More than 153,000 people will be diagnosed with colorectal cancer (CRC) in 2023. Among them were approximately 20,000 children, teenagers and adults under 50 years of age.

This is not breaking news The incidence of CRC is increasing In this unusual population: Since the early 2010s, researchers have noticed a significant increase in cases (about 3% per year) in individuals under the age of 50.

However, latest research A study from the University of Missouri-Kansas City adds another reason to focus on this alarming trend. Increasingly, younger patients are being diagnosed, including children and teenagers too young to drive, vote or graduate from college.

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

Although the absolute number of patients in these groups remains low (0.6/100,000 children and 2/100,000 young adults), clinicians are concerned about the increase over time; especially because of the reasons behind the increasing numbers. remain uncertain. Lifestyle and dietary habits likely play a role, and there may be additional genetic components that scientists have not yet uncovered.

Jeffrey Reese | Image credit: Reese Pharma

The lack of hard evidence behind trends makes it difficult for clinicians to reliably understand which populations are at high risk, creating challenges in changing recommended screening guidelines to catch cancers as early as possible.

As a result, not only are more young people being diagnosed with CRC, but they are also being diagnosed at later stages of the disease, which is more difficult to treat. According to the American Cancer Society, the rate of regional or distant-stage cancer increased from 52% in the mid-2000s to 60% in 2019; This is due to a 1% increase in annual death rates among younger people from 2019. 50 years since 2005.

It is becoming increasingly clear that CRC is no longer a disease that only older people should worry about. But the country’s screening rules and the reimbursement structures behind them do not 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 young people with affordable and accessible screening options, including FIT tests and other stool-based sampling. cancer among these groups.

The affordability issue of colonoscopy access for young adults

Currently, the US Preventive Services Task Force recommends Average-risk adults ages 45 to 75 have regular screening with a number of different possible methods, including a colonoscopy every 10 years or CT colonography or flexible sigmoidoscopy every 5 years.

Most health plans will cover the cost of colonoscopy provided on a recommended screening schedule for people over 45 thanks to the Affordable Care Act. But the situation is different for young people.

These colonoscopies are not recommended because young patients are excluded from the established recommendation program. typically classified as “diagnostic” procedures, not “screening” procedures, which allows health plans to bill the patient for related services. This can make colonoscopies or other imaging tests financially out of reach for many young adults or families, contributing to later diagnoses and potentially worse outcomes.

Prioritizing education and awareness of symptoms

There’s another reason why young people don’t get screened for CRC: They don’t know they need to get it. CRC symptoms can range from mild to severe, and young people may be more likely to blame stress, poor eating habits, or hemorrhoids as the cause of their symptoms rather than considering CRC, which can further delay access to screenings.

American Cancer Society calls on young people The four main symptoms most commonly linked to a cancer diagnosis should not be ignored: abdominal pain, rectal bleeding, diarrhea and iron deficiency anemia.

Inside a new studyHaving just 1 of these symptoms before age 50 was associated with almost twice the odds of being diagnosed with early-onset CRC, while having 3 or more was associated with a 6-fold increase in the odds of being diagnosed with CRC.

Teens should be encouraged to talk to their doctor about worrying symptoms. They should also make an effort to collect family history data that can be effective when starting screenings. Because the risk of developing cancer increases significantly in first-degree and second-degree relatives with CRC, especially in those diagnosed at an earlier age.

A Call to Action: Reimagining Displays as the CRC Rejuvenates

With so much at stake for young people, the healthcare system needs to take another look at how to accurately and reliably catch cancers in people under 45 while balancing the overall costs and potential risks of significantly expanding the nation’s screening initiatives.

A colonoscopy would be impractical for anyone starting at an age decades younger than current guidelines, and it is not necessary for people at average risk. However, colonoscopies are not the only effective screening method.

The U.S. Preventive Services Task Force also endorses the use of high-sensitivity guaiac fecal occult blood testing (HSgFOBT) or fecal immunochemical testing (FIT) annually to provide important data that can be further investigated with additional testing if necessary.

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

They are an important bridge to appropriate clinical care for people who are not yet eligible for regular colonoscopy screenings. evidence suggesting Using these tests can reduce the likelihood of death from CRC by up to 33%, with notable gains among traditionally underserved racial and ethnic groups. being considered close to 5% of people For people aged 40-49 who screen positive during FIT testing, this could mean many lives saved.

As cancer professionals rethink how to educate young people about the importance of screening, how to connect people with screening options, and how to manage the growing number of young patients presenting with concerning symptoms, FIT tests must become a bigger part of the solution.

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

With increasing evidence of the reliability and potential life-saving benefit of stool-based testing, integrating these options into clinical guidelines could have a major impact on reversing recent trends and improving outcomes for children, adolescents, and young adults at risk of developing CRC.