Incidence of CRC Increasing in Younger Patients



A rise in early-onset colorectal cancer (CRC) in patients younger than 50 prompted leading health organizations to recommend CRC screening starting at age 45 for all average-risk individuals.

A study published Jan. 7 in “Gastroenterology” supports the lowered CRC screening age. The study was conducted by AMSURG and researchers at the Icahn School of Medicine at Mount Sinai.

"We have known for many years that rates of colorectal cancer are rising in individuals younger than 50, prompting several medical organizations to recommend lowering the screening age from 50 to 45. What has been missing until now is confirmatory data of the prevalence of precancerous polyps in younger individuals,” said lead author Steven H. Itzkowitz, MD, FACP, FACG, AGAF, Professor of Medicine (Gastroenterology), Icahn School of Medicine at Mount Sinai, in Medical Xpress. “Our study provides an important piece of the puzzle and supports the recommendation changing the screening age to 45."

Study Finds ‘45 is the New 50’

According to statistics, the number of colorectal cases has been increasing since the mid-1990s in adults ages 40-54. These cases are often misdiagnosed or diagnosed later in the course of the disease — a younger individual’s CRC risk factors and symptoms can be easily overlooked.

In this first large-scale study to look at precancerous polyps in this age group, researchers analyzed data collected between Jan. 1, 2014, and Feb. 5, 2021. The study focused on approximately 131,000 patients aged 40-49 from 123 AMSURG (a division of Envision Healthcare) ambulatory endoscopy centers across 29 states that report their results to the GI Quality Improvement Consortium (GIQuIC) Registry.

Several factors were associated with higher odds of finding advanced premalignant lesions (APLs) and colorectal cancer, including age, family history of CRC, sex (male), race (white) and examinations performed for evaluation of rectal bleeding or screening.

In this study, entitled “Prevalence and Predictors of Young-Onset Colorectal Neoplasia: Insights from a Nationally Representative Colonoscopy Registry,” results were reported among patients aged 45-49. Some of the study’s findings regarding this age group are listed below:

  • 32 percent had neoplasia (precancerous or cancerous lesions considered precursors of colorectal cancer)
  • Nearly 8 percent had APLs
  • 0.58 percent had CRC
  • Prevalence of neoplasia and APLs were almost as high as those of 50-54 year olds, and the rates of CRC were even higher.

Additionally, among 40-44 year olds, rates of APLs were almost as high as for those aged 45-49, and colorectal cancer rates were comparably high, according to the study.

Dr. Itzkowitz told Healio that the data confirmed that “45 is now the new 50” for CRC.

“Colon cancer used to be considered a disease of old age and that is no longer true,” Dr. Itzkowitz told Healio. “Our data also suggest that clinically important lesions occur about five years earlier in individuals with a family history of colorectal cancer compared to those without a family history. That is why it is very important to take a good family history.”

Study co-author, Jay Popp, MD, Medical Director for AMSURG, told Medical Xpress that "the team's findings reiterate the importance of colorectal cancer awareness — both among patients and clinicians.”

"Colorectal cancer is the second leading cause of cancer death in the United States, but it is one of the most preventable cancers,” Dr. Popp said. “The more patients know about their bodies and risk for colorectal cancer and the more clinicians can do to help patients receive routine and timely screenings, the more lives we can save. Everyone can play a role in helping a loved one or neighbor prevent colorectal cancer."

New Law Changes Follow-up Screening Cost

March is Colon Cancer Awareness Month. According to the ACS, about 60 percent of all colon cancer fatalities in the United States could be prevented if every man and woman 45 years or older would choose to be screened for colon cancer.

If you have a positive stool-based test, a follow-up colonoscopy is critical. In fact, if you delay a colonoscopy for nine months or more after a positive stool-based test, you are much more likely to have an advanced cancer.

In the past, most patients were required to pay the deductible for a follow-up colonoscopy to evaluate a positive stool-based test. Stool-based tests include the fecal immunochemical test (FIT) and stool-DNA test (Cologuard). A new law changes the requirement for patients to share in the cost. Health insurance plans within the Affordable Care Act will be required to provide no-cost coverage of this follow-up procedure. This coverage is for plan or policy years beginning on or after May 31, 2022.

To avoid confusion, contact your healthcare provider first and then schedule an appointment.

Colonoscopy Is Gold Standard for CRC Screening

If you are 45 or older, get screened for colorectal cancer.

In 2020, about 12 percent of all cases of CRC occurred in individuals under 50, according to the American Cancer Society. Patients diagnosed prior to age 50 were more likely to have advanced disease at diagnosis.

When colorectal cancer is found at an early stage before it has spread, the five-year survival rate is about 90 percent.

Many screening methods are available, but colonoscopy is the gold standard procedure because it allows your doctor to see the entire length of the colon to examine for polyps, lesions and abnormalities. A quality colonoscopy is the only screening that can both detect and prevent colon cancer.

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