By Matt McMillen
WebMD Health News
Reviewed by Brunilda Nazario, MD
Nov. 30, 2016 -- Three different doctors over 3 years dismissed Ashley Flynn's complaints.
"I had blood in my stool, and each doctor pushed it off as if it were fissures or hemorrhoids or something else minor," says Flynn, who lives outside Kansas City, KS.
But it wasn't something minor. Flynn was only 24 when she was diagnosed in 2011 with stage 3 rectal cancer. She had surgery and chemotherapy beginning in late 2011 and has been cancer-free since August 2012.
Cases of colon and rectal cancer are on the rise in people under the age of 50, a group that's rarely screened for them. According to a recent study, rates among younger people increased by more than 11% between 2004 and 2014.
In 2016, about 135,000 people will be diagnosed with colorectal cancer, which includes colon cancer and rectal cancer, according to the American Cancer Society. About one in seven of them will be under 50. Researchers at The University of Texas MD Anderson Cancer Center predicted last year that cases of colon cancer among people ages 20 to 34 will increase by 90% by 2030. They expect the number of rectal cancer diagnoses to more than double.
The problem appears to be particularly pronounced among certain minority groups, says Durado Brooks, MD, managing director of cancer control intervention at the American Cancer Society.
"African-Americans are about twice as likely as whites to be diagnosed before the age of 50," Brooks says. "Young Alaska natives are diagnosed at 3 times the rate of whites. And this is not a uniquely American phenomenon. European nations and Australia are also seeing a rise."
Although the overall number of young people with it remains small compared with older people, younger people are often diagnosed with more advanced disease that requires more aggressive treatment.
Flynn's experience is typical for such cases in younger people, says Brooks.
"I hear often from young people with the disease that when they told their doctor they had rectal bleeding, their doctor told them, 'You're too young to have colorectal cancer screening,' " says Brooks. "That tendency for clinicians to disregard the possibility of colorectal cancer in younger people is one of the things we are working very hard to overcome."
Overall, says Brooks, the outlook for many younger people is worse because of how late their cancer is diagnosed.
"But because they are younger, they do better," Brooks says. "Someone diagnosed with stage 3 colorectal cancer in their 30s can tolerate more aggressive treatment and will therefore be more likely to do better than someone in their 80s who has stage 3 colorectal cancer along with other health problems."
Dan Hawkins, an inventory supervisor in Salem, OR, learned he had stage 3 colon cancer in 2013, at age 29. He, too, had symptoms for several years before he was diagnosed with colon cancer.
"I didn't have insurance, so I went to an urgent care clinic," Hawkins says. "They told me not to worry about it."
Two years later, when he could no longer ignore the pain that had started building in his groin, he went to the emergency room. That visit led to a colonoscopy, which revealed a tumor pressing against his prostate.
"I wish the first doctor I had seen had been more proactive and referred me to a specialist," says Hawkins, who has been in remission since late 2013, after surgery and chemotherapy.
No Known Reason for Rising Number of Cases
Experts don't know why the rates of colorectal cancer are rising among young people, which began around 1990, says Yi-Qian Nancy You, MD, a colorectal cancer surgeon and researcher at the University of Texas MD Anderson Cancer Center in Houston.
You says that about a third of the cases can be attributed either to a genetic condition or family history of the disease. For the remaining two-thirds, it's unclear.
Brooks points to changes in diet over the last few decades as a possible explanation.
"Younger people today eat a lot more fast food and processed food -- things we know are associated with colorectal and other kinds of cancers," he says. "And the increasing obesity rate is a huge concern."
Hormones and antibiotics used on livestock and found in meat and other animal products might reduce the ability of our gut bacteria to protect us from disease, says Brooks.
"There's a lot of speculation about potential underlying causes," he says.
Be an Advocate for Your Health
Current guidelines recommend testing for colorectal cancer starting at age 50. You says that screening should start much earlier if you have a family history of the disease or a genetic condition, such as Lynch syndrome, a disorder that increases your risk of colorectal and other cancers, or familial adenomatous polyposis (FAP), which causes benign growths that will eventually become cancerous.
"We need to identify those 15% who have a hereditary syndrome," says You, "and we need to get people with a family history of the disease to show up and get screened."
Your family history should go back two generations and include your parents, grandparents, aunts, and uncles. If anyone in your family had colorectal cancer, says You, get tested 10 years before the age at which the youngest person in your family got the disease. The American Cancer Society also suggests talking with your doctor about genetic counseling if you have a family history of colorectal cancer. A genetic counselor can help determine if you have genes that put you at increased risk of colorectal cancer.
"If you diagnose people with such a history or genetic syndrome, their whole families should be diagnosed very early and very aggressively," says You.
Flynn and Hawkins, however, had no such risk factors. And for young people like them, it's unlikely that testing guidelines will change any time soon.
"We have to do studies to find out what effect screening would have in young patients and in what age groups screening would be most effective," says Matthew Kalady, MD, a colorectal surgeon and co-director of the Cleveland Clinic's Comprehensive Colorectal Cancer Program.
Experts recommend that patients and primary care doctors recognize and take seriously the symptoms of colorectal cancer. The most common include:
- Changes in bowel habits
- Blood in the stool or rectal bleeding
- Persistent abdominal cramping or pain
"It's really, really important for people who have such symptoms to talk to their doctor and get evaluated," says Kalady. "Express your concerns and be an advocate for yourself. If your concerns are not met, seek a second opinion."
Flynn, a pediatric oncology nurse practitioner, has a message for practitioners: "As a provider, you have to keep those rare cases on your mind so that the next time a 30-year-old comes in with rectal bleeding, you don't push it off as fissures or hemorrhoids right away. Instead, maybe dive into the causes a little deeper."
Now 29, Flynn, who married last summer, may be cancer-free, but she never expects to be worry-free. She wonders: What if the cancer comes back? But she tries not to live in fear. Hawkins, who goes in for checkups every 6 months now, must use a colostomy bag for the rest of his life.
"My life will never be what it was before," he says. "However, as cancer survivors, we have to create a new normal."
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SOURCES: Durado Brooks, MD, managing director, cancer control intervention, American Cancer Society, Atlanta. Ashley Flynn, rectal cancer patient, Olathe, KS. Dan Hawkins, colon cancer patient, Salem, OR. Matthew Kalady, MD, co-director, Comprehensive Colorectal Cancer Program, Cleveland Clinic. Yi-Qian Nancy You, MD, colorectal surgeon and cancer researcher, University of Texas MD Anderson Cancer Center, Houston. American Cancer Society: "American Cancer Society recommendations for colorectal cancer early detection," "Colon Cancer Cases Rising Among Young Adults," "Genetic testing, screening, and prevention for people with a strong family history of colorectal cancer," "Key statistics for colorectal cancer." Cancer.net: "Lynch Syndrome." National Library of Medicine: "familial adenomatous polyposis." O'Connell, JB. The American Surgeon, October 2003. Siegel, RL. Cancer Epidemiology, Biomarkers and Prevention, June 2009. Society for Surgery of the Alimentary Tract: "An Update on Young-Onset Colorectal Cancer, an NCDB Analysis." U.S. Preventive Services Task Force: "Colorectal Cancer: Screening."
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