There is good news and bad news when it comes to colorectal cancer. The good news is that screening rates are increasing for adults over the age of 50, and we are seeing a decrease in colorectal cancer incidence. The bad news is that colorectal cancer incidence is increasing among our youth, especially those under the age of 35.
According to the Journal of Clinical Oncology, more than one-third of people diagnosed with colorectal cancer at age 35 or younger had identifiable hereditary cancer syndrome. Maureen Mork, MSc, from the University of Texas MD Anderson Cancer Center in Houston, says that the answer to this problem lies in genetic counseling, independent of family history or tumor features.
Mork and her colleagues examined records of patients no older than 35 who underwent genetic counseling at the cancer center from 2009 to 2013. Patients with and without identified hereditary cancer syndromes were compared in the following categories: demographics, clinicopathology, tumor/genetic testing and family history. Out of the 193 patients with sufficient evaluable data, the group was 52.3% female, 75% white and had a mean age of 29 years.
In the cohort study, 67 patients (34.7%) had identifiable hereditary cancer syndrome, including patients with Lynch syndrome, familial adenomatous polyposis and other genetic disorders.
Patients without a hereditary syndrome presented more often with stage IV disease, whereas syndrome patients were more likely to present at earlier stages and to have a family history of cancer. However, 19 percent of hereditary syndromes were diagnosed in patients with no family history of the disease. Non-syndrome patients were also more likely to be diagnosed with more aggressive cancers. These include tumors located on the left side of the colon, tumors with poor differentiation, or tumors with signet ring cells.
The authors of the study addressed the 46.6 percent of patients with metastatic disease, saying, “For these patients, genetic assessment may be seen as low priority, because oncologic care tends to be prioritized. However, referral for genetic counseling is critical, because it may help diagnose a genetic condition that will affect the care of the family members and may trigger needed surveillance or chemopreventative treatments for those relatives.”
Mork and her team noted several limitations in the study, but they will continue to research young-onset colorectal cancer, hereditary syndromes and the necessity for genetic counseling (Source: Medpage Today).