March is National Colorectal Cancer Awareness Month — and the disease is hitting people younger

March has been designated National Colorectal Cancer Awareness Month, bringing with it more tools and information for individuals on screenings and risk.

According to the Colorectal Cancer Alliance, one in 24 people will be diagnosed with colorectal cancer (the second deadliest cancer in the U.S.) in their lifetimes.

“Colon cancer rates in young adults have been steadily rising over the past several decades,” said Dr. James McCormick, a surgeon specializing in colon and rectal surgery for the Allegheny Health Network.

Researchers are not certain the reason for this change, as it is even occurring in individuals with no family history. Nearly 18,000 people under age 50 will be diagnosed yearly with colorectal cancer in the U.S., according to the National Cancer Institute.

While screenings beginning at 45 do help, those in their 20s and 30s are encouraged to be vigilant and to have symptoms checked out via colonoscopy immediately, according to McCormick.

Dr. Vince Reyes, a medical oncologist at UPMC Hillman Cancer Center, has been seeing younger patients in his clinic — those in the millennial generation and even younger. Reyes said he has read research that those born in 1990 have a two times higher risk of developing colon cancer than those born in 1950.

Reyes said the rising rates could be caused by dietary factors, like the number of processed foods we eat, environmental factors or even alcohol or smoking.

“If you’re diagnosed before age 55, you have a 60 percent likelihood of more advanced cancer that’s (spread to) other organs,” Reyes said. “That is why I am encouraging younger people to get colonoscopies when they can.”

According to Excela Health gastroenterologist Dr. Rupam Sharan, young people should also be aware of certain genetic conditions like Lynch syndrome, also known as hereditary non-polyposis colorectal cancer, the most common cause of hereditary colon cancer.

There’s also familial adenomatous polyposis, which raises the risk and effect 10% to 20% of the early onset colorectal cancers.

If one is worried about their possibility of developing colon cancer in their lifetime, Sharan mentioned five factors that determine whether a person is considered at above average risk for the disease:

• Past colorectal cancer or polyps

• A family history of colorectal cancer

• Personal history of inflammatory bowel disease as ulcerative colitis or Crohn’s

• Hereditary colon cancer syndromes

• Radiation to the abdomen or pelvic area

Of course, every individual is different, and some may need to be screened more often or at an earlier age.

Another aspect that could be the result of rising colorectal cancer (and advanced cancer) rates is that ever since the covid pandemic, people have seen doctors far less than they have before.

Colonoscopy rates have also taken a hit — Reyes noted a 50 to 60 percent decrease in colonoscopies since covid began. “As a result, we’ve seen a higher rate of more advanced cancers,” he said. “Since people are not getting screenings early enough, cancer is already spread.”

As a result, patients who could have gotten easy adenoma resections are now unable to stop the spread of the disease to other parts of the body.

Fears, prep and other options

There are also always patients fearful of undergoing a procedure like a colonoscopy. McCormick said the hardest part of the procedure for most patients is dealing with the preparation beforehand.

“The procedure is done under sedation, so patients do not feel or remember it,” McCormick said. “Colonoscopies are very safe with only a small risk of complications.”

If someone wishes to avoid the procedure or can’t undergo one, there are alternative testing methods. Many reading this may have seen the “Cologuard” commercials on television with the smiling cartoon box. There is also a FIT Test (aka Fecal Immunochemical Test, designed to screen for the presence of hidden blood in your stool to help detect early signs of colon cancer). Like Cologuard, FIT tests can be done at home.

“While these are better than not getting colon cancer screening at all, they are considered inferior to the gold standard colonoscopy,” McCormick said.

Reyes echoed the same sentiment saying if you can get a colonoscopy, that is the best option for visualizing the colon and surrounding areas. Often, if you get a positive result on other tests you will need to end up going in for a colonoscopy anyway.

“The prep is hard, and you’ll have to take the day off of work, but if you’re medically able to handle it, it’s the gold standard screening,” Reyes added.

It is believed that changes occur to the lining of the colon because of exposure. This lining is essentially skin on the inside, McCormick said. Just like our skin developing changes from increased exposure to the wind or sun, your colon lining will develop changes with exposure to certain elements. These changes result in cellular, genetic mutations that are required for the development of colon cancer.

While age is the most important risk factor, there are some behavior modifications that can potentially decrease risk of developing colon cancer.

“A healthy diet, emphasizing consumption of fresh fruits and vegetables, green leafy vegetables, fish and pork may be protective,” McCormick said. “Red meat and processed meats should be taken sparingly, if at all.”

Sharan, Reyes and McCormick all mentioned that avoiding tobacco products, limiting alcohol consumption and regular exercise as well as maintaining a healthy body weight are all also important.

“Multiple dietary interventions like fiber, calcium and vitamin supplementation have not convincingly shown to reduce the incidence of colorectal carcinoma,” Sharan said.

Sharan did say that in multiple studies, aspirin taken daily has been shown to reduce the risk of developing adenomas and colon cancer.

“What is not clear is the minimal dose and duration of aspirin therapy to achieve the protective effect,” he added. “Whether it is also beneficial for all subgroups of patients is also not clear.”

He advised to consult your physician as to the appropriateness or safety of the medication, as they have a significant rate of unforeseen side effects, including life-threatening bleeding.

More information on colorectal cancer can be found by visiting cancer.org.