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Common Early Warning Signs for Colorectal Cancer in Young Adults 

Often, colorectal cancer (CRC) doesn’t cause symptoms until it grows or spreads. It is often harder to detect in the younger population who might ignore symptoms due to lack of insurance coverage, and because they are not yet eligible for screening because of their younger age. However, findings from a recent study might provide some clues to identifying the early onset of CRC among young adults not old enough to qualify for CRC screening. 

Those under 45 may not have insurance coverage for any form of CRC screening—colonoscopy, FIT, or FOBT—because the recommended age to start screening for CRC is 45 years. According to the American Cancer Society, 2,001,140 new cases of cancer are projected in the U.S. in 2024,152, 810 of which may be CRC. Another concerning statistic is the 2% rise in the annual CRC incidence rate among young adults (ages <55 years). 

Paying Attention to The Early Signs

The study identified 4 red-flag signs and symptoms occurring at least three months before diagnosis that were associated with a subsequent risk of early-onset CRC:

  • Abdominal pain 
  • Rectal bleeding 
  • Diarrhea
  • Iron deficiency anemia 

A total of 5,075 early-onset CRC cases and 22,378 controls were included in the study. 63% of the cases were diagnosed with CRC. The authors found that in the study population:

  • Abdominal pain and rectal bleeding were the most common symptoms
  • Abdominal pain was associated with a 34% higher risk of early-onset CRC 
  • Signs of rectal bleeding had the greatest association with developing CRC 

Diarrhea and iron deficiency anemia were also identified as a common symptom but did not have a high association with CRC.

Having one, two, or three of these warning signs and symptoms were linked to a 1.9-, 3.6-, and 6.5-fold higher risk of developing CRC, respectively. These correlations were stronger for rectal cancer and young-onset cases (average 43 years).

Despite the possibility that this study helped focus on the early warning signs and symptoms of CRC, it is crucial to remember that the signs and symptoms described above can also be the result of other health conditions such as inflammatory bowel disease, hemorrhoids, irritable bowel syndrome, or infections. In order to properly identify and treat the condition, it is important to see a doctor and get screened if you are experiencing any of those symptoms.

 

Emmanuel Olaniyan is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Picture credit: Muhammad Daudy on Unsplash

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Tips to Tailor Health Education on EAO-CRC for College Audiences

By Vanessa Seidner

The Colon Cancer Foundation and the 2024 Early-Age Onset Colorectal Cancer (EAO-CRC) Chair, Dr. Cathy Eng of the Young Adult Cancer Program at Vanderbilt-Ingram Cancer Center, will be hosting the 8th Annual EAO-CRC Summit in Nashville, Tennessee, which will provide the grounds for discussions about the latest technological and medical advances, how to build community, and about what actions can be taken at various levels to address the rise in EAO-CRC. 

Colorectal cancer (CRC) is the third most common cancer among men and women. This cancer occurs more often in the older population, yet there has been a rapid rise in CRC incidence among young people. Early-Age Onset (EAO) CRC refers to cases of colon or rectal cancer that occur in people under the age of 50 years. There has been an annual increase in these cases of approximately 2% since 2011.

Some of the best ways to prevent CRC or avoid unfavorable outcomes include on-time screening (starting at age 45 years – earlier if there are symptoms or family history), knowing the risk factors and family history, and consulting medical professionals when potential symptoms arise. One of the most effective ways to increase awareness of these solutions is through health education.

How Can We Encourage Health Education on EAO-CRC for College Students?

There are several opportunities to host educational events. The implementation of peer educators in colleges and universities is a cost-effective approach that allows students to impart valuable knowledge to their peers about meaningful and healthy lifestyle changes. While health outlooks differ, health education can be tailored to specific audiences to increase the likelihood that someone can reach and maintain their concept of optimal health. 

Health education events can appear as presentations, panels, tabling, and expositions. 

