Beware Millennials: Colon Cancer is on the Rise

Gut Check | Tuesday, July 31, 2018

Kristen L. Seay, MSN RN CGRN

As most of us in the field are aware, colorectal cancer (CRC) is the second-leading cancer which causes death. A study performed in 2016 estimated that 134,000 patients were diagnosed with CRC that year, and approximately 49,000 of those patients died (Dana-Farber, 2017). The trends continue to diagnose people ages 65 to 74 most frequently.

A new study from the American Cancer Society (ACS) is reporting a steady drop in the rate of CRC diagnoses for patients born between 1890 and 1950 (Dana-Farber, 2017). ACS contributes the decline of CRC as a result of widespread screening tests, such as colonoscopies.

The rates among young and middle-aged adults, though, have returned to the rates which were seen in 1890.Currently 30 percent of CRC diagnoses are in patients younger than 55. Patients who are born in 1990 have twice the risk of colon cancer and four times the risk of rectal cancer.

CRC Rates

Age	Rate
20-39	Increased by 1-2.4% since mid-1980’s
40-54	Increased by 0.5-1.3% since mid-1990's
55+	Rates have declined

Rectal Cancer Rates

Age	Rate
20s	Increased by 3.2%, diagnosed 1974-2013
55 or younger	15% diagnosed 1989-1990 30% diagnosed 2012-2013

RC Rates by 2030

Age	Rate
20-34	Increase by 90%
35-49	Increase by 28%
Generation X (1960-1980) Millennials (1980-2000)	Increasing for both

The majority of the research suggests the increase of CRC rates has a direct correlation to the obesity epidemic. Although, it is not the only factor to blame for the epidemic, as there are other factors which influence obesity, such as a lack of exercise and poor diet.

One study demonstrated that people from Africa who switched to an American diet showed signs of inflammation in their colons within two weeks. According to Siegel, “this change can happen fairly rapidly,” (Harris, 2017). It has also been mentioned that those who are obese are 30 percent more at risk to have CRC than those who are not.

But not everyone agrees obesity is to blame. A study from Britain suggested that only 11 percent of colon cancer cases are tied with the obesity trend (Harris, 2017). Research is largely still unclear at this point.

When it comes to CRC, other risk factors young people must consider include heavy alcohol use, red meat and processed meat consumption, poor nutrition, bowel disease (ulcerative colitis and Crohn’s disease), race (African Americans should start screening at age 45), and tobacco usage. Genetics are also a contributing factor, as 20 percent of those with CRC are linked to a positive family history. In addition, 3 to 10 percent of patients have a first degree relative who also has CRC. Another consideration is whether the patient has a chronic condition such as IBS or Type 2 Diabetes.

Symptoms which patients should be aware of include: bleeding, anemia, a change of bowel habits (either constipation or diarrhea), bloating, gas, abdominal pain and ribbon like stools. Weight loss and fatigue could also be included. The signs of CRC can be quite subtle, which is why a large number of patients who are diagnosed under 50 are already in Stage 3 or 4 in comparison to the older population. (Miller, 2017)

There are additional challenges with the younger population, as well. Trends show that younger patients are more likely than older patients to have a positive diagnosis of a distal lesion. This age group is also more likely to be uninsured, thus have less access to preventative care. This creates an increased risk of diagnosis later in the course of the disease, and a delayed diagnosis, which can result in a less treatable cancer. There needs to be additional emotional support for this age group with a multidisciplinary team to address their specific needs. Social workers, nutritionists, psychiatrists and fertility specialists should be considered as additional support.

Tips for Prevention and Lowering Risks

Watch your weight
Regularly exercise
Avoid tobacco
Limit alcohol: ACS recommends no more than two drinks a day for men and and one drink a day for women
Eat less red meat and processed meats
Eat more Omega-3 fatty acids (about one to three times a week), which are found in flax seed, flax seed oil, walnuts, canola oil, salmon, herring and mackerel
Eat whole grains
Eating a variety of colorful fruits and vegetables rich in vitamins, minerals, antioxidants
Taking a standard multivitamin with 100 percent of each vitamin and mineral needed for the day
Get enough dietary fiber: it has a protective effect on the pathophysiology of CRC. Diets rich with vegetables and grains show significant protection against fatal CRC in a study of more than 760,000. (Hackethal, 2017)

Recommendations for Millennials:

Colonoscopy screenings recommended starting at age 50 for average risk
Screenings for African Americans start at age 45
Screenings recommended at age 40 with a family history of CRC or adenomas in a first degree relative
Young adults know their own bodies and must advocate for themselves with the health care team

What can we do as healthcare professionals?

