Colorectal cancer screening among young adults is increasingly important as cases rise

When Fredric Allen Rivers Jr. was diagnosed with colon cancer at age 31, the New Jersey resident had never heard of anyone so young getting a disease more commonly associated with aging.

But between 1995 and 2019, colorectal cancer rates have doubled among people under 55, even as the overall incidence declined, according to new data from the American Cancer Society. Adults younger than 55 accounted for about 20% of colorectal cancer diagnoses in 2019.

In New Jersey and Pennsylvania, the disease is even more prevalent than in other parts of the country. Across all ages, the incidence rate is 39.7 cases per 100,000 people, compared with a national average of 36 cases per 100,000, according to an American Cancer Society report released March 1.

What’s more, these cancers are being diagnosed at a later stage, when they are more difficult to treat and more likely to have spread. Genetics is thought to play a role in colon cancer at any age, as well as lifestyle factors such as smoking or eating too much processed food. Researchers are still studying what causes colon cancer and what is putting younger and younger adults at risk.

“It’s alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population,” Rebecca Siegel, a senior scientific director at the American Cancer Society, said in a statement.

The trend underscores why the cancer society and the U.S. Preventive Services Task Force both recommend beginning colon cancer screening at age 45, down from age 50, to detect and remove pre-cancerous polyps, but screening rates for this age group remain low.

“There is a clear relationship between colon cancer screening rates and the incidence of colon cancer,” said Ahmedin Jemal, a senior vice president at the American Cancer Society. “Why do young people have a higher rate? It’s squarely because their screening rates are very low.”

» READ MORE: Colonoscopies save lives, but many Americans don’t get one. Home tests could help change that.

Colon cancer is among the most preventable and treatable types of cancer, thanks to colonoscopies and stool-based tests that are highly effective at identifying pre-cancerous polyps. The tests are covered by most insurance.

Yet just 20% of adults ages 45 to 49 were up-to-date with colorectal cancer screening, compared with 70% of adults ages 50 to 75, according to the American Cancer Society’s data for 2020.

Rivers, who lives in Williamstown, began routine colonoscopies around his 30th birthday because he was considered at higher risk for colon cancer.

He was diagnosed with a liver disease as a teenager and needed a liver transplant in his mid-20s. Rivers also has ulcerative colitis, a gastrointestinal condition that elevated his risk of colon cancer.

Although Rivers was accustomed to seeing doctors regularly, many men his age don’t even bother going for an annual physical, Jemal said. People who don’t routinely interact with the health system are less likely to know about the screening guidelines, or see a doctor who may recognize early warning signs.

“I wouldn’t be here right now if I had that kind of mentality,” Rivers said.

Colorectal cancer rates were 33% higher in men than in women across all age groups between 2015 and 2019, according to the American Cancer Society’s 2023 statistics report.

Other key findings:

» READ MORE: Colonoscopy isn’t the only way to screen for colon cancer. Here are your options.

As for what causes colon cancer in the first place, researchers are still figuring it out.

Family history of the disease is the strongest risk factor researchers have identified so far. People with a first-degree relative — a parent, sibling, or child — who has been diagnosed with colorectal cancer are up to four times as likely to develop the disease, the American Cancer Society has found.

About 55% of colorectal cancer cases are linked to lifestyle factors, such as an unhealthy diet, insufficient physical activity, high alcohol consumption, and smoking, according to the American Cancer Society report.

A similar rise in other cancers — such as breast and pancreatic cancer — among younger adults may point to environmental factors that have not yet been thoroughly studied, Jemal said.

“We do wonder if there’s something else happening,” he said.

Jemal and his colleagues urge people to talk to their immediate family members to identify whether they may have a genetic risk for colon cancer and discuss with their doctor when to begin screening.

Early-stage colon cancer can be removed with minimally invasive laparoscopic surgery. More advanced cancers may require removing a portion or all of the colon.

For Rivers, despite beginning regular colonoscopies years before the recommended age for average-risk adults, his cancer was already advanced when diagnosed in 2012. He needed his entire colon removed.

The procedure involved two surgeries: First, doctors removed the colon, and several months later, after he’d healed, they reconnected his gastrointestinal tract.

In 2019, during a routine follow-up exam, doctors found that the cancer had come back, this time on his kidney. He had surgery to remove part of his left kidney.

The cancer recurrence came just as Rivers was beginning to feel like his old self.

“I have my good days and bad days,” he said. “Because of all the things I’ve gone through, it’s hard for me to determine how I’m going to feel.”

These days, Rivers enjoys spending time with his wife and children outdoors or cooking healthy meals — anything that allows him to appreciate, for a moment, how grateful he is for his health today.