Recent rates of colorectal cancer have risen sharply in young populations even while colorectal cancer rates decline in older populations, according to a new study from Advocate Aurora Health researchers.
Significantly, the researchers found that if colorectal cancer screenings in young people are limited only to those with a family history of colorectal cancer, then a majority of cases in young people will go undetected.
The study findings, published in a recent issue of the journal Gastrointestinal Endoscopy, led the authors to echo recent clinical recommendations that colorectal cancer screening begin even earlier in life. Furthermore, the researchers suggest patients with rectal and anal symptoms should promptly seek evaluation from a gastroenterologist.
“Our study results support the recent guidance from the U.S. Preventative Task Force to begin colorectal cancer screening at age 45 instead of age 50,” said Advocate Aurora gastroenterologist Nimish Vakil, MD, lead author of the study. “And, even prior to that, any young patients presenting with changes in bowel habits, rectal bleeding, anemia or weight loss should undergo colonoscopy promptly.”
The study aimed to evaluate colorectal cancer detection rates at Aurora Health Care, a large midwestern integrated health system that is now part of Advocate Aurora, by analyzing confirmed cases using a cancer database spanning from 1985 to 2017. The researchers evaluated three cohorts: the “young cohort” consisted of patients ages 18 to 44, the “new screening cohort” consisted of patients ages 45 to 49 and the “standard screening cohort” consisted of patients age 50 and older.
The researchers found that the young cohort saw a 2.7% annual increase in colorectal cancer detection rates while the new screening cohort saw a 4.15% annual increase. No significant changes in detection rates appeared in the standard screening cohort.
“A colorectal cancer detection strategy that limits colon cancer screenings to individuals under age 50 with a family history of colon cancer would have found only 49% of cancer cases in the young cohort and only 37% of cases in the new screening cohort,” said Kristin Ciezki, PhD, coauthor of the study and a lead investigator from Advocate Aurora Research Institute.
The study also found that when doctors made a diagnosis, they were more likely to find cancer that had spread outside of the colorectal area in patients younger than age 50 compared to patients older than age 50. However, survival rates increased in younger patients, as they were more likely to receive multimodality treatments (i.e., surgery with chemotherapy or radiation).
Of note, the two younger cohorts had a high proportion of African American and Hispanic patients, though the researchers found colorectal cancer survival probability was similar across different racial and ethnic groups treated at Aurora.
Obesity has been proposed by some clinicians as a possible risk factor for colorectal cancer in young patients. In this study, patients under the age of 50 had a higher rate of obesity than the general population of Wisconsin, however, the researchers found the prevalence of obesity within the three cohorts to not be statistically significant.
“Advocate Aurora Health is proud to support research such as this that will only help strengthen the excellent care we provide our patients,” said Amit Acharya, PhD, chief research officer and system vice president for Advocate Aurora and the Research Institute. “Dr. Vakil and his team continue to publish research findings that challenge the status quo and change the standard of care.”
The study authors noted that more research is needed to determine if new screening guidelines will aid in the detection and treatments of precancerous lesions, which could help avoid the need for surgery.
“Ideally, researchers will one day discover a molecular biomarker that could identify a patient as high risk for colorectal cancer if it’s found in the patient’s stool or blood,” Dr. Vakil said. “But until then, our conclusion is that clinicians should have a low threshold for colonoscopy in symptomatic patients.”
To learn more about Advocate Aurora’s research, visit aurora.org/research.