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Study Finds Sharp Rise in Colon Cancer and Rectal Cancer Rates Among Young Adults

Saturday 16th September 2017
Mr J Shabbir, Consultant Colorectal Surgeon

Bowel Cancer is the 4th most common cancer in the UK accounting for almost 11% of all new cancers. It is slightly more common among men with a male to female ratio of12:10. Around 110 people are diagnosed with bowel cancer every day in the UK, that's someone every 15 minutes. Bowel cancer incidence is strongly related to age, with the highest incidence rates being in older males and females. In the UK in 2012-2014, on average each year more than 4 in 10 (44%) cases were diagnosed in people aged 75 and over.

A study published in the Journal of the National Cancer Institute in Feb 2017 found that new cases of colon cancer and rectal cancer are occurring at an increasing rate among young and middle-aged adults in the US. They looked at the records of almost 500,000 people 20 years and older who were diagnosed with colon or rectal cancer from 1974 through 2013. The data came from the Surveillance, Epidemiology, and End Results (SEER) program registries of people diagnosed with cancer. They included people born in 1890 through those born in 1990.
This study found Colorectal cancer (CRC) incidence in the United States is declining rapidly overall but, curiously, is increasing among young adults. After decreasing in the previous decade, colon cancer incidence rates increased by 1.0% to 2.4% annually since the mid-1980s in adults age 20 to 39 years and by 0.5% to 1.3% since the mid-1990s in adults age 40 to 54 years. The rectal cancer incidence rates have been increasing longer and faster (eg, 3.2% annually from 1974-2013 in adults age 20-29 years).

The study also demonstrated the reduction in the overall incidence of bowel cancer in the US, thanks largely due to the screening program. To detect cases of bowel cancer sooner, the NHS offers two types of bowel cancer screening to adults registered with a GP in England.

• All men and women aged 60-74 are invited to carry out a faecal occult blood (FOB) test. Every two years, they're sent a home test kit, which is used to collect a stool sample. Those with positive FOB are invited for a one off colonoscopy ( a camera examination of the large bowel).
• An additional one-off test called bowel scope screening is gradually being introduced in England. This is offered to men and women at the age of 55. It involves a doctor or nurse using a thin, flexible instrument to look inside the lower part of the bowel.

However, the findings of the above study are extremely important and highlight the need for educating, both the general public and the clinicians about this increase trend of bowel cancer in younger population to avoid delays in diagnosis.

Signs and Symptoms of Bowel Cancer:

According to the study, people younger than 55 are 58% more likely to be diagnosed with late-stage disease than older people. This is mostly due to delay in the diagnosis, as cancer is not the radar of both the patients and their health care providers. The symptoms of bowel cancer are subtle and there is considerable overlap with benign conditions such as Haemorrhoids, IBS or Inflammatory bowel disease. Some of the red flag symptoms are given below and if these persist for more than six weeks, patients should seek advice from their GP.

• persistent blood in the stools - that occurs for no obvious reason or is associated with a change in bowel habit
• a persistent change in your bowel habit - which usually means going more often, with looser stools
• A feeling that you need to have a bowel movement that is not relieved by doing so
• persistent lower abdominal (tummy) pain, bloating or discomfort - that's always caused by eating and may be associated with loss of appetite or significant unintentional weight loss

There is not enough evidence to suggest a reduction in the age of screening for bowel cancer below the age of 50. However, this study gives an important message that we need to educate our clinicians and general public to take these symptoms seriously and seek medical advice if the symptoms persist longer than six weeks.

References:
• http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/incidence#heading-Ten
• https://academic.oup.com/jnci/article/109/8/djw322/3053481/Colorectal-Cancer-Incidence-Patterns-in-the-United#.WbMmot1cZYw.email
• http://www.nhs.uk/conditions/Cancer-of-the-colon-rectum-or-bowel/Pages/Introduction.aspx