When Should I Worry About...

Why Even Young Adults Should Care About Colorectal Cancer Screening

Oct. 29, 2020 - Katie McCallum

You're young and you're healthy, but how much do you really know about your colorectal cancer risk?

While colorectal cancer is certainly more common in older adults, your risk for it is more complicated than just your age. In fact, colorectal cancer rates are actually increasing in young adults.

"On the one hand, we're seeing a decrease in the rates of colorectal cancer in people who are over the age of 65. But, on the other hand, we're seeing more and more young adults being diagnosed with colorectal cancer — and these are adults who are still in their 20s and 30s," warns Dr. Maen Abdelrahim, gastrointestinal medical oncologist at Houston Methodist. "In fact, by the end of 2020, it's expected that 12% of this year's colorectal cancer diagnoses will have been made in people under the age of 50. That's somewhere around 18,000 cases."

The reason for the uptick in colorectal cancer rates in younger adults? It remains unclear. What is clear, however, is that understanding colorectal cancer, including how it can be caught early, is important — even if you're in your 20s and 30s.

"When colorectal cancer isn't caught early, treatment is more aggressive and a person's prognosis is often fairly bleak," explains Dr. Abdelrahim. "Even a young adult can be diagnosed with late-stage colorectal cancer, so it's incredibly important to understand your risk, know the symptoms of colorectal cancer and not delay a screening colonoscopy if one is recommended."

Who's most at risk for developing colorectal cancer?

Your age alone can put you at a higher risk for colorectal cancer, and anyone over the age of 45 is considered to have an average risk of developing this cancer. It's why screening guidelines and cancer experts now recommend beginning screening colonoscopies at age 45.

But, with rates rising in younger adults, a person's risk is clearly more complex than just his or her age. So, what puts a young adult at a higher risk of colorectal cancer?

"Irrespective of age, men are typically at higher risk than women, and African Americans, regardless of gender, are 20% more likely to get colorectal cancer than any other racial group in the U.S.," explains Dr. Abdelrahim.

The complete list of colorectal cancer risk factors includes your:

  • Gender – men are at higher risk than women
  • Ethnicity – African Americans have a much higher risk
  • Family history of colorectal cancer or polyps
  • Additional medical conditions, such as irritable bowel syndrome (IBS) or Chron's disease
  • Genetic syndromes, including Lynch syndrome and Familial Adenomatous Polyposis (FAP)
  • Risk of exposure to radiation in your pelvic area

"Even if you're young and feel healthy, it's really important to understand if you have an increased risk of colorectal cancer. If you are at higher risk, begin establishing a relationship with a gastrointestinal specialist now so that you have someone who already understands your health history in the event you do begin to experience concerning symptoms," recommends Dr. Abdelrahim.

What are the colorectal cancer symptoms to be on the lookout for?

Anyone can be diagnosed with colorectal cancer — whether high risk or not, and whether old or young. This means it's important for all adults to be aware of the symptoms that might signal colorectal cancer.

"The colorectal cancer symptoms that are the largest red flags are rectal bleeding, darker than usual stool and blood in your stool. But, keep in mind that other diseases can cause these symptoms, too," says Dr. Abdelrahim. "If you're experiencing any one of these symptoms, schedule an appointment with your doctor as soon as possible."

Other symptoms of colorectal cancer are more common and/or subtle, including:

  • Changes in bowel habits or the texture of your stool
  • Abdominal pain and/or cramping
  • General fatigue
  • Unexplained weight loss

"If you have an increased risk of colorectal cancer, no symptom is too general to avoid mentioning it to your doctor," recommends Dr. Abdelrahim. "He or she knows which symptoms are most concerning and can perform a medical workup to help determine whether you need to be more thoroughly screened or not."

If you're not high risk but are experiencing one or more of these general symptoms, it's still a good idea to see your doctor, explain your symptoms and have a workup done. If no clear cause can be identified and your symptoms continue or get worse over time, it's time to visit a gastrointestinal specialist for further exploration

What are my colorectal cancer screening options?

Colonoscopies. We don't really like to talk about them, and we often think of them as a procedure just for older adults. The reality is that colonoscopies are the gold standard when it comes to screening for colorectal cancer — a cancer that can strike even young adults.

"A colonoscopy is a screening tool that provides a visual of your colon, and it can help determine whether it's healthy or not. If we do see something unusual during a colonoscopy, this procedure also gives us the ability to intervene right then and there, taking a biopsy or even administering treatment in some cases," explains Dr. Abdelrahim. "For a young adult, a colonoscopy isn't recommended unless other workups or tests indicate that there's good reason for a more thorough check of your colon."

Typically, screening colonoscopies begin at age 45 and are done every 10 years. If you're higher risk, however, your doctor may recommend beginning screening colonoscopies earlier and having them more frequently.

"Whether you're higher risk due to your family medical history or because you're an African American male, for instance, the decision of when to begin your screening colonoscopies will vary from person to person. It will be a one-to-one discussion with your gastrointestinal specialist," says Dr. Abdelrahim. "To help reduce your colorectal cancer risk as much as possible, it's important to establish a relationship with your doctor and begin these conversations even as a young adult."

In addition, there are other less invasive colorectal cancer screening options your doctor can use before recommending a colonoscopy, such as:

  • Immunochemical fecal tests
  • High sensitivity blood tests
  • Stool DNA tests
  • CT colonography
  • Flexible sigmoidoscopy

Why is catching colorectal cancer early so important?

Catching any type of cancer early is always best, including when it comes to colorectal cancer. That's because a person's outcomes are very different if diagnosed late rather than early.

"Caught in the later, more advanced stages, colorectal cancer is very hard to cure and treatment is usually palliative — meaning we're just trying to relieve the symptoms associated with the disease," explains Dr. Abdelrahim. "But when we catch colorectal cancer early, treatment is administered with a curative intent. Often, the cancer can be removed and the person can be in remission long-term."

And, remember, even a young adult can be diagnosed with late-stage colorectal cancer. So if you're high risk or if you're experiencing unusual symptoms, don't delay talking to your doctor just because you think you're too young and too healthy to have colorectal cancer.

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Categories: When Should I Worry About...