Scientists reveal reason behind 'steep' increase in colon cancer cases among young people
An investigation by the American Cancer Society (ACS) found that after a stable 15-year trend, diagnoses of local-stage colorectal cancer (CRC) rose steeply in adults aged 45 to 49 years old between 2019 and 2022 in the US.
From 2021 to 2022, there was a 50 percent relative increase in diagnoses from 11.7 to 17.5 cases per 100,000 people.
Local or early stage indicates the cancer is confined to the original site where it started, has not spread to other areas of the body and usually has no symptoms.
If colon cancer is detected and treated in its early stages, the five-year survival rate is approximately 90 percent, while it is around 60 percent if it is diagnosed in its advanced stages.
The cost of treatment also dramatically increases, with early-stage colon cancer costing around $40,000 to treat, while advanced stages can exceed $300,000.
The study's lead author Elizabeth Schafer put the rise in early-stage colon cancer cases down to recommendations for younger average-risk adults to begin testing for earlier.
While the disease is known to be linked to obesity, experts have noted that the disease also seems to also be occurring in fit and healthy patients.
Some experts believe the explanation must lie in environmental factors young people have been exposed to more than previous generations.
While no 'smoking gun' has been found, there are multiple theories. These include modern chemicals in diets, microplastics, pollution, and one recent study even pinned the surge on exposure to E. coli in food.
The recommended age to begin CRC screening was lowered from 50 to 45 years by ACS in 2018 and the United States Preventive Services Task Force (USPSTF) followed suit in 2021.
The US already has a lower colon cancer screening age than some other Western nations, including Canada — where it is set at 50 years — and England — which lowered the age from 60 to 50 years in 2021.
Early onset colorectal cancer has become the leading cause of cancer-related deaths for men under 50 and the second-leading cause for women under 50 in the US.
Over 50,000 Americans are expected to die from colorectal cancer this year, while 150,000 are predicted to be diagnosed with the disease.
For the recent ACS study, published Monday in the Journal of the American Medical Association (JAMA), researchers analyzed CRC cases diagnosed from 2004 to 2022 among adults 20 to 54 years old in the 21 geographic areas of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.
Cases were sorted by age, where the cancer was located, and stage at diagnosis.
Results showed that CRC incidence increased steadily by 1.6 percent annually since 2004 among adults 20 to 39 years old and by two percent to 2.6 percent per year since 2012 among adults 40 to 44 and 50 to 54 years old.
However, in people 45 to 49 years old, an increase of one percent annually during 2004 to 2019 accelerated to 12 percent per year from 2019 to 2022.
This steep increase was driven by the detection of early, local-stage tumors, which increased from 2019 to 2022 by 19 percent per year for colon cancer after previously stable rates and by 25 percent per year for rectal cancer after declining rates.
Advanced-stage disease has continued to increase steeply over the past two decades.
Incidence of advanced CRC increased from 1.7 to 2.9 percent annually since 2004 among adults under 45 years old and even more rapidly during the past decade in ages 45 to 54.
In support of these findings, another ACS led study also published today in JAMA reports that CRC screening among US adults 45 to 49 years of age increased by 62 percent from 2019 to 2023.
'It's not only thrilling to see the increase in colorectal cancer screening among younger adults, but also how it likely ties into rises in earlier stage diagnosis as noted in the other ACS led paper,' said lead author Jessica Star, an associate scientist of cancer risk factors and screening surveillance research at the ACS.
'However, we still have a long way to go. Screening for colorectal cancer in ages 45-49 remains suboptimal and has not increased equitably by both educational attainment and insurance status.'
For this study, scientists analyzed the data of more than 50,000 individuals from the National Health Interview Survey, comparing changes in CRC screening from 2019 to 2023 within age groups 40 to 44; 45 to 49; 50 to 54; 55 to 64; and 65 to 75 years old.
The data were adjusted for age, sex, race/ethnicity, education, and region.
The researchers found up-to-date CRC screening was up 20 percent in 2021 and 37 percent in 2023.
The study results showed that among 45- to 49-year-olds, colonoscopy screening increased by 43 percent and stool-based testing increased more than five-fold from 2019 to 2023.
Screening increased significantly from 2019 to 2023 in every racial and ethnic group, but remained unchanged among individuals with less than a high school education and those who were uninsured.
'These studies further demonstrate the importance of people having access to comprehensive health insurance, which covers evidence-based preventive services,' said Lisa A. Lacasse, president of ACS's advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN).
'With more than 2 million people in America expected to be diagnosed with cancer in 2025, it's more important than ever to make sure that everyone can access necessary screenings.
'ACS CAN will continue to advocate at the state and federal level to expand access for all because it isn't just good policy, it's lifesaving.'
Doctors say people with symptoms of colon cancer or those who are concerned about the disease and are under 45 years old may still be able to get screened on their health insurance.
Insurance would consider screening tests for this group as diagnostic screenings - a test to investigate specific symptoms - rather than a preventative screening - a test done on someone without symptoms to catch a disease early.
Out-of-pocket, a colonoscopy costs between $1,250 and $4,800 — although this varies significantly by state.
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