Is 40 the new 50?

Published 3:29 pm Friday, March 17, 2017

For years we’ve be promoting the need for regular colon cancer screening.

By now most people already know that:

  • Colon cancer screening saves lives.
  • Early detection is the best prevention.
  • Men and women are equally at risk for colon cancer.
  • Worrisome symptoms should not be ignored.
  • Everyone needs to have a colonoscopy or other screening at age 50.

So, what’s new?

Well, the recommendations may be changing. I’ll explain why.

Colon cancer has generally been a disease of middle- to older-age individuals. Historically, 93 percent of colon cancers occurred in individuals 50 or older. Of the colon cancers developing in people younger than 50, the majority were felt to be genetically linked (occurring in people with a strong family history of colon cancer) or were part of hereditary cancer syndrome.

Recent data is showing that colon cancer is more and more becoming a disease of younger adults — much less than 50 years old. Now, 10 percent of colon cancers are being detected in younger adults. Often these cancers are discovered at a later stage when the disease has already advanced. This is alarming and deserves greater attention.

The explanation for these “younger” cancers is not known. Some have suggested it is related to poor dietary habits including consuming a lot of red meats and processed foods (think fast foods and ready-to-eat frozen foods). Lack of adequate fruits, vegetables and nuts in the diet may be important, too. Other theories postulate that the bacteria and immune system in the colon of younger adults have not been appropriately stimulated during childhood. This may be a result of living in a highly developed country where kids play in “sterile” environments and not in the “dirt.” Research is looking into all these areas. Obviously, these are critical issues to resolve.

It is important to realize that a delay in diagnosis was common among young colon cancer patients. Many say that a cancer diagnosis was never considered because they were so young (and perhaps did not have a worrisome family history). Many felt that their symptoms were ignored or they were misdiagnosed.

These are unfortunate situations, and that is why discussing this topic is so important. Patients, young and old, are encouraged to speak up if something doesn’t feel right about their body. Everyone should know his family history and know the warning signs and symptoms of colon cancer. Don’t ignore rectal bleeding or blood in the stool. Find out why you have recurring abdominal pain, a change in bowel habits, unexplained weight loss or chronic fatigue. The answer may not be colon cancer (and hopefully not), but until it is evaluated and explained, you just don’t know for sure.

Guidelines for colon cancer screening currently suggest that it be done at age 50 for low-risk patients, and 45 for African-Americans. This may change as more is learned about these “younger” cancer patients.

There are many ways to get screened for colon cancers. Colonoscopy remains the “Gold Standard,” as it is the only test to identify and remove the pre-cancerous growths. It also has the highest sensitivity for finding the polyps and tumors. This means with a colonoscopy you are not likely to miss as many growths in the colon as occurs in all the other screening tests.

Beyond screening, everyone can lower cancer risk by maintaining a healthy weight, eating a balanced diet and avoiding use of tobacco and excessive alcohol.

Let me close by saying: Fear the disease, not the screening. Talk to your doctor or provider about your risk factors. Colon cancer is one of the few preventable cancers, and that’s reason enough to schedule your evaluation.

Thomas Ruffolo, MD, is a gastroenterologist with Vidant Gastroenterology in Washington.