Advanced colorectal cancer seen in people under 55, while rates decline in those over 65, says American Cancer Society

The under-55 set increasingly is stricken with “more advanced” colorectal cancer, and diagnose rates are declining for those who are at least 65 years old, the American Cancer Society said Wednesday.

This cancer, whose risk factors include being overweight, drinking too much alcohol, smoking, and eating processed meats, was detected after it had spread to other organs at higher rates — 60% in 2019, up from 52% in the mid-2000s.

And the percentage of individuals diagnosed who are younger than 55 nearly doubled to 20% in 2019 from 11% in 1995.

More people turned to home tests during the pandemic, while fewer underwent the more time-consuming and costly colonoscopies, said Dr. Ahmedin  Jemal, senior vice president, surveillance and health equity science at the American Cancer Society and senior author of the study.

“Home results are very similar to a colonoscopy … I’m very encouraged those rates went up during COVID-19, that tells me people find ways to make [tests] work for them.”

Home tests can reveal whether any microscopic amounts of blood are leaking from precancerous lesions or check for mutant DNA signaling a cancer.

“The best screening test is the one that gets done,” he said.

Those tests should begin at 45; the previous recommendation of age 50 was cut 5 years ago, he said.

And anyone younger, who has a family risk of cancer, should begin earlier, he advised, recommending a decade before a relative was diagnosed.

Dr. Deborah Nagle, chief, division of colon and rectal surgery, Stony Brook University Hospital, highlighted both rising cases among younger patients and the importance of follow-up colonoscopies. 

“The rate of colorectal cancer in younger people who would not normally think of themselves at risk has [risen] and therefore symptoms should always be evaluated and colonoscopies considered early.”

This type of cancer, which ranks as the third deadliest, afflicts more men than women: 41.5 out of 100,000 of males.

For women, the rate is 31.2, possibly because men tend to take more risks with their diets or other behaviors, the experts say.

This disease, again gauged annually, per 100,000 people, is more likely to arise among Native Americans, who have an 88.5 rate, followed by American Indians at a rate of 46, and Blacks at a 41.7 rate. For whites, the rate is 35.7. Alaska Natives have the highest death rate of 50.5. For Blacks, the rate is 17.6; for American Indians, it is 17.5; and for whites, it is 13.1. 

By two measures, the rate of medical advances has slowed. Incidences eased 1% a year and mortality just 2% in the last 10 years, the cancer society said, down from the 3% to 4% during the 2000s.

This year alone, 153,020 people will be diagnosed with colorectal cancer, which will claim the lives of 52,550 individuals, the society estimated.

It typically is treated by surgically removing a segment of the bowel, and possibly chemotherapy or radiation.

“Once they recover from surgery, most have a normal bowel function,” Dr. Nagle said. Removing the whole bowel is rarely required and surgeons have devised ways of reconstructing organs, removing the need for external appliances of earlier eras, though patients still may have concerns. 

Jim Arthur, 53, of Patchogue, said his doctor recommended a colonoscopy last year where doctors discovered a 7.4 cm mass in his colon . He had surgery March 3, 2022 to remove it and underwent five months of chemotherapy.

He underwent a repeat colonoscopy Wednesday.

“My spirits are fine. I recommend everyone get it,” Arthur said. “Who knows where I would be today if I hadn’t done it.  It’s nothing and it’s so easy to do. They make you feel comfortable and I got the best 10 minutes of sleep in my life.”