Dodging Colorectal Cancer Under 40

Colorectal cancer is the third most common cancer found in men and women in this country. The risk of a man having colorectal cancer in their lifetime is about 1 in 19; for women it is about 1 in 20.

The American Cancer Society's, (ACS), most recent estimates for colorectal cancer in the United States for 2010:
    *About 102,900 new cases of colon cancer
    * About 39,670 new cases of rectal cancer
    * About 51,370 deaths from colorectal cancer

The ACS cites, "The death rate from colorectal cancer has been going down for the past 15 years. One reason is that there are fewer cases. Thanks to colorectal cancer screening, polyps can be found and removed before they turn into cancer." Earlier diagnosis and improved treatment contribute to a higher incidence of curing colon and rectal cancers.

Colorectal cancer is cancer that starts in either the colon or the rectum. Common features of both colon cancer and rectal cancer are that both begin in the digestive system which processes food for energy, ultimately passing it from the body as solid waste through the large intestine (colon) and rectum both of which are made up of layers of tissues.  Colorectal cancer starts in the inner layer and can grow through some or all of the other layers.  The cancer is "staged" based on how deep the cancer has spread into these layers.

Most colorectal cancers develop slowly over several years and start as a growth of tissue (polyp) that begins in the lining growing into the center of the colon or rectum which may or may not be cancer.  Removal of a polyp early may keep it from becoming a cancerous adenoma.  Over 95% of colon and rectal cancers are adenocarcinomas.

A new study, led by Dr Joshua Meyer, Radiation Oncologist, Fox Chase Cancer Center, Philadelphia, Pennsylvania, published online today, in Cancer, a peer-reviewed journal of the American Cancer Society, reports that while colon cancer rates have remained steady for several decades, the incidence of rectal cancer appears to be rising among Americans under 40.

Prompting this study was the belief that rectal cancer is rare in the 40 and under age group, and may delay diagnosis allowing the cancer to grow requiring more involved and rigorous treatment.

Researchers examined data from the US Surveillance Epidemiology and End Results (SEER) cancer registry, about 26% of US cancer cases, comparing trends in rectal cancer to trends in colon cancer between 1973 and 2005.

Finding 7,661 people under 40 years of age diagnosed with colon and rectal cancer during that time period, analysis revealed that rates of colon and rectal cancer were low, and rates of colon cancer remained relatively even.  Rectal cancer however has been increasing steadily since 1984 and risen about 3.8% between 1984 and 2005 across all races in both sexes.

The American College of Gastroenterology (ACG) currently recommend that colorectal cancer screening begin at age 50 for average-risk individuals and at age 45 years for African Americans, who are at higher risk. Earlier initial screening is suggested only for those with a positive family history of colorectal cancer, familial adenomatous polyposis, or hereditary nonpolyposis colorectal cancer.

Unable to offer a clear explanation for the changing incidence of rectal cancers, researchers didn't recommend a change to ACG guidelines, but warned physicians to seriously consider symptoms in younger patients employing thorough evaluation and possible endoscopic measures.

"Patients presenting with rectal bleeding or other alarming signs or symptoms should be evaluated with this finding in mind," Meyer's group wrote in Cancer.

Although the researchers offered no clear explanation for the changing incidence of rectal cancers and didn't recommend a change to screening guidelines, they warned physicians to take symptoms seriously in younger patients rather than dismissing symptoms as hemorrhoidal bleeding.

There are risk factors for colorectal cancer that an individual cannot change such as age, family history of colorectal cancer, bowel disease such as ulcerative colitis and Crohn's, certain family syndromes and race or ethnic background.

However, risk factors related to lifestyle strongly linked to colorectal cancer that you can control are:

    *Diet - high in red and/or processed meats - increased risk
          -high in vegetables and fruits - lower risk
    *Lack of exercise - increased risk
    *Overweight - increased risk
    *Smoking - increased risk
    *Alcohol - heavy use increased risk
    *Diabetes - Type 2 increased risk and worse prognosis

Possible prevention which should be discussed with your health care professional especially if you are at high risk, in addition to consideration and moderation of lifestyle risk factors above:

    *Genetic testing/screening
    *Vitamins and minerals
    *Aspirin and other drugs
    *Female hormones

For more information, go to: www.cancer.org/Cancer/ColonandRectumCancer/OverviewGuide/colorectal-cancer-overview

Laura Lamp King