text: More from this journal ||||| Colorectal cancer is often considered a disease that affects primarily older men, yet this perception may be changing. An extensive analysis of recent data showed that one in every seven colorectal cancer patients was younger than 50. The University of Michigan study raises questions about the current guidelines to begin screening at age 50. 
   
   Signs of colorectal cancer, often called the “symptomless cancer,” include anemia, a dramatic change in the size or frequency of bowel movements, and dark blood or blood mixed with stool, (sometimes appearing as black threads), in bowel movements. Because these symptoms may be nonexistent, mild, or infrequent, many people are not aware of their condition until their malignancy becomes advanced and spreads into the lymph nodes. A colonoscopy is the usual screening test, but stool tests are also effective for some people. If you are worried, you can request your primary care physician provide you with one of these simple stool tests, no matter your age. 
   
   Younger Patients Increasing 
   
   Seeing a recent rise in cancer cases among younger people, a team led by Dr. Samantha Hendren conducted a study of the nationally representative Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Insitute to assess age and treatment patterns among colorectal patients. Specifically, they gathered and analyzed data from patients diagnosed in the United States between 1998 and 2011. Their results point to important changes. 
   
   Of more than 258,000 total colorectal cancer patients, 37,847 (about 15 percent) were younger than 50. These younger-than-expected patients were more likely to be diagnosed with either regional or distant malignancies, both of which are more dangerous than localized tumors. 
   
   In terms of treatment, younger patients suffering with a distant metastasis — where the cancer has spread from an original tumor — were more likely to undergo surgery than older patients; 72 percent versus 63 percent. Radiation therapy was more likely to be used with younger rectal cancer patients than in older patients; 53 percent versus 48 percent. 
   
   By various measures, younger patients saw more positive results. Despite the tendency to have more advanced disease when diagnosed, younger-than-50 colorectal cancer patients overall lived slightly longer without a cancer recurrence. With regard to localized disease, the five-year survival rate was 95.1 percent for younger patients versus 91.9 percent for older patients, with regard to regional disease, 76 percent versus 70.3 percent, and with regard to distant disease 21.3 percent versus 14.1 percent. 
   
   “These findings suggest the need for improved risk assessment and screening decisions for younger adults,” wrote the researchers in the study. They believe their work is a wake-up call to the medical community, which should be looking for the signs of colorectal cancer in patients younger than 50. 
   
   If age 50 is maintained as the recommended time to begin screening, this study suggests that nearly 15 percent of all patients may be caught late in the process of disease. By comparison, breast cancer screening is recommended to begin at age 40. Less than 5 percent of invasive breast cancers occur in women under that age. 
   
   Source: Abdelsattar Z, Wong S, Regenbogen S, et al. Colorectal Cancer Outcomes and Treatment Patterns in Patients Too Young for Average-Risk Screening. CANCER. 2016. ||||| (Reuters Health) - One in seven colon and rectal cancers in the U.S. are now diagnosed in patients younger than age 50, which is when people are advised to begin routine screenings for these tumors, a new study finds. 
   
   By 2030, nearly one in four rectal tumors and more than one in 10 colon cancers will be diagnosed in people under 50, researchers estimate in the journal Cancer. 
   
   “Colorectal cancer has traditionally been thought of as a disease of the elderly; this study is really a wake-up call to the medical community that a relatively large number of colorectal cancers are occurring in young people,” said senior study author Dr. Samantha Hendren of the University of Michigan in Ann Arbor. 
   
   Researchers analyzed cancer registry data from 1998 to 2011 for about 258,000 patients with colorectal tumors and found that 37,847 of them, or almost 15 percent, were diagnosed before age 50. 
   
   Compared with older patients, those under 50 were 30 percent more likely to be diagnosed with tumors that had spread to the lymph nodes and 50 percent more likely to have cancer that had advanced to other organs, the study found. 
   
   Younger patients with tumors that had metastasized, or reached other organs, were also more likely than older people to get more aggressive treatments. 
   
   About 72 percent of people under 50 got surgery, compared with 63 percent of older individuals. And while 53 percent of younger patients received radiation, just 48 percent of older people did. 
   
   Even though patients diagnosed younger tended to have more aggressive disease, they also lived slightly longer without tumors returning after their initial course of treatment. 
   
   Five-year survival odds were about 95 percent for patients under 50 diagnosed with local tumors that hadn’t spread yet, compared to roughly 92 percent for older people. 
   
   With tumors that spread to the lymph nodes, five-year survival rates were 76 percent for young people and 70 percent for older patients, while with cancers that metastasized to other organs the survival odds were 21 percent versus 14 percent, respectively. 
   
   One shortcoming of the study is that researchers lacked data on family history and other risk factors for colorectal cancers, the authors note. It’s also possible that treatment choices and overall survival were influenced by what’s known as selection bias, when healthier people may get more interventions and have better outcomes. 
   
   Often, patients may get an early warning of colorectal tumors with symptoms such as bleeding, changes in bowel habits or pain when going to the bathroom that can point to the need for diagnostic screening, said Dr. Joel Randolph Hecht, director of the gastrointestinal oncology program at the David Geffen School of Medicine at the University of California Los Angeles. 
   
   “Unfortunately, these symptoms are often ignored by the patient or doctor or ascribed to something like hemorrhoids,” Hecht, who wasn’t involved in the study, said by email. 
   
   There are guidelines for screening some people starting at age 40 if they have a family history of colorectal cancer, noted Dr. Sidney Winawer of Memorial Sloan Kettering Cancer Center in New York. 
   
   “Without a family history, physicians need to use their judgment when seeing young people who have bowel symptoms and refer those of concern to a gastroenterologist for a diagnostic workup, “ Winawer, who wasn’t involved in the study, added by email. “This is difficult since we do not wish to expose young people to unnecessary tests.” 
   
