A study in Cancer1 finding an increasing rate of colorectal cancer among patients under the age of 50 should serve to raise awareness about the need for testing among those with “red-flag” symptoms and earlier screening for those at high risk, the study’s corresponding author, Samantha Hendren, MD, MPH, told The ASCO Post. Dr. Hendren is Associate Professor of Colorectal Surgery at University of Michigan Health Systems, Ann Arbor.
The “red-flag” symptoms are anemia, a change in bowel movements, and blood in the stool. If patients are concerned about blood in the stool, Dr. Hendren advises explaining, “There are two kinds of bleeding you can get with your bowel movement. The bright red bleeding signifies hemorrhoids. Then there is the dark blood, blood clots, old blood. That is really a red-flag symptom. “Anybody with that kind of a symptom,” Dr. Hendren stressed, “should be getting a colonoscopy.”
“One of the tragedies that we see in our practice,” Dr. Hendren said, “is that patients who are 45 with colorectal cancer have often had symptoms for a year before anybody even thought to test them for colorectal cancer. So by the time they are diagnosed, they have a more advanced cancer that is more challenging to treat and, ultimately, to cure,” Dr. Hendren said.
“In the current study, young patients were more likely to present with advanced-stage disease, which may be explained largely by the finding that current screening guidelines do not recommend routine screening for this apparently low-risk population,” the investigators wrote. Those who are under 50 but at increased risk because of family history or other factors need to start screening earlier, Dr. Hendren emphasized.
“This study points out a big success story in modern medicine: colorectal cancer screening in people aged 50 and older,” Dr. Hendren said. “We have seen the numbers of cancer decline and the stage at diagnosis decline because colonoscopy screening is so successful. We are picking up cancers either before they are even cancers—when they are just precancerous polyps—or at a much earlier disease stage, when they are much more likely to be cured. What we are seeing in the younger people who don’t get screened is the type of cancers that we used to see back before there was widespread screening of people 50 and older.” ■
Disclosure: Dr. Hendren has received research funding from the National Cancer Institute and the American Society of Colon and Rectal Surgeons’ Research Foundation.
1. Abdelsattar ZM, Wong SL, Regenbogen SE, et al: Colorectal cancer outcomes and treatment procedures in patients too young for average-risk screening. Cancer. January 25, 2016 (early release online).
In clinical practice, Samantha Hendren, MD, MPH, has been “shocked by what a large proportion of patients we are seeing who are under 50 and presenting with colorectal cancer,” often with advanced disease due to delayed diagnosis. “And that is because patients and physicians don’t even think of...