Trend will likely lead to physicians ordering more clinical laboratory screening tests for cancer among all age groups, including young patients
Upticks in colorectal cancer cases among younger populations, as reported in recent news stores, is an issue that has implications for clinical laboratories. According to a study conducted at the University of Missouri-Kansas City (UMKC), the number of colorectal cancer cases in the US has increased greatly since 1999 with the “most dramatic jumps” seen in children, teens, and young adults, a Digestive Disease Week (DDW) news release reported.
“Colorectal cancer is no longer considered just a disease of the elderly population,” said lead researcher Islam Mohamed, MD, an internal medicine resident physician at UMKC. “It’s important that the public is aware of signs and symptoms of colorectal cancer.”
The researchers noted in the DDW news release that “colorectal cancer cases, over about two decades, increased by 500% among children, ages 10 to 14; 333% in teens, ages 15 to 19; and 185% among young adults, ages 20 to 24.”
The UMKC researchers presented their study, “Evolving Trends in Colorectal Cancer Incidence among Patients Under 45: A 22-Year Analysis of the Centers for Disease Control Wonder Database,” at the 2024 Digestive Disease Week conference in May.
DDW is “the largest international gathering of physicians, researchers, and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT),” the news release states.
“[The results of the UMKC study] means that there is a trend. We don’t know what to make of it yet. It could be lifestyle factors or genetics, but there is a trend,” lead researcher Islam Mohamed, MD (above), Internal Medicine Resident, University of Missouri-Kansas City, told NBC News. If proved, this trend could lead to increased demand for clinical laboratory screening tests for colorectal and other cancers among young people. (Photo copyright: Digestive Disease Week.)
Small Number of Cases, Big Rate of Change
Mohamed and his UMKC research team tapped the Centers for Disease Control and Prevention Wonder online database to determine the incidence of colorectal cancer in people aged 10 to 44 from 1999 to 2020. They found that in 2020 cases had reached:
- 0.6/100,000 children ages 10 to 14 (a 500% increase).
- 1.3/100,000 teens ages 15 to 19 (a 333% increase).
- Two/100,000 young adults ages 20 to 24 (a 185% increase).
Albeit small numbers, the cases are growing at a rate that is troublesome, according to experts. As NBC put it, “any increase can take on a larger significance” when rates begin at low points.
“When you are starting off with a very rare disease in a 15-year-old and you add a couple cases, you are going to have a huge percentage increase,” Folasade May, MD, PhD, Assistant Professor at the David Geffen School of Medicine and an Associate Director of the UCLA Kaiser Permanente Center for Health Equity, told NBC News.
The study also found incidence of colorectal cancer up in people in their 30s and 40s, reaching by 2020:
- 6.5/100,000 people ages 30 to 34 (a 71% increase).
- 11.7/100,000 people ages 35 to 39 (a 58% increase).
- 20/100,000 people ages 40 to 44 (a 37% increase).
Screening Guidelines May Need to Change
Further research based on UMKC’s study findings could lead to changes in cancer screening guidelines.
“We were screening people from the age of 60 for colon cancer. This has now been lowered to 55, and that is due to be lowered again to 50 over the next few months,” Jude Tidbury, RN, nurse endoscopist and clinical nurse specialist, gastroenterology and endoscopy, at the UK’s East Sussex Healthcare NHS Trust, told Healthline.
In the US, the American Cancer Society advises people of average risk for cancer to start screening for colorectal cancer at age 45. The test options ACS recommends annually include:
Other Study Findings
What is behind early-onset colorectal cancer among certain age groups? An international study led by Fred Hutchinson Cancer Center (Fred Hutch), Seattle, found “strong correlations” with consuming alcohol and being obese with early-onset colorectal cancer in adults under age 50, according to a news release.
The researchers set out to explore the common genetic variants and causal modifiable risk factors that are behind early-onset colorectal cancer, according to a paper they published in the journal Annals of Oncology.
To do so they used big databases, pulling out 6,176 early-onset colorectal cancer cases and 65,829 controls from sources including:
- The Genetics and Epidemiology of Colorectal Cancer Consortium
- Colorectal Transdisciplinary Study
- Colon Cancer Family Registry
- UK Biobank
They then conducted a genome-wide association study and Mendelian randomization analysis to identify causes of early-onset colorectal cancer.
They focused on “lifestyle factors increasing risk” by comparing the genetic variations in those with colorectal cancer to healthy people, the Fred Hutch news release explained.
“It’s important to see that alcohol and obesity are linked to early-onset colorectal cancer. Also, insulin signaling and infection-related biological pathways. These are all really important to understand—it’s helping us to develop interventions,” said Ulrike Peters, PhD, Professor and Associate Director, Public Health Services Division, Fred Hutch, who co-led the research, in the news release.
Peters noted future research may aim to address data gaps relating to racial and ethnic groups.
More Colorectal Cancer Tests
As studies continue to explore the notion that cancer may not be a disease of aging,
clinical laboratories could see more primary care physicians and healthcare consumers using colorectal cancer screening tests, which require analysis and reporting by labs.
Medical laboratory leaders may want to proactively encourage lab sales and service representatives to educate physician office staff about using the lab’s available resources for screening young adults for colorectal cancer.
—Donna Marie Pocius
Related Information:
Colorectal Cancer Cases More than Tripled among Teens over Two Decades
Colon Cancer Rates Have Been Rising for Decades in Younger People, Study Finds
Colorectal Cancer Rates Falling in Older Adults but Rising in Children