2017-11-09 15:34:09 UTC

What to Make of Colorectal Cancer in Patients Younger Than 50?

Nov. 9, 2017

Most cases of colorectal cancer (CRC) in young adults seem to “just happen.” Best opportunity to prevent CRC death is prompt evaluation and early diagnosis.

Colorectal cancer (CRC) in people younger than age 50 is increasing in the United States. Recent annual increases in colon cancer incidence and rectal cancer incidence have been, respectively, 2.4 percent and 3.2 percent in 20-29 year-olds, 1 percent and 3.2 percent in 30-39 year-olds, and 1.3 percent and 2.3 percent in 40-49 year-olds. In contrast, incidence rates in persons over 50 have decreased by even larger fractions, which is attributed at least in part to screening. Why is this happening? This unfortunate trend remains unclear. There is currently no evidence to confirm that obesity, diabetes or diet are a cause. 

So what can you do as a GI? Uri Ladabaum, MD, MS, provides the following guidance:

  • Identify cancer genetic syndromes in our patients’ families so young family members can be managed appropriately — yet this will not address most cases of young-onset CRC. 
  • Encourage referral of patients with family history of CRC for early screening. 
  • Educate our colleagues in primary care and emergency medicine to consider CRC in young persons with rectal bleeding or new and persistent abdominal and bowel symptoms, and to refer them for endoscopic evaluation — all while recognizing that the rate of CRC in these scenarios is low. 

Read the full article in AGA Perspectives. 

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