Colorectal cancer (CRC) may be a familiar disease, as many of us know someone who has been diagnosed with it. However, recent years have seen a concerning trend: an increasing number of diagnoses in individuals in their 40s and even younger. Experts are still determining the exact reasons behind this rise in young adults, but it is clear that multiple factors are contributing to this increase.

Insights into Colorectal Cancer Rates

According to the American Cancer Society, the occurrence of colorectal cancer has been rising significantly in adults younger than 55 years.  Those born between 1960 -1980 (Generation X) and those born between 1980 – 2000 (Millennials) are particularly being affected. Currently, three out of every 10 people diagnosed with CRC are younger than 55 years old.  A person born in 1990 has two times the risk of colon cancer and four times the risk of rectal cancer compared to those born around the 1950s when the risks began increasing. The rates of rectal cancer are increasing faster than the rates of colon cancer.

Unfortunately, about 60% of those in the younger age groups who are being diagnosed with colorectal cancer are being diagnosed in the later stages of the disease, making it more difficult to treat and cure.  There are various reasons.  Younger people may not know about symptoms of cancer and are not thinking it could happen to them.  Also, primary care physicians may not have cancer high on their list of differential diagnosis for younger people when symptoms are present.  Therefore, detection is delayed. CRC is now the #1 cause of cancer death in men under the age of 50, and the #2 cancer for women younger than 50. Over all, in the adult age groups, there are estimated to be almost 153,000 new cases of colorectal cancer in 2024, and it is the 2nd most common cancer to cause death in the U.S. Estimates are that we will see more than 53,000 deaths in 2024.

Data has shown that Black Americans have a 15% higher chance of developing CRC and could be more likely to die from it, by about 35% more, compared to non-Hispanic White Americans.  Across the globe, Alaskan Natives have the highest CRC occurrence and the greatest death rates. For some people, a diagnosis of CRC can be humiliating due to its association to the digestive tract.  It is one of the most stigmatized cancers.  So, frequently, patients are not comfortable discussing CRC because the signs and symptoms have to do with irregular bowel movement, which is usually something they like to keep private.

Risk factors that may increase the chance that someone will develop CRC

Having a family history of colorectal cancer or polyps significantly raises your risk of developing the disease. Specifically, this risk is heightened if you have a first-degree relative (a parent, child, or sibling) who has been diagnosed with colorectal cancer, especially if they were diagnosed before the age of 50, or if you have multiple relatives with the disease. The risk is 2 to 4 times more likely compared to people who don’t have a family history. If multiple relatives are affected, the risk is higher for diagnosis before the age of 50.  Distant relatives with CRC, and first or second-degree relatives with adenomas or polyps, can also increase CRC risk.  The family risk is thought to represent a combination of lifestyle factors and the cumulative effect of genetic variations. Some factors include:

  • Inherited genetic disorders like Lynch syndrome, familial adenomatous polyposis, or Gardner’s syndrome.
  • Inflammatory bowel diseases such as Crohn’s disease and Ulcerative Colitis or other inflammatory bowel diseases.
  • Type-2 Diabetes.
  • People who lead a sedentary lifestyle, such as spending many hours watching TV, face a 25% to 50% higher risk of developing colon cancer compared to those who are more active.
  • Obesity, excessive body weight.
  • Personal history of other cancers such as ovarian, breast, and endometrial.
  • Poor diet. This includes a diet low in fiber, high in fat, red meat, processed meats, processed foods, and refined carbohydrates. The direct role of specific foods in CRC occurrence is hard to measure accurately because of variations in intake, food sources, and the connection between other poor health and dietary behaviors.
  • A high bacteria count in the gut microbiome. High levels of specific bacteria in the microbiome are associated with CRC risk. Anything that disrupts the normal balance of gut bacteria may be associated with an increased risk of CRC, this includes heavy antibiotic use.
  • Chemicals in the environment that may be linked to colon and other cancers. Excessive consumption of grilled foods that have been charred, foods that have been heat-treated, contain preservatives (ham, bacon, sausage, hotdogs) or have been contaminated with pesticides all have the potential to cause colon cancer. For instance, french fries that have been fried in oil that has been used more than twice cause the oil to produce chemicals as it deteriorates. Acetaldehyde is one ingredient in alcohol.  Regular drinking can cause this chemical to accumulate in the body and can stimulate cancer causing genes.

How to Reduce the Risks

  • Increase Physical Activity: Engaging in regular exercise can significantly lower your risk.
  • Limit Alcohol Consumption: Reducing the amount of alcohol you drink can decrease your susceptibility to colon cancer.
  • Maintain a Healthy Diet: Focus on a diet that’s low in animal fats and high in fruits, vegetables, and whole grains. Eating 30 grams of whole grains daily can reduce your risk of colon cancer by 5%. Additionally, ensuring adequate intake of calcium and vitamin D may also help lower your risk.
  • Knowing Your Family History: Being aware of your family’s health history can guide your prevention strategies.
  • Pursue Early Screening: Regular screening is crucial, especially if you’re at a higher risk due to family history or other factors, as it can lead to early detection and more effective management.

Almost 1/3 of people who are diagnosed with colorectal cancer under the age of 50 can point to a link of genetic factors or family history.  Guidelines now say that most people should begin getting colorectal cancer screening at age 45.  However, those with a family history of CRC may need to get checked even earlier.

There are several types of colorectal cancer screening methods, but the most recommended method is the colonoscopy. Generally, physicians prefer the colonoscopy because they can see the entire colon during the procedure and can remove any polyps they may find before they turn into cancer. Talk to your doctor to determine which screening method is right for you.

For both young and older adults, it is important to recognize the symptoms and risk factors associated with colorectal cancer. Always talk to your healthcare provider if you notice any abnormalities, such as:

  • Abdominal pain—cramps, pain, bloating, gas.
  • Blood in the stool.
  • A change in bowel habits.
  • Excessive gas.
  • A change in the stool caliper—thin stools.
  • Feeling that your bowels are not emptying completely.
  • General fatigue.
  • Unexplained weight loss.

To ensure you receive personalized guidance on screening options and intervals, consider consulting with a physician affiliated with the TopLine MD Alliance. They can provide expert advice tailored to your health needs, allowing for timely intervention.

Dr. Jennifer Romero is a proud member of the TopLine MD Alliance practicing Primary Care in Broward County.

The TopLine MD Alliance is an association of independent physicians and medical practice groups who are committed to providing a higher standard of healthcare services. The members of the TopLine MD Alliance have no legal or financial relationship with one another. The TopLine MD Alliance brand has no formal corporate, financial or legal ties to any of the affiliated physicians or practice groups.