Colorectal cancer increases in patients under 50

Colorectal cancer should have been one of the last things Kelli McDonald worried about in her late 30s.

There was no family history. She wasn’t overweight and exercised regularly. She knew something was wrong, though, when she began noticing blood in her stool.

A physician said it was most likely hemorrhoids. But the problem, including anemia, got worse.

She went to a gastroenterologist who scheduled a colonoscopy the next day. The news was not good. She had Stage 3 colon cancer.

She was 37.

“When you’re that young, you don’t want to believe anything is wrong,” said McDonald, now 40.

After radiation, chemotherapy and multiple surgeries, she is now in remission.

While 90 percent of colorectal cancer occurs in people 50 and older, doctors are noticing a disturbing trend in the last few years.

More patients under 50 are being diagnosed with the disease. And when they are diagnosed, the cancer is usually farther along because they weren’t tested earlier.

Colorectal cancer is one of the leading causes of cancer-related deaths in the nation. Roughly, 50,000 people in the United States are expected to die of this type of cancer in 2014, according to the American Cancer Society.

While the incidence rate of colorectal cancer has been declining steadily by about one percent a year, because of greater awareness and screening among older populations, the rate has been rising among people under 50.

A study recently published in the JAMA Surgery, suggested that by 2030, looking at past trends, the incidence rates for colorectal cancers among those under 50 could double — going from about 8 percent to as high as 16 percent. The biggest increase will be among people ages of 20-35.

Dr. George J. Chang, associate professor of the departments of surgical oncology and health services research at the University of Texas MD Anderson Cancer Center and a senior researcher on the study, called the rise “dramatic.”

The U.S. Preventive Services Task Force recommends screening for colorectal cancer, using high-sensitivity fecal occult blood testing, sigmoidoscopy or colonoscopy, beginning at age 50.

The study does not recommend lowering the age for screenings.

“Obviously, today, we’d have to screen a lot of people to detect cancer in younger patients,” he said.

Dr. Charles Staley, the chief of surgical oncology for Winship Cancer Institute of Emory University and a colorectal cancer specialist, said a close family history significantly raises the risk of developing colorectal cancer.

He is seeing more adults under the recommended screening age of 50 with colon or rectal cancer and recently treated a woman in her 30s.

He and Chang agree that people who are obese, eat a fat-laden, low fiber diet, smoke and lead a sedentary lifestyle increase their risks. Other risk factors include genetic alterations and health conditions that may increase the risk such as ovarian or uterine cancer and inflammation of the colon. Chang said there could be environmental factors as well.

McDonald said older colon cancer patients would look at her in surprise when she went in for treatments.

“I never once said this is not fair,” said McDonald, who eventually had to quit her job as a medical sales rep to take care of her health. “It’s not fair to anyone. I had to deal with this one day at a time and look for the light at the end of the tunnel.”

Dr. Marc Sonenshine, of Atlanta Gastroenterology Associates, cautioned that people under 50 still represent a small number of patients diagnosed with colorectal cancer.

People younger than 50 should be evaluated when symptoms include rectal bleeding, a change in bowel habits, pain and weight loss, he said.

In patients over 50, screening for colorectal cancer with colonoscopy has worked and significantly driven down the rate of cancer and extent of cancer when found, he said.

Staley thinks there should be more efforts to educate people about the benefits of screenings and the importance of knowing the symptoms. And that awareness extends to the medical profession as well. If someone is young, colon cancer may not immediately rise to the top of the list as possible causes, he said. People may be told bleeding is caused by hemorrhoids and then “they show up with advanced cancer. I can’t tell you how many times I’ve heard that story. Nothing can be taken for granted anymore.”

McDonald has a message for those who think they’re too young for colorectal cancer.

“I promise you I would rather have a simply colonoscopy than what I went through. Pay attention to your body.”

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