As Colorectal Awareness Month wraps up, health care providers are highlighting the importance of screening, especially as colorectal cancer rates rise among younger US adults.
Research from the American Cancer Society this year shows the stark reality: Colorectal cancer is now the leading cause of cancer death for Americans under age 50, and it’s the second most common cause of cancer death for adults in the US. An estimated 158,850 new cases of colorectal cancer are projected for 2026, and 55,230 individuals could die from CRC this year, according to research published in the society’s journal CA: A Cancer Journal for Clinicians.
The American College of Gastroenterology also has highlighted this trend. People born around 1990 are estimated to have double the risk of developing colorectal cancer than people born in 1950.
Risk factors and lifestyle modifications
The reasons for the increase are complex, but experts said an unhealthy diet and sedentary lifestyle contribute to the risk. Obesity and metabolic syndrome also are factors that contribute to this trend, said gastroenterologist Dr. Aasma Shaukat of NYU Langone Health, who is an ACG trustee and leading expert in colorectal cancer screening and prevention. She suggested several ways younger Americans can lower their risk of this disease:
- Reduce red meat and ultra-processed food intake
- Eat more fiber, vegetables, fruits and whole grains
- Stop smoking
- Maintain a healthy body mass index
- Engage in regular physical activity
According to a study published in February in The American Journal of Gastroenterology, high BMI and current smoking status were among modifiable risk factors for people younger than 50 who had right- and left-sided advanced neoplasia.
Additionally, a survey from the Physicians Committee for Responsible Medicine and Morning Consult showed that nearly half of Americans did not know that eating processed foods raises the risk of developing colorectal cancer. And those foods have little benefit, so it’s important to educate patients about this risk, said Dr. Reezwana Chowdhury, a gastroenterologist at Johns Hopkins and chair of ACG’s Public Relations Committee.
“Obviously, it’s easy to make a turkey deli turkey sandwich or roast beef sandwich, but what is that really made of? What are the nitrates? What are the different compounds that are in there? And what is that doing to our gut?” Chowdhury added.
When to see a doctor
Symptoms may not always be apparent, and Chowdhury encouraged people to see a physician if they experience any change in their bowel habits.
“Any symptoms they may have, they shouldn’t minimize,” Chowdhury said. If people have abdominal pain, blood in their stools or changes in their bowel habits, those could be signs to see a physician, either a gastroenterologist or a primary care doctor, she added. Other symptoms that should be investigated include a low blood count showing anemia, fatigue or weight loss.
“For younger individuals, the most important point for them to understand is really just don’t ignore symptoms,” Chowdhury said. “Don’t look at colorectal cancer as a disease of older individuals. It is really rapidly rising in younger individuals. … It doesn’t always mean it’s colon cancer, but make sure you’ve at least addressed it and gotten appropriate testing.”
Screening methods
Colonoscopy is considered the gold standard of colorectal cancer screening methods, allows for polyps to be removed at the same time, and can be done at 10-year intervals starting at age 45 if the colonoscopy is normal, Shaukat said. It requires preparation the night before and time off work for the procedure, but other options are also available, such as CT colonography, fecal immunochemical testing and multitarget stool DNA testing (Cologuard), in which patients collect samples at home and send them in for testing.
“Stool tests are easy to do, can be completed in the comfort of one’s home and mailed in, don’t require any special preparation and have no complications or side effects. However, if the stool test is positive, it requires a colonoscopy for evaluation,” Shaukat said, adding that stool tests need to be repeated every one to three years.
Chowdhury noted some of those tests are “not great at detecting advanced polyps.”
“In a colonoscopy, you find a polyp, you remove that polyp, [and] you’re reducing the risk of someone developing colon cancer,” she said. “So in that sense, a colonoscopy is both a screening tool as well as a therapeutic tool. Now, some of these Cologuards can miss polyps because they don’t have the sensitivity for these polyps.”
Raising awareness
In 2021, the American College of Gastroenterology lowered the recommended screening age to 45 from 50 for people at average risk – those who don’t have a personal or family history of colorectal cancer or polyps or a personal history of inflammatory bowel disease.
Physicians can raise awareness of the lowered screening age with outreach and education, reminding patients when it’s time to screen for colorectal cancer, Chowdhury and Shaukat said.
Clinicians can send “mail or a chart message to patients 45 and older who are on their panel but don’t have an upcoming appointment. Organized outreach is important,” noted Shaukat, who is the first author of the ACG’s 2021 guideline. Other ways to encourage screening involve developing organized screening approaches, such as mailed FIT and offering free screening through state, manufacturer or GI practices’ programs, she said.
At ACG, “45 is the new 50,” Chowdhury said, highlighting one of the organization’s campaigns during Colorectal Cancer Awareness Month. ACG kicked off the month on March 1, volunteering at Fight CRC’s United in Blue installation on the National Mall in Washington, D.C. — a powerful display of more than 27,000 blue flags, each representing a person under age 50 projected to be diagnosed with CRC by 2030. This year, ACG also led a Colorectal Cancer Awareness Month media tour, pairing GI experts with local and national TV and radio outlets to raise awareness of and encourage screening.