program at UVA Cancer Center, leads studies exploring how the complex interplay of genetic, lifestyle and community factors drives colorectal cancer disparities.
He spoke with UVA Today about what is important for the public and medical providers to know, given the new research.
Q. What is important to know about the rise in colorectal cancer in people under 50?
A. We call colorectal cancer diagnosed in people under age 50 “early-onset CRC.” It has been extensively documented that the incidence of early-onset CRC continues to increase for the past two decades while the overall incidence of CRC in the general population decreases. We are now seeing young people in their 40s, 30s, even 20s getting diagnosed with CRC. Those are average-risk young adults who do not have a strong family history of CRC or a known genetic predisposition to CRC. It’s alarming as this new study adds that in parallel to the increase of incidence, the death rate of early onset CRC is also steadily climbing to become the top cancer killer among younger adults
That being said, CRC is a largely preventable disease. Probably around 60% of the CRC is driven by modifiable environmental, lifestyle and societal factors. So that means actually a lot can be done to decrease the burden of CRC. The main focuses should be on prevention, early detection and treatment. According to this new study, 70% of people diagnosed at a younger age actually had advanced disease, highlighting early detection is the key to reducing death from early-onset CRC.
Li conducts studies examining disparities in colorectal cancer incidence and works to understand their links to environmental and societal factors. (Contributed photo)
Q. How should the public and clinicians be responding?
A. The most important way to lower the risk of CRC is to work on healthy lifestyles: exercising regularly, eating healthy foods, maintaining healthy body weight, getting sufficient sleep. Avoiding alcohol, smoking and processed foods is also important for prevention.
Screening is crucial, especially as younger populations are starting to see higher rates. Currently in the United States, the screening recommendation for the general public from the U.S. Preventive Services Task Force and the American Cancer Society is to start screening at age 45. That means that, for many people, they will not be recommended for colon screening until they turn 45.
In the absence of recommended screening for those younger than 45, I encourage young adults to bring up any concerns they have about CRC to their health care providers, especially if any vague, problematic symptoms present themselves. In the context of colorectal cancer, these tend to be rectal bleeding, abdominal pain, changes in bowel movements or unintentional weight loss.
Q. What is the gold standard for colorectal cancer screening?
A. I think many people have anxiety about colonoscopies, and it’s important to know that colonoscopy is not the only way for CRC screening. In effect, there is no gold standard for colon screenings. There are several different ways one can get screened, including at-home stool-based tests. Discuss with your clinician to choose the one that is best for you.
People with a strong family history should bring that up with their healthcare providers and discuss screening at an early age. For those with first- and second-degree relatives who were diagnosed of CRC, the recommendation is to begin screening 10 years younger than the age of their relatives when they were diagnosed. So, if your father got colorectal cancer at age 52, you should start screening at 42.