  • Presentations
      • Longer, more information-dense messaging
        • Can incorporate interactive questions and activities and pre/post surveys that allow participants to think critically about what they have learned and about how they will apply it to their lives moving forward. Information pamphlets and giveaways can also bolster interactivity. 
      • Key takeaways: Elaborate and in-depth, allows for active participation, and allows for future action to be taken.
  • Panels
      • Question and answer sessions. These can allow for an increased sense of closeness.
        • Panelists can provide a variety of perspectives germane to their topic
        • They can share anecdotes and experiences – personal, occupational, or both 
        • Specific contact information can be provided in case an audience member wishes to reach out to a panelist.
      • Key takeaways: Allows sharing of diverse viewpoints, opportunity for an open dialogue 
  • Tabling Events 
    • Drop-by event; can give quick overviews
    • Opportunity to share information pamphlets and giveaways
    • Can host activities to engage visitors in discussion and have giveaways
    • Key takeaways: Cost- and time-effective, succinct, and engaging – tabling events are a popular health education method                                                                                                   

Colleges and universities can host one or more of these events to increase awareness on risk factors, symptoms, the need to consult a medical professional if symptoms occur, and the importance of regular screening. As for timing, it is best to do so on days where there are not as many classes, in populous areas, and during a time of day when there is a higher influx of people, such as around a mealtime or when a certain timeblock for classes commonly ends. 

March is Colorectal Cancer Awareness Month. Consider a tabling event with information about the disease and with some free merchandise. Students can also be encouraged to wear dark blue to increase awareness of CRC.

Reach out to us at info@coloncancerfoundation.org if you would like to partner on an information event in March or any other time!

 

Vanessa Seidner is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

Photo Source: Naassom Azevedo on Unsplash

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Rise in CRC Among Young Adults Continues to Baffle Researchers

Cancer incidence has been growing among younger adults—not just in the U.S., but globally. According to a recent analysis, the three decades between 1990 and 2019 saw almost an 80% increase in incidence of early-onset cancer. Following breast cancer, cancers of the digestive tract (stomach and colorectal) have seen a rise among young adults—in 2019, 37% of early-onset cancers diagnosed across the world were in the colon and rectum.

These trends are also reflected in the U.S. population. Here’s a startling prediction: by the year 2040, colorectal cancer (CRC) is estimated to be the second-leading cancer in the 20-49 age group and the top cause of cancer-related death in that age group.

The Need to Raise Awareness Among Providers

What is frustrating for the early-age onset CRC (EAO-CRC) community is that young individuals are not your typical candidate for developing colon cancer, which means their symptoms are either dismissed or attributed to some other gastrointestinal issue. According to cancer epidemiologist Yin Cao, 50% of EAO-CRC cases are among those under 45 years of age. Current guidelines recommend that someone with an average risk for CRC should start screening at age 45, so anyone younger may not get screened despite their symptoms.

An average-risk person is someone who does not have a known family history of CRC or a known genetic condition that’d increase their risk for developing CRC.

As a result, diagnosis is delayed, which raises the risk of an advanced-stage disease that may be harder to treat. One such study among nearly 1,200 EAO-CRC patients found that 71% were diagnosed at an advanced stage (stage III or IV).

*Information on the various stages of CRC can be found here.

What’s Leading to the Rise in EAO-CRC?

While there are a lot of guesses, researchers and clinicians are not quite sure. There are talks about a birth cohort effect, which is a term that describes the unique experiences or exposures faced by a group of individuals based on their year of birth. For example, Americans born prior to 1945 have been found to have a lower risk of being obese.

Going back to CRC, medical oncologist Christopher Lieu told ScienceNews that those in their 40s today are at a greater risk of developing CRC than those who turned 40 a decade ago (so now in their 50s). Several different risk factors are being investigated in those who develop EAO-CRC:

  • Obesity
  • Antibiotic exposure
  • Changes in the gut microbiome (meaning the microbes that live in our gastrointestinal tract)
  • Dietary habits
  • Environmental exposures

However, there’s no definitive answer for the cause. The best preventive efforts include being physically active, managing your body weight, reducing the intake of processed food and integrating fresh fruits and vegetables in your diet.

What Do We Know?

What is definitely known are the telltale symptoms: pain in your abdomen, abnormal bowel movements (unexplained diarrhea or constipation), blood in your stools/rectal bleeding, unexplained weight loss, weakness. It is important to pay attention to these symptoms, which are often misdiagnosed as inflammatory bowel disease or hemorrhoids, especially in young adults. Any two of these signs could indicate a serious problem with your gastrointestinal tract—potentially, cancer.

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Alcohol: Destroying Your Liver and Colon, Increasing Your Risk of Early CRC

By Parker Lynch

In a recent study conducted in Korea, it was found that higher levels of alcohol consumption increase an individual’s risk of early-onset colorectal cancer (early-onset CRC), specifically distal colon and rectal cancers. Using data from the Korean National Health Insurance Service, investigators retrospectively compared the drinking habits of 5.7 million Korean adults (all younger than fifty years old) and their corresponding CRC risk. 

