Too young? Colon cancer in the under-50s

COLON CANCER: AN UNDER-50 DISEASE?

Although among individuals over the age of 50, the incidence and mortality of colorectal cancer have declined in recent years, thanks largely to screening programs, for reasons as yet unknown the incidence of the disease in the population under the age of 50 has increased dramatically. In the United States alone, as per epidemiological records, the incidence of colorectal cancer per 100,000 young adults has increased by 1.6 percent in women and 1.5 percent in men per year between 1992 and 2005; also in the U.S., the number of newly diagnosed cases per year in the under-50s reaches 13,000.

colon cancer, under 50

COLON CANCER UNDER 50: HIGH MORTALITY

The dramatic finding is the high mortality observed in these patients, mainly due to a delay in diagnosis, for which both patients and physicians are responsible: the former because they often do not understand or underestimate the symptoms, and the latter because they tend not to correlate the symptoms with the pathology, in view of the age of the patients: the consequence is that a diagnostic error is recorded in 15-50% of cases, depending on the reports.

Doctors have always associated the occurrence of colon cancer at a young age with certain hereditary syndromes, such as Lynch syndrome. However, today we know that in about 75% of cases in these patients the cancer is not correlated with either a hereditary syndrome or any familiarity.

On the other hand, it is interesting to note that, in the U.S., the increased incidence over the past 30 years of colon cancer in the under-50s is accompanied, in the same group of patients, by a parallel increase in the incidence ofobesity and diabetes. In the same population, an increase in the consumption of sugar-sweetened beverages and a decrease in the intake of milk - rich in calcium, which seems to be a protective factor against colon cancer- was observed during the same period. Other factors, both behavioral and dietary, have also been recorded to be associated with early onset of the disease, and among them are increased consumption of industrial meat preparations, alcohol abuse and poor exercise. However, there is still insufficient data available. Currently, research is underway on possible relationships between the disease and changes in gut flora and exposure to environmental toxins and drugs such as statins and antibiotics.

COLON CANCER UNDER 50: WHAT TO DO?

What to do, then? Colon cancer is a curable disease when diagnosed early, but the dramatic reduction in the average age of its onset should give both epidemiologists and us clinicians pause for thought. I personally believe that the maximum effort should be produced both in identifying risk factors in young adults and ineducating this population group, making them aware of possible early signs of the disease - changes in alvus, bleeding, changes in the appearance of stool... - and, above all, in expanding screening programs, including by implementing new molecular biology techniques, some of which we have discussed in previous articles.

Source: "Why Is Colorectal Cancer Targeting the Young?", by Cynthia J. Gordon