A report published by the American Cancer Society in January suggests that rates of colorectal cancer are rising rapidly among people in their 20s, 30s and 40s — even as incidence is declining in people over the age of 65.
“It’s unfortunately becoming a bigger problem every year,” said Dr. Michael Cecchini, a co-director of the colorectal program in the Center for Gastrointestinal Cancers and a medical oncologist at Yale Cancer Center. He added that early-onset colorectal cancers have been increasing by about 2 percent per year since the mid-1990s. This increase has moved colorectal cancer up to being the top cause of cancer deaths in men under the age of 50 and the second-leading cause of cancer deaths in women under 50 in the United States.
In fact, experts are noticing a rise in early-onset colorectal cancers around the world — a trend that they are racing to explain.
Why is colorectal cancer increasing among young people?
Colon and rectal cancers share many similarities and are typically lumped into one category, called colorectal cancer. Studies, however, show that the increase in diagnoses is mainly driven by a rise in rectal cancers and cancers found in the left, or distal, side of the colon, near the rectum. “That maybe provides an important clue for understanding what might be going on,” said Caitlin Murphy, an associate professor and cancer researcher at UTHealth Houston.
Colorectal cancers in younger people also tend to be more aggressive, and they are often found at a more advanced stage, Dr. Murphy said. But most people affected by early-onset colorectal cancer are too young to be recommended for routine cancer screenings, which have helped decrease rates in adults over 50. In 2021, the U.S. Preventive Services Task Force reduced the recommended age for starting colorectal cancer screening by just five years — from 50 to 45.
A vast majority of colorectal cancer diagnoses are still made in people 50 and older. The American Cancer Society predicted last year that roughly 153,000 new diagnoses would be made in the U.S. in 2023, of which 19,550 would be in people younger than 50. But millennials born around 1990 now have twice the risk of colon cancer compared with people born around the 1950s, while millennials’ risk for rectal cancer is about four times higher than that of older age groups, according to a study published in the Journal of the National Cancer Institute. That means diagnoses are likely to “continue going up as these higher-risk generations age,” Dr. Murphy said.
When cancer is found at a younger-than-usual age, doctors usually suspect that genetic mutations may be to blame. And some molecular studies suggest that tumors in early-onset colorectal cancers do have different mutations driving the cancer compared with tumors in older adults. Another piece of evidence that there is a genetic component: It is clear that having a first-degree relative who had colorectal cancer — or even a precancerous polyp — can increase your risk, Dr. Cecchini said. But genetic changes do not explain the full picture, he said.
Some research has linked lifestyle and dietary changes to increased rates of colorectal cancer in both young people and older adults. Recent generations have consumed more red meat, ultraprocessed foods and sugary beverages, and have been known to binge drink more frequently; between 1992 and 1998, cigarette smoking also increased before declining again, while physical activity has continuously declined for decades. All of these factors — along with the rise in obesity rates since the 1980s — are associated with cancer risk. But once again, none of them fully account for the increase in early-onset colorectal cancer.
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