Colorectal cancer rises among younger patients

By KATHERINE ZEHNDER NEWS-PRESS STAFF WRITER

March is Colorectal Cancer Awareness month.

In light of that, Sansum Clinic is highlighting the alarming statistics surrounding this type of cancer. Current statistics show an increase in cases among those under age 50, while the overall rate of colorectal cancer is dropping.

“Colorectal cancer is a term used to describe cancer in the colon or rectum. It is two entities because the anatomy is different. Typical patients have one or the other,” Dr. Cristina Harnsberger, a Sansum Clinic fellowship-trained colorectal surgeon, told the NewsPress.

Statistics show that approximately 153,000 patients will be diagnosed with colorectal cancer in the United States this year, and 10% of those diagnosed will be younger than 50.

While the overall rate of people diagnosed with colorectal cancer has been dropping since the 1980s due to screenings, the number of people younger than age 55 diagnosed with colorectal cancer nearly doubled from 11% in 1995 to 20% in 2019, according to the American Cancer Society.

Experts say colorectal cancer is on track to become the leading cause of cancer death in adults under 50.

In the U.S., colorectal cancer is the third most commonlydiagnosed cancer and the second most common cause of cancer-related deaths overall.

According to the American Cancer Society, there are now 106, 970 new cases of colon cancer and 46,050 new cases of rectal cancer. Screenings and colonoscopies, though, are making a difference.

“The decrease overall is because more people are being screened,” Dr. Harnsberger told the News-Press. “A colonoscopy detects and prevents cancer.

The cancer can be prevented by removing small polyps before they develop into cancer.

“The rate is increasing, especially those between (ages) 20-50 increasing steadily since the mid 90s,” she said. “Because of the increased rate of this type of cancer in those under 50, the recommended screening age has been moved down from age 50 to 45.”

The News-Press asked Dr. Harnsberger about what is causing this increase in colorectal cancer in those under 50. She said this is an area of “active research” and that the cause remains undetermined.

Signs of colorectal cancer include rectal bleeding, change in frequency and consistency of bowel movements, and abdominal pain or anemia.

Dr. Harnsberger advised against ignoring symptoms.

“A colonoscopy is a safe test and the best test for diagnosing and preventing colon and rectal cancer,” she added.

Factors that can place an individual more at risk include obesity, diabetes, smoking or heavy alcohol use. Additionally, genetic syndromes that can place an individual more at risk — Lynch syndrome is one example — are more common in younger patients.

“There are a number of pathways by which colorectal cancer can develop,” Dr. Harnsberger said.

“One is chromosomal instability, which is when the cells lining the colon can develop mutations that cause them to grow abnormally, which usually manifests as a small polyp,” she explained. “As more mutations develop, it has the ability to invade and spread into many types of mutations in the cells.

“Another way is when the repair mechanisms for mistakes in the cells don’t function properly, when the machinery of the cells develop problems and cells with mistakes are allowed to grow.

“A third way is through inherited genetic syndromes, which accounts for about 10%, and Lynch syndrome accounts for less than 5%,” said Dr. Harnsberger.

Hannah Andrews, a genetic counselor at the Ridley-Tree Cancer Center in Santa Barbara, told the News-Press that Lynch syndrome is a genetic change, harmful variant or mutation. She said it’s a hereditary condition that increases the risk of certain types of cancer.

“The general population has a 4% chance of developing colorectal cancer,” she said.

“Those with Lynch syndrome have a 20-60% lifetime chance of developing colorectal cancer.”

“When we evaluate an individual personal or family history to see if Lynch syndrome is likely, we look for certain features,” she said, citing the inclusion of individuals diagnosed with cancer at an early age or colon cancer before age 50.

“We also look for a diagnosis for multiple types of cancer or for multiple people diagnosed with colon cancer,” said Ms. Andrews. She said genetic counselors can assist patients by looking at their family history and doing risk assessments. “If you have questions, speak with your healthcare provider to see if it would be helpful to meet with a