Don’t Disregard Questions About Possible Symptoms of Colorectal Cancer Just Because the Patient Is ‘Too Young’

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Adherence to [the fecal immunochemical test and the multitarget stool DNA test] is much better, because you don’t have to undergo the colonoscopy procedure, and that may be more suitable to a younger population.

—Jason A. Zell, DO, MPH

While colorectal cancer predominantly occurs in people over 50 years old, rates are increasing among younger patients. It is important for physicians not to ignore symptoms in patients who are young, “simply because they are young,” Jason A. Zell, DO, MPH, told The ASCO Post. Dr. Zell is the corresponding author of a recent study1 finding that colorectal cancer is significantly increasing among younger adults and Assistant Professor, Department of Medicine and Department of Epidemiology, and Program Director, Hematology/Oncology Fellowship Program, Division of Hematology/Oncology at the UC Irvine Medical Center, Orange.

‘Never Too Young’

“Individuals under 50 who have symptoms that may be consistent with colon cancer need to seek medical attention so the appropriate testing can be done and deserve a prompt and thorough examination,” according to the Never Too Young Coalition. “Physician-related delays (eg, missed symptoms, initial misdiagnosis) have been estimated to occur in 15% to 50% of young-onset colon cancer cases,” a coalition fact sheet noted.2

The Never Too Young Coalition member organizations include the Colon Cancer Alliance, as well as other medical professionals, patient advocacy organizations, cancer survivors, and caregivers. Its aim is to educate the public about colon cancer among people younger than 50 and reduce the number of late-stage cases diagnosed among younger adults. The study coauthored by Dr. Zell found that colorectal cancer in young adults “was more likely to be diagnosed at an advanced stage and therefore less likely to be cured.”

Tests More Suitable to a Younger Population

“Because it is already a test that we don’t optimally deliver for screening,” Dr. Zell noted, colonoscopy does not seem a workable approach to detect colorectal cancer earlier in younger patients. Colonoscopies “are very expensive, and 50% to 60% of eligible patients are not being screened, either because they don’t like the test or because there are not enough gastroenterologists to do all the procedures,” Dr. Zell said.

“But we are currently able to benefit from advantages in screening with tests such as the fecal immunochemical test [FIT] and the multitarget stool DNA test,” Dr. Zell said. The Cologuard test uses an immunochemical test similar to FIT as well as DNA biomarkers that have been found in colorectal cancer and precancerous advanced adenoma.

These tests “have been shown in prior reports to have excellent results in determining who has colon cancer and who doesn’t when compared with colonoscopy,” Dr. Zell stated. “We don’t have the outcomes data that will inform us if they predict death from colorectal cancer, which is the ultimate goal of any screening test. But we have two very good tests. They pick up colon cancer at a very high rate. They are also more cost-effective.”

Having these two tests available to help detect colorectal cancer “does change the conversation a little bit,” Dr. Zell said. “Adherence to these new tests is much better, because you don’t have to undergo the colonoscopy procedure, and that may be more suitable to a younger population.”

The largest biannual percentage increases of colorectal cancer among those aged 29 to 50 were observed for left-sided lesions, which the study report noted “are more likely to result in clinically identifiable rectal bleeding due to their distal location and also can be detected by all routine colorectal cancer screening modalities, including flexible sigmoidoscopy, which cannot be used to detect proximal (right-sided) colorectal cancer.”

“So we are not talking about lesions in the colon that are hiding out and developing with a more aggressive behavior. We are talking about a lesion on the left side, which is likely to bleed, which is easily detected by FIT, Cologuard, colonoscopy, or flexible sigmoidoscopy,” Dr. Zell stated. ■


1. Singh KE, Taylor TH, Pan CG, et al: Colorectal cancer incidence among young adults in California. J Adolesc Young Adult Oncol 3:176-184, 2014.

2. Never Too Young Coalition: Know the Facts. Available at Accessed March 14, 2015.


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