The study’s population was split into four groups (after being adjusted for age, sex, smoking status, exercise, income, and comorbidities): 

  1. Nondrinkers (no alcohol consumption)
  2. Light drinkers 
  3. Moderate drinkers 
  4. Heavy drinkers.

During the mean follow-up period of 7.4 years, there were 8,314 cases of early-onset CRC overall. When being compared with the light drinking group, those in both the moderate and heavy drinking categories had a significantly higher CRC risk, though the most intense discrepancy was demonstrated among men. Among men, there was a:

  • 26% increase in risk of distal colon cancer 
  • 17% higher risk of rectal cancer 
  • 29% higher risk of unspecified colon cancer when comparing the heavy versus light drinking group. 

Among women, there was a: 

  • 47% increased risk of distal colon cancer among moderate drinkers 
  • 14% reduced risk of rectal cancer among the light drinkers. 

Overall, this study provides strong evidence that higher levels of alcohol consumption can increase one’s risk of early-onset CRC. 

What Are the Implications of These Findings?

Although the aforementioned study is limited to generalizability among Korean citizens, its findings are still very important to consider when looking at the diverse American population.

In fact, the dangers of excessive alcohol use and its connection to increased CRC risk are not something that American researchers or doctors are unfamiliar with. In an article published by the Ocean Endosurgery Center, less than half of Americans are even aware that alcohol consumption has an impact on cancer risk at all. Additionally, the official Dietary Guidelines for Americans strongly suggests that men should not consume more than two alcoholic drinks per day, while women should drink no more than one. In terms of what is best for an individual’s health, researchers have determined that people really should only be drinking on special occasions.

Many Americans don’t know this information, and there must be a push for increased education and awareness so that people are able to make informed decisions about their own health. Regardless of whether or not people choose to drink after discovering the risks involved, everyone deserves to know the implications of potential lifestyle choices. 

 

Parker Lynch is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

 Photo credit: CHUTTERSNAP on Unsplash

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Colorectal Cancer in Young Adults: What Are We Learning?

By Deepthi Nishi Velamuri

Colorectal cancer (CRC) is a disease that typically affects older adults, but it is becoming increasingly common in young adults. In fact, data indicate that 15% of patients diagnosed with CRC in the U.S. are under the age of 50 years and the mean age at diagnosis is 42.5 years.

There are a number of factors that may contribute to the rising risk of CRC in young adults. These include:

  • Changes in diet and lifestyle: Young adults are more likely to eat a diet high in processed foods and red meat, and to be less physically active than previous generations. These factors can increase the risk of developing CRC. Young adults with CRC are more likely to be obese. This suggests that obesity may be a modifiable risk factor for the disease in young adults.
  • Genetics: Some people have a genetic predisposition to CRC. If you have a family history of the disease, you are at an increased risk.
  • Inflammatory bowel disease: People with inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease, are also at an increased risk of CRC.

Prevention, Genetics, and Disease Outcomes

The good news is that CRC is often preventable. If you are at an increased risk, you should talk to your doctor about getting screened for the disease. Screening can help identify polyps, which are growths that can develop into cancer. If polyps are found, they can be removed before they have a chance to turn cancerous.

Young adults diagnosed with CRC are more likely to have advanced-stage disease at the time of diagnosis. This suggests that young adults are less likely to be screened for the disease—often despite showing symptoms such as rectal bleeding, abnormal or changing bowel patterns, fatigue, etc—which can lead to later-stage diagnosis and poorer outcomes.

A number of genetic mutations associated with CRC in young adults have been identified. These mutations can help identify people who are at an increased risk of the disease, and they can also be used to develop new targeted therapies.

Need for Improved Management of Young Adults

While we are still trying to understand the mechanism of CRC development in young adults, it is clear that this is a serious and growing problem. By understanding the risk factors for the disease and getting screened, young adults can protect themselves from CRC.

Here are some tips to reduce your risk:

  • Eat a healthy diet that is low in processed foods and red meat
  • Get regular exercise
  • Maintain a healthy weight
  • Don’t smoke
  • Limit your alcohol intake
  • Talk to your doctor about getting screened for CRC if you are at an increased risk

 

Deepthi Nishi Velamuri is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Paying Attention to the Rise in Advanced-Stage Early-Onset CRC

March is National Colorectal Cancer Awareness Month – an ideal time to educate and inform the population about the trends of colorectal cancer (CRC) incidence and mortality in the U.S. New data released by the American Cancer Society predict that of the 153,020 new CRC cases predicted in 2023, 13% (nearly 20,000) will be in individuals younger than 50 years (early-onset CRC). This means improving screening rates in the 45-49 population is even more important. Also important is  improving awareness of the signs and symptoms of CRC.

