Colon cancer may no longer be a disease of just the over-50 crowd.
A new study from the American Cancer Society supports what many doctors nationwide have been seeing in their practices in recent years: an increase in colon cancer patients who are younger than 50.
It's the third most common cancer in American men and women. More than 95,000 new cases will be diagnosed this year, according to the cancer society. Ninety percent will be patients age 50 and older. The median age for diagnosis is 69 in men and 73 in women.
But an unusually steady flow of patients younger than 50 caught the attention of Dr. Samantha Hendren, a surgeon who specializes in the treatment of colorectal cancer in Ann Arbor, Mich.
"Every week, it seemed, we were seeing a patient in their 30s or early 40s," said Hendren, who is also an associate professor of surgery at the University of Michigan Health System. "We wanted to know: Is this really happening nationwide? That's what inspired us to do the study."
Hendren led a team that looked at the records of more than 258,000 colorectal cancer patients from across the United States who were diagnosed between 1998 and 2011. They found that 37,847 — nearly 15 percent — were younger than 50.
"We were surprised that the numbers were that high," Hendren said. For average adults, screening for colon cancer doesn't start until age 50.
Because of aggressive efforts encouraging screening, the cancer society reports that colon cancer rates have been declining by 4.5 percent a year in adults 50 and older. During screening, doctors are able to find and remove polyps before they become cancerous. "And in this age group, we tend to discover these cancers at an earlier stage, so screening has been a real success story," Hendren said.
That raises questions about whether screening should begin at an even earlier age. Probably not, say most experts.
Current guidelines call for earlier screening of high-risk individuals — those with a brother, sister, parent or child who had colon cancer.
"I think our current guidelines are good enough," said Dr. Sophie Dessureault, a surgical oncologist at Moffitt Cancer Center in Tampa and professor of surgery at USF Health. "We don't need to change what's in place, we just need to better apply the guidelines so younger patients aren't dismissed as having nothing."
Dessureault said it's common for young colon cancer patients to say they've had symptoms for several months or more than a year and their doctor said not to worry.
"The frontline physicians don't think colon cancer because the patient isn't old enough, isn't the typical older patient," she said. "We don't need to screen them younger, we need to work them up when they present symptoms of colon cancer."
Why the hesitancy on screening? It can be costly, usually requires time off from work and is not without risk of complications.
Chief among symptoms of colon cancer is blood with bowel movements. "But not just bright red blood, that is more associated with hemorrhoids," Hendren said. "With cancer, it's dark red in color. It's also common to see blood mixed in with the stool."
Also on the list is a change in the size or shape of bowel movements. "Small, skinnier, pencil-thin stools are often a sign of a tumor being present," she said, adding that weight loss is another red flag symptom, but that may develop with later stage disease.
Any of these symptoms should be evaluated by a physician. "I know it's awkward to talk about, but you have to," Hendren said.
People who are at high risk for colon cancer, especially those with a close family member who had the disease, are generally advised to begin screening at age 40.
"But if you have a first-degree relative, mother, father, sister, brother, child, who was diagnosed, you need to begin screening 10 years before that relative's age of diagnosis," Dessureault said. "So if Mom was diagnosed at 52, you need to be scoped starting at 42."
While younger patients in the Michigan study were more likely to be diagnosed with advanced-stage disease, they were more aggressively treated and lived longer without a recurrence of cancer. The study was published online in Cancer, a journal of the American Cancer Society.
"What we have here is new information for physicians that more of these cancers are being found in younger people. Now we can move toward doing more screening of younger patients who have those red flag symptoms," Hendren said.