Early age onset colorectal cancer is on the rise

In 2022, researchers found a 29.6 per cent increase in colorectal cancer (CRC) rates in 20–34 year olds from 2001 to 2011, projecting a 42.8 per cent increase by 2030. As a disease most commonly diagnosed in individuals 50 and older, researchers have been interested in this upward trend.

Why are early-age-onset colorectal cancer (EAO-CRC) rates rising? What can young adults and the healthcare industry do to lower the rates? These are “the million-dollar question[s],” according to Dr. Maya de Vera, epidemiologist and associate professor in UBC’s Faculty of Pharmaceutical Sciences.

To her, answering these questions is more than just research. Following her own diagnosis with EAO-CRC at the age of 36, de Vera was motivated to start “breaking and entering into CRC” by filling in gaps in knowledge and providing education.

CRC development begins with the growth of small clumps of cells called polyps in the colon or rectum. Most polyps remain benign and are relatively common with age. However, some grow and develop to become cancerous over time.

Traditional risk factors for EAO-CRC include family history of the disease, sedentary lifestyle and high BMI. But de Vera, along with many other patients diagnosed with EAO-CRC, had no family history, was regularly physically active and had a normal BMI.

Current research is looking at the potential molecular basis of CRC, early life exposure factors, patients’ personal health histories and the role of the gut microbiome to clarify the complex and varied risk factors for the disease.

“The challenge with colorectal cancer [is that] the symptoms are nonspecific,” said de Vera.

Many of the early symptoms — changes in bowel patterns, more frequent diarrhea or constipation and abdominal pain — can be explained by other conditions.

Indeed, in 2022, 54 per cent of EAO-CRC patients reported their symptoms being misdiagnosed by healthcare providers as hemorrhoids, irritable bowel syndrome, anemia, mental health conditions, symptoms attributed to childbirth and more.

By the time most patients get diagnosed, including de Vera, they are already in stage III or IV of cancer with escalated symptoms.

“There’s also a whole body of research showing that people aren’t doing screening for colon cancer,” said de Vera.

CRC screening allows doctors to spot potential markers, such as polyps, and remove them.

In other words, screening gets rid of cancer before it becomes cancer.

CRC screening has typically been recommended for those 50 and older, but with increasing rates of EAO-CRC, the American Cancer Society lowered its recommended screening age to 45 years old.

In terms of mitigating your chances of developing CRC, de Vera suggested considering screening if you have a parent who was diagonosed --- and recomended starting screening 10 years ahead of the age the parent was diagnosed. She also recommends monitoring abnormal bowel movements and generally leading a healthy lifestyle by being physically active, eating a balanced diet, prioritizing your mental health and avoiding smoking.

De Vera also said it is crucial to eliminate the taboo of talking about bathroom habits, in order to normalize having these conversations with healthcare providers.

“Even though [EAO-CRC rates are] rising, it’s still quite uncommon among young people,” said de Vera. EAO-CRC makes up approximately 8 per cent of CRC cases in Canada. Ultimately, the goal is to raise awareness about EAO-CRC and considerations of lowering the screening age.

For more information on EAO-CRC, visit the CCRAN website, one of Canada's leading organizations for colorectal cancer. There, you can find past symposium recordings, EAO-CRC therapeutic treatments and even a live chat with EAO-CRC experts.