I did not sign up to be a doctor for young people. I wanted old people with cancer. All of a sudden, I have a bunch of young people, young adults, in my clinic with colon cancer.
—John L. Marshall, MD
The incidence of colorectal cancer continues to decrease among the US population as a whole; however, splitting the population into two subsets according to age reveals a worrisome fact. Although incidence is sure enough declining in patients aged 50 years or older, it is actually on the rise in individuals younger than 50 years—and the sharpest increase occurs in those aged between 20 and 29 years (J Natl Cancer Inst, 2017). There is no question that these statistics are concerning, but raising awareness among the general population and their physicians could break this trend.
Physicians have found that younger patients are more likely than their older counterparts to be diagnosed with advanced stage colorectal cancer. Patients aged 50 years and older have the opportunity to undergo routine disease screening by colonoscopy, but, for a host of reasons, this preventive screening is not approved for the average younger person. Therefore, this younger age group needs to be particularly aware of colorectal cancer symptoms—blood in stool; changes in bowel habits such as diarrhea, constipation or narrowing of stool that lasts more than a few days; unintended weight loss; and cramps or abdominal pain—and visit their primary care doctor with any concerns; likewise, doctors should have the possibility of colorectal cancer in younger adults on their radars. Dr. John Marshall of the Ruesch Center said that younger patients generally aren’t diagnosed in a timely manner, although he hopes that this will change as awareness spreads. He notes that Georgetown physicians are seeing an increasing percentage of younger patients with colorectal cancers in their clinics—in fact these younger patients now make up more than half of the patient population.
Dr. Mohamed Salem, a former Ruesch Center oncologist, understands that patients in their twenties, thirties, and forties are likely working for a living and need to take care of children or are planning to start a family. Treatment impacts the whole family, as well as fertility and pregnancy. Juggling time off work for treatment, while maintaining health insurance and arranging childcare can be very difficult and very stressful. At Ruesch and Lombardi, we attempt to assist with every aspect of patient care and offer social work services and support groups, as well as other patient and family resources; the Ruesch Center works closely with advocacy groups, who can help with many practical aspects of a cancer diagnosis. View our advocacy section.
Looking forward, an increasing awareness of the risk of colorectal cancer in younger patients, combined with the use of novel immunotherapy and precision medicine offers hope for all patients.
Why are young adults getting colorectal cancer? This three-part series examines what is known about the growing incidence of early-onset colorectal cancer, what factors may be driving it, and the heroic efforts to arrest this devastating and frequently deadly form of the disease. Dr John Marshall, a leading oncologist, explores this phenomenon by taking us into the exam rooms and labs of a major cancer research center, and into the lives of two patients in their 30s who have metastatic colorectal cancer.