In 2023, more than 153,000 people will be diagnosed with colorectal cancer (CRC). Among them were nearly 20,000 children, young people and adults under the age of 50.

This is not breaking news the incidence of CRC has increased in this atypical population: since the beginning of the 2010s, researchers have noted a significant increase in cases – around 3% per year – among individuals under 50 years old.

But, recent research from the University of Missouri-Kansas City adds a new reason to focus on this worrying trend. Younger and younger patients are being diagnosed, including growing numbers of children and adolescents too young to drive, vote or graduate from college.

The new study shows that over the past two decades, CRC cases have increased by 500% among children aged 10 to 14, more than 330% among adolescents aged 15 to 19, and 185%. in young adults aged 20 to 24.

Even if the absolute number of patients in these groups still remains low (0.6/100,000 children and 2/100,000 young adults), clinicians are concerned about their increase over time, particularly because the underlying reasons -tend this increase in the number of patients remains unclear. Lifestyle and dietary habits likely play a role, and there may be other genetic components that scientists have yet to discover.

Jeffrey Reese | Image credit: Reese Pharma

The lack of concrete evidence behind these trends makes it difficult for clinicians to reliably understand which populations are at high risk, which in turn creates challenges for modifying recommended screening guidelines to detect cancers as early as possible .

As a result, not only are more younger people being diagnosed with CRC, but they are also being diagnosed at later stages of the disease, when it is more difficult to treat. According to the American Cancer Society, the proportion of regional or distant stage cancers increased from 52% in the mid-2000s to 60% in 2019, which is linked to the 1% increase in annual mortality rates among people under the age of 10. 50 years since 2005.

It is becoming increasingly clear that CRC is no longer just a disease that older adults need to worry about. But national testing guidelines — and the reimbursement structures that underpin them — simply don’t adequately recognize this new reality for much younger people.

It is time to reexamine how and when CRC screenings are offered to people younger than the typical CRC age group and develop new strategies to connect younger people to affordable and accessible screening options, including FIT tests and other stool sample collections, in order to combat the increase in the number of cases. cancer among these groups.

The Affordability Challenge of Colonoscopy Access for Young Adults

Currently, the U.S. Preventive Services Task Force recommended that average-risk adults, aged 45 to 75, benefit from regular screenings via a number of different possible modalities, including colonoscopies every 10 years or CT colonography or flexible sigmoidoscopy every 5 years.

Most health plans cover the costs of colonoscopies performed on the recommended screening schedule for people over 45, thanks to the Affordable Care Act. But it’s a different story for the youngest.

Since younger patients do not fit the established recommendation schedule, these colonoscopies are generally classified as “diagnostic” procedures, not “screening,” allowing health plans to bill the patient for associated services. This can make colonoscopies or other imaging tests out of financial reach for many young adults or families, contributing to later diagnoses and potentially worse outcomes.

Prioritize education and awareness of symptoms

There’s another reason why young people can’t get CRC screening: they don’t know they should. CRC symptoms can range from subtle to severe, and younger people may be more likely to blame stress, poor eating habits, or hemorrhoids rather than thinking of CRC as the cause of their symptoms, which can further delay access to screening.

The American Cancer Society urges young people Don’t ignore four main symptoms most often linked to a cancer diagnosis: abdominal pain, rectal bleeding, diarrhea and iron deficiency anemia.

In a recent studyhaving just 1 of these signs before age 50 was associated with nearly twice the odds of being diagnosed with early-onset CRC, while having 3 or more was linked to a lower odds 6 times higher to be diagnosed with CRC.

Younger people should be encouraged to talk to their doctor about any concerning symptoms. They should also work to collect family history data that could influence when they begin screenings, because first- and second-degree relatives with CRC, especially those who were diagnosed at earlier ages , significantly increase the risk of developing cancer.

A call to action: reinventing projections as the CRC gets younger

With so much at stake for young people, the health system must re-examine how to accurately and reliably detect cancers in people under 45, while balancing overall costs and the potential risks of a significant expansion of country’s screening initiatives.

Colonoscopies for anyone starting decades earlier than current guidelines would not be practical, nor are they necessary in people at average risk. But colonoscopies are not the only effective screening methodology.

The U.S. Preventive Services Task Force also endorses the use of a high-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) each year to provide important data that can then be explored in more detail with additional testing, if necessary.

These tests are inexpensive, reduce financial barriers associated with nonroutine colonoscopies, are available over-the-counter, and are easy to perform at home at the patient’s convenience with less extensive bowel preparation.

They provide an important bridge to appropriate clinical care for people who are not yet eligible for regular colonoscopy exams, with evidence suggesting that use of these tests can reduce the likelihood of CRC death by up to 33%, with notable gains among traditionally underserved racial and ethnic groups. Considering almost 5% of people aged 40 to 49 test positive on the FIT test, this could translate into a large number of lives saved.

As cancer experts reexamine how to educate younger people about the importance of screenings, connect people to screening options, and manage the growing number of young patients with concerning symptoms, FIT testing is expected to become a most important part of the solution.

There is an opportunity to consider a new set of guidelines for people under 45 with certain risk factors that recommend periodic FIT or HSgFOBT testing as first-line screening, followed by colonoscopy or other testing appropriate imaging methods if necessary.

With growing evidence of the reliability and potential usefulness of stool-based tests in saving lives, integrating these options into clinical guidelines could have a major impact on reversing recent trends and improved outcomes for children, adolescents and young adults at risk of developing CRC.