Young Adults With Colon Cancer May Be Hit by More Aggressive Disease

Key Takeaways

• Young adults with colon cancer are typically diagnosed at a later stage and with a more aggressive type of the disease, a new study says.
• Obesity, family history, inflammatory bowel disease, and symptoms like abdominal pain or rectal bleeding are factors strongly associated with colon cancer in younger adults.
• Important concerns for younger adults diagnosed with colorectal cancer include fertility, family planning, career aspirations, and financial security.

The number of men and women in the prime of their lives with colorectal (colon and rectal) cancer has been steadily rising over the past few decades. Since the early 1990s, rates of colorectal cancer have nearly doubled in adults under 50 in the United States.

New research presented this week at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco has found that young adults are typically diagnosed with colon cancer when the disease is at a later stage compared with older adults, and their cancer is usually more destructive.

"Our study corroborates prior studies demonstrating colon cancer in young adults has more aggressive molecular and genetic characteristics," says lead author Kelley Chan, MD , a clinical scholar with ACS Cancer Programs , and resident at Loyola University Medical Center in Chicago.

Looking at patients diagnosed with colon cancer between 2015 and 2021 from the National Cancer Database , Dr. Chan and her team identified about 17,000 (6 percent) who were young adults, between ages 18 and 44, and about 300,000 (94 percent) who were older adults, age 45 and older.

After comparing the age groups, researchers noted that a higher proportion of young adults had later-stage disease with more aggressive types of tumors.

Half of Colorectal Cancer Cases in Young Adults Have No Known Cause

"Younger adults with colon cancer are more likely to have an inherited syndrome, which accounts for 20 to 30 percent of cancers, such as Lynch syndrome , and inflammatory bowel disease , which also accounts for up to 20 percent," says Chan. "However, it is concerning that we don't know the cause for the remaining 50 percent of young-onset cancers."

The analysis further showed a strong association between colon cancer risk and obesity , family history of gastrointestinal malignancy, and symptoms such as abdominal pain or rectal bleeding.

For John Marshall, MD , chief medical consultant for the Colorectal Cancer Alliance and director of the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University in Washington, DC, however, several of the findings go against what he is seeing in everyday practice.

"The young patients we are seeing are not obese and have no family history or known risk factors," says Dr. Marshall.

He does agree that younger adults are often not diagnosed early on, when the disease may be more treatable. This delay may be due to patients and healthcare providers not connecting symptoms with cancer.

"We all need to be more aware of the symptoms so we take them seriously right away," says Marshall.

Currently, the Centers for Disease Control and Prevention (CDC) recommends that people begin screening for colorectal cancer soon after turning 45.

Sticking with this guideline still makes sense, according to Chan. While the rise in early onset colon cancer is alarming, the study found that young adults only represent about 6 percent of the patients with colon cancer.

Young Black Adults Have Higher Cancer Odds Than Older People

In looking at racial and ethnic disparities, a higher proportion of young adults with colon cancer were non-Hispanic Black - almost 17 percent, compared with 12.6 percent in the older cancer patient group and 12 percent of the population as a whole, according to U.S. Census data.

The reason behind such a risk difference among ethnicities is unknown, according to Nancy You, MD , a professor of colon and rectal surgery and medical director of MD Anderson's Young-Onset Colorectal Cancer Program in Houston.

"However, there may be differences [among ethnic groups] in dietary patterns, health behaviors, obesity rates, and other factors," says Dr. You, who was not involved in the research.

Cathy Eng, MD , executive director of the Young Adult Cancers Program at Vanderbilt-Ingram Cancer Center (VICC) in Nashville, Tennessee, adds that more can be done to help specific population groups.

"Community outreach and access [to care] remains an issue, along with potential time constraints due to work and family, possible language barriers, and lack of education and awareness," says Dr. Eng, who is also not a study author.

Life Concerns for Young Cancer Patients

In related research also presented at the ACS Clinical Congress, a separate group of scientists from the University of Michigan found that young adult colon cancer patients were most worried about physical health, mental health, family planning, and their careers.

The factors that mattered most to them were infertility, anxiety, and uncertainty surrounding the diagnosis and long-term survival, as well as not being able to build assets, pursue higher education, or establish job security.

The results were based on interviews with a small group of 35 patients who were diagnosed with colorectal cancer before the age of 50.

"This matches what our licensed mental health professionals across the country who run our support programs for people living with cancer and their loved ones hear on a daily basis," says Claire Saxton , executive vice president of insights and impact with the Cancer Support Community.

"Young-onset patients are more likely to want mental and health support, particularly in areas such as nutrition guidance, telehealth services, support groups, and digital mental health apps," says Saxton "Gaps clearly remain in providing emotional and mental health support, and programs tailored to the specific needs and wants are warranted."

Lifestyle Changes Can Reduce Colorectal Cancer Risk

Saxton, who is not a study author, urges young adults to pursue the following tips to help reduce colorectal cancer risk:

• Increase physical activity.
• Maintain a healthy weight.
• Eat a diet low in animal fats and high in fruits, vegetables, and whole grains.
• Limit alcohol (2 drinks or fewer a day for men, 1 drink or fewer a day for women).
• Avoid tobacco, or get help to quit.
• Limit sugar-sweetened drinks.
• Limit fast food, processed foods, and foods high in fat, starches, or sugars.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

1. Dharwadkar P et al. Colorectal Cancer in Young Adults. Hematology/Oncology Clinics of North America . May 13, 2022.
2. Colorectal Cancer Diagnosis Found to Impact Lives of Younger Adults Differently Than Older Adults. American College of Surgeons . October 18, 2024.
3. You YN et al. Colorectal Cancer in the Adolescent and Young Adult Population. JCO Oncology Practice . January 10, 2020.
4. Screening for Colorectal Cancer. Centers for Disease Control and Prevention . October 17, 2024.

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Don Rauf

Author

Don Rauf has been a freelance health writer for over 12 years and his writing has been featured in HealthDay, CBS News, WebMD, U.S. News & World Report, Mental Floss, United Press International (UPI), Health , and MedicineNet. He was previously a reporter for DailyRx.com where he covered stories related to cardiology, diabetes, lung cancer, prostate cancer, erectile dysfunction, menopause, and allergies. He has interviewed doctors and pharmaceutical representatives in the U.S. and abroad.

He is a prolific writer and has written more than 50 books, including Lost America: Vanished Civilizations , Abandoned Towns , and Roadside Attractions . Rauf lives in Seattle, Washington.

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