Blacks, Young Adults See Increase In Colon Cancer Risks

The absolute numbers remain low, but since the 1990s, the rate of colon cancer among Americans younger than 50 has more than doubled, according to the U.S. National Cancer Institute. What's more, those cancers are often detected late -- in part because young adults do not routinely undergo colon cancer screening. Researchers found that Americans in their 20s and 30s are seeing the steepest rise in distant-stage colon cancer -- later-stage tumors that have spread to other sites in the body. The new findings, published recently in the journal Cancer Epidemiology, Biomarkers & Prevention, are based on figures from a U.S. federal cancer registry. There were nearly 104,000 Americans ages 20 to 54 who developed colorectal adenocarcinoma between 2000 and 2016. When it came to colon cancer specifically, people in their 30s showed the steepest increase in late-stage cancers over time, at 49%. Meanwhile, those in their 20s had the sharpest rise in advanced rectal cancer, 133%.

“This is something that unfortunately happens with a lot more commonality than we  know,” said Dipen Maun, MD, a colorectal surgeon with Franciscan Physician Network Indiana Colon & Rectal Specialists in Indianapolis. “Colon cancer is historically thought of as  a disease that affects primarily older patients, but now, we're seeing  younger patients with colon cancer in their 30s and 40s.”

Blacks At Highest Risk Of Colon Cancer

Colorectal cancer is the third-leading type of cancer among black men and women, and blacks have the highest rates of colon and rectal cancer among any ethnic group in the United States, according to the American Cancer Society.

For many, delaying getting screened for colon cancer leads to a later diagnosis and treatment, which may also require a more advanced treatment plan.

“We do know that African Americans tend to get colon cancers at an earlier age, often present at a more advanced stage, and do have lower survival rates,” Dr. Maun said. “And there are ideas as to why that may be. Perhaps it's related to diet, maybe diets that are higher in animal fat and lower in fiber are contributing to that. Perhaps African American populations have a little less access to healthcare, as we're talking to a lot of these issues systemically. And perhaps there's just a higher amount of uninsured patients who are African American. All of this then translates to not having access to care, having later diagnoses, and just not doing as well when they get diagnosed.”

Black and Hispanic Americans in their 20s had a particularly high proportion of late-stage cancer -- a situation that has worsened over time. Among young Black adults, for example, the proportion of rectal cancers that were late-stage shot up from none to 46% between 2000 and 2016.

Race and colon cancer screening guidelines

Because Blacks are thought to be at a higher risk for colon cancer, experts recommend being screened for colon cancer at an earlier age than other adults. Historically, that had meant recommendations of 45 years old, but recent changes in American Cancer Society guidelines and Indiana state law, which now mandates coverage of colonoscopies for adults 45 and older, which could eventually lower this requirement.

“Many people may not know that African Americans are a slightly higher risk and doctors may still recommend colonoscopies at age 50,” Dr. Maun said. “And they should be educated and trained to encourage their patients who are healthy, but turning 45, to get screened."

Family history impacts screening schedule    

“When it comes to family history, we kind of go with two benchmarks. It's either age 40 or 10 years before the youngest person in the family got colon cancer,” Dr. Maun said.

So, as an example, siblings or children of a 35-year-old woman who was diagnosed should begin colon cancer screenings at age 25.

“With a family history, we recommend colonoscopies every 5 years apart, whereas in the average person without a family history, it's every 10,” Dr. Maun said. “So it's a big difference knowing your family history and when you'd start your screening process.”

More Younger Adults Being Diagnosed With Colon Cancer

One in five colorectal cancer patients are between 20 and 54 years old, and colon and rectal cancers are the third leading cause of cancer death in young adults. An estimated 18,000 adults under the age of 50 are expected to be diagnosed with colorectal cancer in 2020, according to the Colon Cancer Coalition.

Symptoms of colon cancer vary, but include changes in bowel habits, blood in the stool, persistent abdominal cramps and unexplained weight loss.

“I think young people just have a sense of invincibility, I'm young, and the stigma that cancers occur in people who are older,” Dr. Maun said. “And so it's very easy to take a minor problem, like a little blood or a bout of diarrhea or constipation, and not realize that it could potentially be a sign of something much more sinister and much more dangerous.”

A 2019 study verified that: Of 1,200 colon cancer patients younger than 50, two-thirds waited three months to a year to see a doctor for their symptoms. And then they usually had to see at least two doctors before getting the correct diagnosis.

Be Aware Of Colon Cancer Symptoms, No Matter Your Age

“There are a variety of warning signs, and colon cancer is very broad when it comes to the different kinds of symptoms,” Dr. Maun said. “The biggest thing to know is that colon cancer can grow silently and have absolutely no symptoms.”

Symptoms of colon cancer include:

• A persistent change in bowel habits, such as diarrhea or constipation that isn't going away,
• A change in the size and the caliber of the stools
• Blood in stool
• Feeling tired and weak

“Even if you haven't been diagnosed but you have symptoms, be your own advocate,” said Andrea Bauer, who was diagnosed with stage 3 colorectal cancer in her 30s. “We know that it's on the rise in young people. You don't want to play around with it, because younger people tend to be diagnosed at later stages. Lower survival rates, basically, is what you're looking at."

“We're having young parents who are passing away because of this disease and aren't able to see their children grow up, or they're not able to play the role in their child's life that they were hoping to have. So don't ignore symptoms, and be your own advocate.”