We need to raise awareness in the medical community that colorectal cancer does occur in younger adults, and we need to take the symptoms seriously. Hemorrhoids are the most common complaint in this age group and can be easily brushed off, but they shouldn’t be. We need to also consider there are no standard guidelines for testing in the young adult population. If symptoms persist, then it’s time.

The Future Projection

If the current trend continues with the increase of 20 to 30 year olds being diagnosed with CRC, the overall CRC rates will ultimately rise. Another possibility is that patients will continue to follow the current guidelines and have a colonoscopy at age 50, when they might need to go sooner. The risk profile at this point would also look similar to what it looks like currently.

But does more people being diagnosed with cancer mean more people are contracting it than normal? Some theorize that patients are getting tested for cancer at a much younger age. Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy & Clinical Practice, says this age group is being diagnosed earlier than they might have been in years past. This occurs because some people are having colonoscopy procedures for reasons other than screening, thus an earlier diagnosis is made (Harris, 2017).

Further support of this evidence includes that even though new cases of CRC have been rising in this age group since the mid-1990s, the death rate among the same age group has remained flat.

A similar occurrence happened in the 1980s with breast cancer. Large numbers of women went for initial mammography screenings, which created a temporary increase of breast cancer diagnoses. The death rates did not rise, and the incidence of breast cancer ultimately decreased. Another comparison is with the rates of thyroid cancer, which is also increasing due to intensive screening and diagnosis. Again, there has not been an increase of the mortality rates for thyroid tumors (Harris, 2017).

Ultimately, many physicians and scientists are perplexed with the exact projection for CRC, as there isn’t enough information in order to make an accurate assumption. In the meantime, as healthcare professionals, we are tasked with educating this age group, in particular to be alert to changes in their bodies and advocate for their own health.

Kristen L. Seay, MSN RN CGRN, graduated from Richmond Memorial Hospital School of Nursing with a Nursing Diploma in 1984. She obtained certification as a Gastroenterology Nurse (CGRN) in 2007. She achieved an MSN with a focus on Leadership and Management in 2012. She has held various Endoscopy leadership positions at Bon Secours Richmond Health System, University of Virginia Health System and Virginia Commonwealth University Health.

She enjoys presenting both locally and nationally on topics such as Employee Engagement for Nurse Managers, Hiring for Fit, Nurse Bullying and other related topics. She participated as a mentor in the Inaugural SGNA Endoscopy Nurse Manager Mentor Circle. She has been a reviewer for the “Gastroenterology Nursing: A Core Curriculum 5th Edition”, April 2013 and Chair of the Revision Committee and Contributor for “SGNA Endoscopy Employee Development Tool”, in September 2014. She has also been a National GI Audit committee member with ABCGN.

Currently, she holds positions as the Secretary of Old Dominion SGNA and is a Director on the ABCGN board. She is on the board for “Hitting Cancer Below the Belt” (HCB2) and enjoys volunteering with HCB2 and other non-profit organizations

References

Clark, B. (2017). Millennials are now more at risk for colon cancer. But should they be screened for it? Retrieved from Tufts Medical Center: https://hhma.org/blog/millennials-colon-cancer-screening/

Harris, R. (2017, Feb 28). Why are more young Americans getting colon cancer? Retrieved from National Public Radio: https://www.npr.org/sections/health-shots/2017/02/28/517563769/why-are-more-young-americans-getting-colon-cancer

Miller, K. (2017, March 1). Colorectal Cancers are increasing in Millennials- 7 Symptoms to Know. Retrieved from https://www.self.com/story/colorectal-cancers-millennials-study

Dana-Farber. (2017, May 3). Colon Cancer on the Rise in Young Adults.

INSIGHT- Information & Inspiration. Retrieved June 9, 2017, from http://blog.dana-farber.org/insight/2017/03/colon-cancer-on-the-rise-in-young-adults/

Hackethal, V. (2017, Feb 28). Dramatic Rise in Colorectal Cancer in Younger Adults. Retrieved June 9, 2017, from Medscape: http://www.medscape.com/viewarticle/876409

Pew Research Center; US Politics & Policy. (2015, September 2). Retrieved from Millennials Less Likely Than Boomers, Gen X to Embrace Generational Label: http://www.people-press.org/2015/09/03/

Rabin, R. C. (2017, Feb 28). Colon and Rectal Cancers Rising in Young People. Retrieved June 9, 2017, from The New York Times: https://www.nytimes.com/2017/02/28/well/live/colon-and-rectal-cancers-rising-in-young-people.

Ross, L. (2017, Feb 28). Millennials' Colorectal Cancer Risk Like Those Born in 1890. Retrieved from Newser.