Anna Canale was 44 when she was diagnosed with Stage 4 colon cancer, one of an increasing number of Americans under age 50 with a disease long associated mainly with older adults.
The Plainview woman never thought of getting screened for colon cancer at her age.
“If I had caught it at a younger age, it would have been caught before it metastasized and got to the level where it is right now," said Canale, now 45.
The colorectal cancer rate for people under 50 rose more than 60% between 1990 and 2018, which is the latest data available, while the rate for those 50 and older fell nearly 50% during the same time period, according to the National Cancer Institute’s surveillance, epidemiology and end results program. The trend led to a recommendation that colorectal cancer screenings begin at age 45, instead of 50, as had been the case for years.
WHAT TO KNOW
- The rate of colorectal cancer for people under 50 increased by more than 60% between 1990 and 2018, federal data shows. The rate for adults over 50 fell nearly 50% during the same time period.
- Experts say the reason for both trends is screening, especially colonoscopies. More people over 50 are screened today than in 1990, while most people under 50 don’t get screened.
- An independent panel of experts last year recommended that all adults get screened beginning at age 45, instead of at age 50, which had long been the case.
Cancer of the colon and rectum kills more than 50,000 Americans a year, making it the second-most deadly cancer, after lung cancer, institute data shows.
In younger adults, risk increases with age, so someone in their 40s is at higher risk than someone in their 20s. And it is still much more common in adults 50 and over.
About 10% of cases today are in people under 50, said Michael Sapienza, chief executive of the Washington, D.C.-based Colorectal Cancer Alliance. Nearly 3,600 people under 50 died of colorectal cancer in 2019, compared with 2,676 in 1990, a much bigger percentage increase than the rise in population, according to institute statistics.
Dr. Christopher DiMaio, chairman of gastroenterology at St. Francis Hospital & Heart Center in Flower Hill, said “14, 15, 16 years ago, when I was still in training, it wasn’t a common occurrence” to see someone under 50 with colon cancer.
“It’s not unusual now,” he said.
The increasing number of older Americans getting colonoscopies and other colorectal screenings is the biggest reason the incidence of colorectal cancer has fallen so sharply among older Americans, said Dr. Arif Kamal, chief patient officer for the American Cancer Society.
The rate for adults 50 and older dropped from 206 per 100,000 people in 1990 to 106 in 2018, cancer institute data shows. In contrast, the rate among adults under 50 rose from 5.3 per 100,000 to 8.5.
That is a reflection of how people under 50 are much less likely to be screened, Kamal said. Rising obesity rates and environmental factors, such as soil contamination, are other possible reasons, he said.
DiMaio said when he sees people under 50 with colorectal cancer, the cancer tends to be more advanced. That’s in part because of the lack of screenings — the cancer is detected when people like Canale come in with abdominal pains, or with other symptoms, such as rectal bleeding or a change in bowel movements, he said.
In addition, he said, in younger adults, “These cancers have a different genetic fingerprint compared to the cancers that a typical 65-year-old would get. There is something biologically different. We don’t know what’s driving that.”
Blacks have highest rate
Overall, Black Americans have the highest rate of colorectal cancer, more than 15% greater than for whites, federal data shows.
But the sharpest increase in cases in adults under 50 is among non-Hispanic whites and Native Americans, and the young-adult rate for whites equaled that of Blacks by 2016, a 2020 cancer society report says.
One barrier to younger adults getting screenings is that many insurance companies don’t cover colonoscopies and other screenings for people under 50, said Michael Davoli, senior government relations director, New York, for the American Cancer Society Cancer Action Network.
Last May, the U.S. Preventive Services Task Force, a 16-member independent panel created by the federal government, recommended that colorectal screenings begin at age 45. The Affordable Care Act requires insurers to follow those recommendations and not charge co-payments, deductibles or other cost-sharing for people 45 and older obtaining colonoscopies and other colorectal cancer screenings. But the recommendations don’t go fully into effect until Jan. 1.
“Every single month insurers are not covering people beginning at age 45 means people are not being screened,” Davoli said. “I’m in that range of 45 to 50, and right now I could be sitting with a ticking time bomb in me. If my insurance would cover me to get screened, I could identify that and potentially start treatment.”
A bill requiring coverage immediately overwhelmingly passed the state Assembly last month and in June 2021, but it has been bogged down in the Senate. Spokespeople for Senate Majority Leader Sen. Andrea Stewart-Cousins (D-Yonkers) did not respond to questions about whether a vote for the bill will be allowed this year.
Actor Chadwick Boseman’s 2020 death from colon cancer at age 43 helped highlight how younger people can get colorectal cancer, Sapienza said.
But it’s still often seen as an older person’s disease. That means many adults under 50 never think of getting a screening, and doctors may not look for signs of colorectal cancer in younger patients, Sapienza said. An alliance survey found that more than half of colorectal cancer survivors under 50 said they had been misdiagnosed.
Canale said when she saw two doctors for constipation in early December, the first doctor put her on laxatives and the second a high-fiber diet. By Christmas, her abdominal pain “became unbearable,” and she couldn’t eat or even sit down. That’s when her husband pushed her to go to the emergency room, where a CT scan revealed a large mass.
“It was a very big mass, the size of that orange,” she said, gesturing to a large orange in a fruit basket.
Chemotherapy shrunk the size of the mass by 70%, but the cancer had spread to her liver. Doctors hope to implant a pump to target chemotherapy directly at the liver, which her oncologist told her has a 50% chance of success of leaving her liver cancer-free.
But doctors now fear the cancer may have spread to the uterus. A CT scan on Thursday detected a new mass, but it’s unclear whether it’s in the colon or next to the colon in the uterus. Canale is awaiting MRI results.
Canale, who lost her mother-in-law to colon cancer in 2007, lamented that, despite how common colorectal cancer is — 1 in 23 men and 1 in 25 women will get it, according to the cancer society — there isn’t as much awareness about it as breast and other cancers, especially among women and adults under 50.
As Canale fights cancer, she urged people to report common symptoms such as blood in the stool and irregular bowel movements to their doctors and ask about colonoscopies.
“They could completely avoid everything I’m going through now,” she said.
COLORECTAL CANCER HIGH RISK FACTORS
- Older age
- Family history of colorectal cancer
- Certain gene mutations
- Type 2 diabetes
- Being overweight or obese
- Lack of physical activity
- Smoking tobacco
- Moderate to heavy alcohol use
- Diets high in red and processed meats
The Colorectal Cancer Alliance has a quiz on screening options: quiz.getscreened.org
SOURCES: American Cancer Society, Colorectal Cancer Alliance