The alarming rise of colon cancer in adults under 50: What you need to know

Colon cancer is now the leading cause of cancer in men under the age of 50 and the second cause of cancer in women of the same age. Young people are often diagnosed with more advanced cancers due to delays in detection.

“We want to spread the word that colon cancer isn’t an ‘older adult disease,’” says Ashley Shustak, M.D., and surgeon at Sentara Surgery Specialists in Norfolk, Va.

The rise of colon cancer in younger adults prompted the U.S. Preventive Services Task Force to change colon cancer screening guidelines in 2021. New guidelines recommend colon cancer screenings begin at age 45.

Why are colon cancer rates rising in younger adults?

Colon cancer in adults under the age of 50 is also known as early-onset colon cancer. While we can’t pinpoint any one reason why colon cancer rates are rising in young adults, we do know that more than half of all colon cancer diagnoses can be attributed to risk factors we can improve, such as:

• Cigarette smoking
• Excess body weight and obesity
• Heavy alcohol consumption
• High intake of red or processed meat
• Physical inactivity, sedentary lifestyle
• Poor diet

Early-onset colon cancer research is looking at a variety of factors, including diet and the role of alterations in the gut microbiome. Approximately 30% of early-onset colon cancer patients have a family history of colon cancer.

“Patients with a family history of colon cancer should talk to their doctor about beginning screening colonoscopies at the age of 40,” says Dr. Shustak. “But anyone with symptoms should be screened, regardless of family history or age.”

Symptoms to watch for

While many people with colon polyps and early-stage colon cancer won’t experience symptoms, people of all ages should be aware of some common symptoms, says Dr. Shustak.

Anyone experiencing the following symptoms should talk to a healthcare provider:

• Rectal bleeding: Blood coming from the rectum or blood in the stool or the toilet after a bowel movement.
• Unusual stools: You should investigate any changes in your stool. This includes dark (or black) stools or changes in stool size, such as narrow or thin stools.
• Changes in bowel movements: Includes loose stool (diarrhea) or constipation, especially if the changes occurred in the last two weeks or more.
• Low energy and fatigue: These symptoms may be caused by blood loss, and it’s a good idea to rule out colorectal concerns.

If you notice changes in your stool, talk to your healthcare provider immediately.

“Even if you think it’s ‘just a hemorrhoid,’ you need to be checked if you have these symptoms, regardless of your age,” says Dr. Shustak.

The importance of early screening and diagnosis

Colon cancer screenings are performed during a colonoscopy. A doctor inserts a flexible tube with a light and camera on the end through the rectum to examine the colon. Colonoscopies are performed under conscious sedation, meaning patients are not entirely asleep but also not typically aware of the exam. Most patients have no memory of the procedure.

The tube allows the doctor to remove any polyps found during the exam. Polyps are small bumps on the surface of the colon or rectum that may be precancerous. Removing them prevents many cancers from developing.

Patients may put off a colonoscopy due to concerns about discomfort and the preparation required for the exam. But newer prep methods may make that step easier. Several colonoscopy preparation methods are available, including newer pill-only preparations that may work for some patients.

Talk to your doctor about prep options based on your individual needs and things like insurance coverage,” says Dr. Shustak. “You may be pleasantly surprised by colonoscopy prep improvements in recent years.”

Learn more about colonoscopy screening.

Other types of colon cancer screening

In addition to colonoscopy, there’s another colon cancer screening method known as a stool check. Two types of stool checks are available: Fecal immunochemical test (FIT) and a stool DNA test. If a stool check finds concerns, a colonoscopy should be scheduled as a follow up.

FIT screenings must be done yearly and involve providing a stool sample for testing. These tests are designed to detect blood in the stool – even if it is not visible to the naked eye. Stool DNA tests also require providing a stool sample to look for certain abnormal sections of DNA from cancer or polyp cells and for the presence of blood. Stool DNA tests should be done every three years.

If a FIT test or stool DNA test is positive, a colonoscopy is needed to find the reason for the presence of blood. You can purchase an over-the-counter FIT test, but you should talk to your doctor first to ensure you use the type of screening that is best for you. Check with your health insurance, as it may cover the cost of a stool check.

Prevention strategies: lower your risk of colon cancer

Lowering your risk of colon cancer begins with managing your diet and physical activity.

• What you eat matters: The role of diet is increasingly being studied as a factor in the rising rate of colon cancer in all adults. One key way to reduce the risk of colon cancer (and other cancers) is to eat a diet supporting colon health, especially high fiber foods.
• Physical activity helps: Being more active lowers your risk of colorectal cancer and polyps.
• Find your healthy weight: Having excess weight increases the risk of colon cancer. Maintaining a healthy weight may help lower your risk.
• Don’t smoke. Quit smoking: Long-term smoking is linked to an increased risk of colon cancer and many other types of cancer.
• Alcohol is a risk factor for many cancer types: Consuming alcohol increases the risk of developing at least seven types of cancer, including colon cancer. Reducing your alcohol intake can help reduce your risk of several types of cancer.

Learn more about colon cancer prevention strategies.

Health disparities and barriers to care impact rates of colon cancer

Health disparities may also influence rates of colon cancer diagnosis. Healthcare disparities hit some communities harder when it comes to colon cancer.

For example, data indicates that Black Americans are 15% more likely to develop colon cancer and 35% more likely to die from it than their non-Hispanic white counterparts. Alaska natives also have the highest colorectal cancer incidence and mortality rates globally. Members of these populations are encouraged to talk with a healthcare provider about their risk factors for colon cancer.

Obstacles that prevent a person from getting the healthcare they need are called barriers to care. Barriers of care may play a role in a lower role in the diagnosis of colon cancer. Age is one barrier to care.

Patients under 50, especially men, are less likely than older patients to have a primary care provider, seek primary care, and have health insurance.

Healthcare providers may also be more likely to delay or skip testing in younger patients than in older, symptomatic patients.

The “bottom” line

Talking about topics such as stool changes with your healthcare provider may be uncomfortable but having that conversation may save your life. Don’t be afraid to address changes quickly, even if you’re under the age of 50 and have no known family history of colon cancer.

Do you need a primary healthcare provider? Sentara Medical Group’s team of doctors, physician assistants, and nurse practitioners is accepting new patients.