A Word from Dr. Andrew Kennedy, MD, FACRO
Colon cancer in the under 50 population is a real issue, with documented rises to prove it. Over the past 20 years, colon cancer rates in the under 50 group have risen about 1.5% per year and declined about 2.8% per year in those older than 50.
No direct cause has been proven to explain this rise in colon cancer diagnoses in younger patients; however the decline in colon cancers in older patients is thought to be secondary to more screening of patients for colon cancer over age 50, and in particular, colonoscopy. It is not felt that colon cancer is a common entity in patients under 50, so they are not as quickly screened when symptoms first appear. Also, screening questions about colon cancer risk (like family history of colon cancer or polyps, etc.) are typically asked only of patients who are older than 50.
Is colon cancer different for someone diagnosed under age 50?
The cancer itself is not different but because it is an uncommon diagnosis in younger patients, the tumor can be advanced, spreading to lymph nodes in the bowel or to the liver. Being younger can also mean somewhat stronger health and a patient being able to receive the most aggressive therapies compared to a much older patient.
Should patients worry about asking their doctor too many questions?
From my own practice and those of colleagues, I know that patients (and their families) who are actively participating in their own treatments, including asking many questions of their doctors, get the best care that can be delivered. I personally want my patients to ask why I am recommending a treatment compared to some other treatment approach they have heard or read about. Although I might be confident that my plan is the most appropriate one for them, with the patient’s involvement, perhaps I can further modify treatment to best fit their individual needs. I always suggest to patients during our initial consultation that I will help them see other experts in their type of cancer if they would like a second opinion. I would never want a patient to be less than absolutely confident they were being treated by the right doctor in the right way for their disease.
What can people do?
It is important for patients to tell their doctors when their family has had cancer (first degree relatives like mother, father, sister, brother, son, daughter), the type of cancer and the age at diagnosis. One of the highest risk factors for early development of colon cancer is a strong family history of the disease, (particularly diagnosed before age 50) as well as history of colon polyps, Crohn’s disease (inflammatory bowel disease) and genetic syndromes like Lynch and Familial adenomatous polyposis. With or without these factors, symptoms in the digestive track should not be discounted as a potential diagnosis just because of age less than 50. Additionally, a factor known to increase risk of colon cancer is tobacco use – this is an area of significant impact where younger patients can individually reduce their risk of developing a life threatening disease through healthier choices.
Why is this issue important?
It is critically important to understand that, unlike other cancers for which we have limited or no chance to cure, colon cancers have been PREVENTED or CURED with diligent screening of patients for risk factors and appropriate levels of follow-up tests. Even if not prevented, as an oncologist, I can offer potentially curative treatments when discovered early, compared to measures to make someone comfortable if diagnosed very late in the tumors course. Everyone benefits by thinking about their own risks, modifying lifestyles if needed and clearly communicating key information about family history to physicians. A patient should feel very comfortable asking their doctor when and how frequently they should undergo cancer screening. There are a variety of recommendations by experts to screen for common cancers, including colon cancer, as part of annual visits. If you are not getting routine cancer screening questions and tests as per national recommendations, you need to ask why not.