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Colorectal Cancer: New Data Suggest Rising Rates, More Advanced Disease in Young Adults 

On March 1, 2023, the first day of Colorectal Cancer Awareness Month, the American Cancer Society released some alarming new statistics regarding early-onset colorectal cancer (CRC) diagnoses: in the U.S. population, people are increasingly being diagnosed with CRC at a younger age and with more advanced disease stage. Advanced-stage CRC diagnoses have risen by eight percent in the past two decades. Additionally, early onset diagnoses rose from one in ten individuals in 1995 to one in five in 2019. While CRC in the general population is declining, rates in younger people are on the rise. 

The complete report contains CRC incidence, mortality, and screening prevalence data that were derived from multiple national databases, including: 

  • National Cancer Institute
    • Surveillance, Epidemiology, and End Results (SEER) program
  • Center for Disease Control
    • National Program of Cancer Registries
    • Behavioral Risk Factor Surveillance System
    • National Center for Health Statistics
      • National Health Interview Survey
  • North American Association of Central Cancer Registries

The report projects that of the 153,020 expected CRC cases in 2023, 13% (nearly 20,000) will be in individuals younger than 50. Seven percent of projected CRC mortality will also be in individuals younger than 50. CRC mortality in individuals under the age of 50 is also on the rise, as the mortality rate in this population has risen one percent every year since 2004. 

Rising cancer trends in the younger U.S. population point to increased exposures to causal agents, and indicate the need for research that identifies newfound risk factors. The data from this report highlights the growing concern that is early-onset CRC incidence and mortality, pointing to a portion of the population that will need more research and funding in the CRC space. 

Efforts to improve screening rates at a health care center in New York City

Racial Disparity in CRC Incidence and Mortality

Racial disparities continue to exist in CRC incidence, mortality, and survival rates. Both incidence and mortality rates in the U.S. are highest among American Indian/Alaskan Native and non-Hispanic Black individuals. Alaskan Native individuals face the highest burden of CRC incidence than any other group (88.5 per 100,000 individuals). Risk factors that contribute to disparities in the Alaskan Native population are likely a combination of environmental factors (low sun exposure, diet low in fiber, smoking, and obesity) and low access to colon health care services. Alaskan Native individuals have the lowest screening rate in the U.S. 

Black Americans are more likely to be diagnosed with metastatic CRC than any other racial or ethnic group in the nation. Black patients also experience significant disparities in care, and are 21% less likely to receive colon cancer surgery and 28% less likely to receive rectal cancer surgery. Additionally, Black patients are more likely to develop right-sided tumors, which are correlated with a poorer prognosis. 

These updated data from the American Cancer Society point to the need for future research in early-onset incidence, racial disparities, and general risk factors for CRC. Scientists should aim to identify newfound risk factors that are contributing to the trend of CRC diagnoses under 50, and to identify factors specific to high-risk racial and ethnic groups as well.

You can learn more about the signs and symptoms of colorectal cancer on this page.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Impact of Social Media on Colon Cancer Screenings

Social media is a powerful tool that can be used to spread important information at unprecedented speed. Many users of TikTok, the short-form video app that has taken the world by storm, have utilized the platform to share their experiences with colonoscopy screenings. Users upload “vlogs” (video blogs) to the platform that document their entire experience in detail and talk to their audience throughout the process. While this may seem like oversharing, the authentic nature of these vlogs has grown popular on TikTok, as videos that do well on the platform often contain genuine and unfiltered content. 

One example of this is @lucindabinney‘s three-part video series:

@lucindabinney

Colonoscopy Vloggy Part 1 🧻🧻🧻 #colonoscopy #gutissues

♬ Just a Cloud Away – Pharrell Williams

 

@lucindabinney

Colonoscopy Prep Part 2 🧻🧻🧻 #colonoscopy #gutissues

♬ original sound – lucinda

 

@lucindabinney

Colonoscopy Part 3 🧻🧻🚽🚽 #colonoscopy #guthealth #gutissues

♬ original sound – lucinda

Lucinda Binney walks her audience through her experience with colonoscopy prep in a humorous, unfiltered manner that is popular among many lifestyle influencers. She details her experience with a liquid diet (she includes jello) and the standard practice of taking laxatives to prepare her colon for screening. Through this three-part vlog, she demystifies this screening procedure for her 340,000 followers, coming clean about both her anxiety surrounding the experience and her surprise that the laxative drink didn’t taste as bad as she thought. 

