Early detection of symptoms and signs can lead to quicker colorectal cancer diagnoses, enhancing the chances of survival.
A groundbreaking study from Washington University School of Medicine in St. Louis has revealed four key symptoms that could indicate an increased risk of colorectal cancer in adults under 50. This discovery comes at a critical time, as cases among younger populations have surged dramatically in recent years.
Colorectal cancer has traditionally been viewed as a disease affecting older populations. However, recent decades have witnessed an alarming trend: individuals born in 1990 face twice the colon cancer risk and quadruple the rectal cancer risk compared to those born in 1950.
This disturbing pattern has prompted major health organizations, including the National Cancer Institute, American Cancer Society, and American Gastroenterological Association, to make early detection research a top priority.
The urgency of this issue led the U.S. Preventive Services Task Force to lower the recommended screening age from 50 to 45 in 2021. Yet many young adults remain vulnerable, as most people under 50 are still considered low risk and don’t undergo routine screening.
The Four Critical Symptoms
According to the study, published in the Journal of the National Cancer Institute, researchers examined anonymized health insurance records from more than 5,000 patients diagnosed with early-onset colorectal cancer, defined as cancer occurring before age 50. Their analysis revealed four red-flag symptoms that appeared between three months and two years before diagnosis:
- Abdominal pain
- Rectal bleeding
- Diarrhea
- Iron deficiency anemia
The research demonstrated a concerning pattern: experiencing just one of these symptoms nearly doubled cancer risk in younger adults. The presence of two symptoms increased risk by more than 3.5 times, while three or more symptoms elevated risk by over 6.5 times.
The Need for Heightened Awareness
“Colorectal cancer is not simply a disease affecting older people; we want younger adults to be aware of and act on these potentially very telling signs and symptoms — particularly because people under 50 are considered to be at low risk, and they don’t receive routine colorectal cancer screening,” said senior investigator Yin Cao, ScD, an associate professor of surgery in the Public Health Sciences Division, and a research member of Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.
Cao emphasized that awareness must extend beyond patients themselves. “It’s also crucial to spread awareness among primary care doctors, gastroenterologists, and emergency medicine doctors,” Cao said. “To date, many early-onset colorectal cancers are detected in emergency rooms, and there often are significant diagnostic delays with this cancer.”
Two symptoms deserve particular attention, according to Cao: rectal bleeding and iron deficiency anemia, a condition characterized by insufficient healthy red blood cells to transport oxygen throughout the body. These signs should trigger immediate endoscopy and thorough follow-up care.
Diagnostic Delays Pose Serious Risks
The research team, led by Cao along with first author Cassandra D. L. Fritz, MD, an assistant professor of medicine in the Division of Gastroenterology, and co-first author Ebunoluwa Otegbeye, MD, a general surgery resident, utilized the IBM MarketScan Commercial Database for their analysis. This comprehensive big-data tool contains longitudinal, de-identified health insurance claims information from approximately 113 million insured adults between ages 18 and 64.
“It usually takes about three months to get a diagnosis from the time a person first goes to the doctor with one or more of the red-flag signs and symptoms we’ve identified,” Fritz said. “But in this analysis, we found that some young adults had symptoms for up to two years prior to their diagnoses. That may be part of the reason many of these younger patients had more advanced disease at the time of diagnosis than what we normally see in older people who get screened regularly.”
These delays have serious consequences. While death rates from colorectal cancer have declined for decades among older adults, thanks to regular colonoscopies and better treatments, the American Cancer Society reports that more young people are being diagnosed at advanced stages and dying from the disease.
Investigating Contributing Factors
Cao, who also serves as an associate professor of medicine, directs a research team dedicated to uncovering risk factors and molecular characteristics of early-onset colorectal cancer.
Her group has been pioneering in reporting that several lifestyle and health factors may drive the increasing rates among younger populations. These potential contributors include obesity, extended periods of sitting, metabolic syndrome, diabetes, and consumption of sugar-sweetened beverages.
The dramatic shift in colorectal cancer demographics highlights the critical importance of early symptom recognition.
“Since the majority of early-onset colorectal cancer cases have been and will continue to be diagnosed after symptom presentation, it is crucial to recognize these red-flag signs and symptoms promptly and conduct a diagnostic work-up as soon as possible,” Cao said. “By doing so, we can diagnose the disease earlier, which in turn can reduce the need for more aggressive treatment and improve patients’ quality of life and survival rates.”
Reference: “Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer” by Cassandra D L Fritz, Ebunoluwa E Otegbeye, Xiaoyu Zong, Joshua Demb, Katelin B Nickel, Margaret A Olsen, Matthew Mutch, Nicholas O Davidson, Samir Gupta and Yin Cao, 4 May 2023, JNCI: Journal of the National Cancer Institute.
DOI: 10.1093/jnci/djad068
The study was funded by the National Center for Advancing Translational Sciences, the National Cancer Institute, and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIH).
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