Younger Colon Cancer Diagnosed at Later Stage

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Samantha Hendren, MD, MPH Associate Professor of Surgery Colorectal Surgery University of Michigan

Dr. Samantha Hendren Interview with:
Samantha Hendren, MD, MPH
Associate Professor of Surgery
Colorectal Surgery
University of Michigan 

Medical Research: What is the background for this study? What are the main findings?

Response: We studied colorectal cancer nationally, and found that about 1 in 7 colorectal cancer patients in the U.S. (that is, 14.7%) is diagnosed before the age of 50.  We also found that these younger colorectal cancer patients were diagnosed when their cancers were more advanced (higher “stage”, meaning more of them had spread to lymph nodes and/or to other organs).  Part of the reason for this is that these young patients are often diagnosed only after their cancers start to cause symptoms such as anemia, bowel bleeding or a blockage in the colon.

The age of 50 is when screening for colorectal cancer is started in the U.S.  This study means that a pretty large proportion of colorectal cancers are  happening in people who are too young to receive screening tests.  To put this in context, breast cancer screening often begins at age 40, and less than 5% of invasive breast cancers occur in women under that age. Our study found that about 15% of colorectal cancers are diagnosed before the screening age of 50.

Fortunately, the young patients with colorectal cancer do a little better than you might predict, knowing that they are diagnosed at a worse cancer “stage”.  For the young patients under 50, about 68% survived 5 years, while about 67% of the patients 50 and older survived 5 years.  It looks like patients’ young age helps them in their cancer treatment and survival; our study found that treatment may be a bit more aggressive in the younger patients.

Medical Research: What should clinicians and patients take away from your report?

Response: Colorectal cancer has traditionally been thought of as a disease of the elderly.  This study is really a wake-up call to the medical community that a relatively large number of colorectal cancers are occurring in people under 50.  In a practical sense, this means that we should look out for warning signs of colorectal cancer such as anemia, a dramatic change in the size or frequency of bowel movements, and bleeding with the bowel movements.  Not all bleeding is concerning for cancer.  Bright red bleeding with a bowel movement is usually due to hemorrhoids or fissures, but dark blood or blood mixed with the stool is a warning sign. Also, people with a positive family history for colorectal cancer (in first-degree relatives such as parents or siblings) and some others who are at higher risk should begin screening earlier than 50.  This is already recommended, but we don’t think this is happening consistently, and this is something we need to optimize.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: In addition to being vigilant for colorectal symptoms in patients under 50, there are two other potential uses of this research.  First, this raises the question of whether screening for colorectal cancer should begin at an earlier age. This would be a big and costly change, and I don’t know whether it would help more people than it would hurt, so a lot of research would be required to understand this before any changes should be made. Also, the cancer community needs to prepare for the increasing number of very young colorectal cancer survivors who will need long-term support to cope with the physical and psychological consequences of their disease and treatments.


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