While it is uncommon for people in their 20s to receive colonoscopies, as the U.S. Preventive Services Task Force does not recommend them until age 45 (a recent change from the previous age 50 guideline), individuals at high risk for colorectal cancer (CRC) may benefit from receiving a screening. CRC rates in the younger population have risen dramatically in the past two decades, with incidence jumping from 2.7 people per 100,000 in the year 2000 to 5.0 per 100,000 in 2019 in the 15-to-39 age group. While these incidence rates are still not high enough to warrant routine screenings in the general young adult population, they help make the case for increased screenings among those at higher-risk. 

Haddon Pantel, MD, of Yale Medicine recommends that people in their 20s and 30s seek CRC screening if they experience any sudden changes in bowel movements, rectal bleeding, or any weight loss, abdominal pain, or appetite changes that are not otherwise explained. For more information about the signs of CRC, check out this resource. 

Emma Edwards is a Colon Cancer Prevention Intern with the Colon Cancer Foundation.

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Early-Age Onset Colorectal Cancer: Health Disparities in the Black Population

Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the U.S., and the incidence of early-age onset CRC (EAO-CRC)—when the disease is diagnosed in those younger than 50 years—is rising. In the Black population, EAO-CRC makes up nearly 10% of all new diagnoses. The incidence of EAO-CRC in the Black population (8.4 cases per 100,000 people in 2019) is slightly lower than that of the White population (8.9 cases per 100,000 people in 2019), but this is reversed when it comes to the mortality rate. The mortality rate of EAO-CRC in the Black population is 2.4 deaths per 100,000 people, while it is 1.8 deaths per 100,000 people in the White population. Between 2015-2019, 5,329 new EAO-CRC cases were diagnosed among Black Americans.

Studies have shown that Black individuals are more likely to be diagnosed with EAO-CRC at a younger age and a more advanced stage than White individuals: 22% of White Americans receive a metastatic diagnosis compared with 26% of Black Americans. 

 

 

While additional research is needed to discern the higher incidence of EAO-CRC in the Black population, certain socioeconomic and environmental factors likely play an important role. These include limited access to proper healthcare services, the prevalence of food deserts leading to poor nutrition, and living in areas with high pollution rates. Additional resources to support research, prevention, and treatment efforts of EAO-CRC in this population are critical.  

Empowering the population via awareness and education campaigns around the early warning signs of CRC and the importance of screening in the Black community would also go a long way. Early warning signs of CRC include changes in bowel movements, blood in stool, unexpected weight loss, and continuous abdominal discomfort. If you are experiencing these symptoms, speak with your doctor. 

Additional information on prevention, symptoms, and diagnosis of CRC can be found under ‘Resources’ on the Colon Cancer Foundation’s website.

 

Emma Edwards is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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Medicaid Expansion May Have Improved Diagnosis of Early-Stage CRC

Health insurance coverage is an important determinant of access to health care. Most people in the U.S. receive health insurance through their employers and many others qualify for government insurance programs like Medicare (generally for those >65 years) or Medicaid (for low-income families/individuals). The 2010 Affordable Care Act mandated preventive screening coverage for those who are enrolled in Medicaid and provided support to participating states. A cross-sectional cohort study has now revealed that after Medicaid expansion in 2014, the proportion of patients diagnosed and treated at Commission on Cancer–accredited facilities increased within expansion states and decreased in non-expansion states. 

This study evaluated whether the proportion of patients diagnosed with early-stage colorectal cancer (CRC) changed over time within states that expanded Medicaid, compared with non-expansion states. The authors queried the multicenter registry data from the National Cancer Database (2006-2016) and identified a total of 10,289 patients in expansion states and 15,173 patients in non-expansion states. They found:

  • A 0.9% annual increase in the number of individuals diagnosed with early-stage CRC in expansion states after 2014 
  • A 0.8% annual reduction in the number of individuals diagnosed with with early-stage CRC in non-expansion states after 2014 
  • By 2016, the absolute difference in the propensity-adjusted proportion of early-stage CRC was 8.8% 

Similarly, a study published in the Journal of American Surgeons also found that Medicaid expansion has had a notable impact on the diagnoses of early-stage CRC compared to non-expansion states. 

Improved insurance coverage following Medicaid expansion may have facilitated access to screenings and earlier diagnoses. 

For more information on insurance coverage for CRC screening, please visit: Insurance Coverage for Colorectal Cancer Screening. 

 

Kitty Chiu is a Colorectal Cancer Prevention Intern with the Colon Cancer Foundation.

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