   It isn’t clear from the study findings, however, whether changing preventive screening guidelines to start at a younger age would ultimately prevent more cancer deaths, said Dr. David Weinberg, chairman of medicine at the Fox Chase Cancer Center in Philadelphia. 
   
   “If the goal of screening is disease prevention, as it generally is for colorectal cancer, it is not clear when screening should start,” Weinberg, who wasn’t involved in the study, said by email. “Too early and the yield of screening will be very low since young people are still less likely to get colorectal cancer than older people.” 
   
   SOURCE: bit.ly/23o5QvC Cancer, online January 25, 2016. ||||| MONDAY, Jan. 25, 2016 (HealthDay News) -- Colon cancer rates are rising among men and women under 50, the age at which guidelines recommend screenings start, a new analysis shows. One in seven colon cancer patients is under 50. Younger patients are more likely to have advanced stage cancer, but they live slightly longer without a cancer recurrence because they are treated aggressively, the researchers reported. "Colon cancer has traditionally been thought of as a disease of the elderly," said study lead author Dr. Samantha Hendren, an associate professor of surgery at the University of Michigan in Ann Arbor. 
   
   "This study is really a wake-up call to the medical community that a relatively large number of colon cancers are occurring in people under 50," she added. 
   
   However, Hendren said it's too soon to say whether colon cancer screening guidelines should be altered to reflect that trend. 
   
   In the analysis, colon cancer among younger patients was often found at an advanced stage, meaning the disease has spread to lymph nodes or other organs. "Part of the reason for this is that these young patients are often diagnosed only after their cancers start to cause symptoms, such as anemia, bowel bleeding or a blockage in the colon," Hendren explained. 
   
   Doctors should be on the lookout for these warning signs of colon cancer, she added. 
   
   Not all bowel bleeding is caused by cancer, she said. "Bright red bleeding with a bowel movement is usually due to hemorrhoids or fissures, but dark blood or blood mixed with the stool is a warning sign," Hendren said. 
   
   People with a family history of colon cancer and others who are at higher risk should begin screening earlier than the age of 50, she said. "This is already recommended, but we don't think this is happening consistently, and this is something we need to optimize," she added. 
   
   The report was published online Jan. 25 in the journal Cancer. 
   
   Dr. Andrew Chan, an associate professor of medicine at Harvard Medical School in Boston, said the reasons for the increase in colon cancer among younger adults isn't known. 
   
   "It is unexplained," he said. "It's not simply a change in diagnoses, it's a very real increase. There may be an effect of our environment that could be contributing to the increase." 
   
   Smoking, obesity and physical inactivity are all risk factors for colon cancer, as is a poor diet, Chan said. "When we are faced with patients who have many of these elements, we should think more about the potential of them developing colon cancer at an earlier age," he said. 
   
   For the study, Hendren and her colleagues culled federal government data on nearly 260,000 patients diagnosed with colon cancer between 1998 and 2011. 
   
   Of these patients, nearly 15 percent were younger than 50. These patients were more likely to be diagnosed with advanced cancer and more likely to have surgery than older patients (72 percent versus 63 percent). Radiation therapy was also used more often in younger patients than in older patients (53 percent versus 48 percent), the researchers found. 
   
   Younger patients lived a little longer without a cancer recurrence, even though they tended to have more advanced cancer, Hendren said. 
   
   For patients under 50, about 68 percent survived five years, while about 67 percent of the patients 50 and older survived five years, she said. "It looks like patients' young age helps them in their cancer treatment and survival," she added. 
   
   These findings raise the question of whether screening for colon cancer should begin at an earlier age, Hendren said. "This would be a big and costly change, and I don't know whether it would help more people than it would hurt, so a lot of research would be required to understand this before any changes should be made," she said. 
   
   Chan noted that although the incidence of colon cancer is increasing among people under 50, the risk is still low. "I don't think the data at this point support expanding screening to younger age groups," he said. 
   
   Hendren said that "the cancer community needs to prepare for the increasing number of very young colorectal cancer survivors who will need long-term support to cope with the physical and psychological consequences of their disease and treatments." 
   
   More information 
   
   Visit the U.S. National Cancer Institute for more on colon cancer.
target: – A new study says one in seven US colon cancer patients is younger than 50—raising questions about why more young people seem to be getting the disease and what can be done about it, reports HealthDay via the Philadelphia Inquirer. "Colon cancer has traditionally been thought of as a disease of the elderly," says lead author Samantha Hendren. "This study is really a wake-up call to the medical community that a relatively large number of colon cancers are occurring in people under 50." Using government data on almost 260,000 colon-cancer patients from 1998 to 2011, the study also says younger patients more often have advanced cancer and undergo surgery (72% compared to 63% of patients over 50). The young are also more likely to use radiation therapy (53% to 48%) and have a slight advantage in surviving for five years (68% to 67%). Younger people are more likely to have advanced colon cancer partly because they get tested after noticing symptoms (like colon blockage, bleeding, and anemia), while people over 50 are advised to begin screenings, says Hendren. "Unfortunately, these symptoms are often ignored by the patient or doctor or ascribed to something like hemorrhoids," a scientist adds, per Reuters. Hendren's team conducted the study after noticing a rise in colon cancer among young people, Medical Daily reports, but that spike remains unexplained. Physical inactivity, obesity, smoking, and "an effect in our environment" are all possible causes, a Harvard professor says. More screenings for young people might help, but the yield would be low because under-50s are still less likely to get colon cancer. "This would be a big and costly change," says Hendren, who recommends "a lot of research" be done first. (A new killer is expected to top cancer by 2050.)