Incidence of colorectal cancer increasing in young people: family doctors urged to be on the alert for alarm symptoms

United European Gastroenterology (UEG) is calling for primary care physicians to be more alert to the symptoms of colorectal cancer (CRC) in young people, as worrying evidence emerges of a growing risk of CRC in the under 50s.

A study conducted in the USA has recently reported ‘unsettling’ evidence that, while the incidence of CRC is declining in the over 50s, more people aged 20 to 49 years are being diagnosed with the condition. Speaking on behalf of UEG, Professor Roger Jones, Emeritus Professor of General Practice at King’s College, London, and member of UEGs CRC Task Force, called for greater awareness of the symptoms of CRC in young people in primary care in order to speed up referrals and save lives. “CRC is becoming more of a young person’s disease,” he says. “Primary care physicians must play their role in identifying high-risk individuals for screening and promptly evaluating any young person presenting with suspicious symptoms.”

CRC in young people

Colorectal cancer (CRC) is the most commonly diagnosed cancer in Europe. Although most cases of CRC are still diagnosed in the elderly, more than 1 in 10 cases occurs in people less than 50 years of age. Studies have found that young-onset CRC is more aggressive, more likely to be diagnosed at an advanced stage, and more likely to be fatal than CRC diagnosed later in life. The results of this latest study suggest that the risk of young people developing CRC is increasing at an alarming rate.

“We don’t really know why the incidence of CRC appears to be increasing in young people, although it may be related to an increasingly sedentary lifestyle, a deteriorating diet, and increasing rates of obesity and diabetes – all of which are risk factors for CRC,” says Prof. Jones. “Around 20% of young people diagnosed with CRC have a strong family history of the condition, and these people should enter national screening programmes well before the age of 50 years.”

Alarm signals in primary care

According to Prof. Jones, primary care physicians should be focussing their efforts on identifying high-risk young people for screening and spotting the signs of CRC as early as possible. Persistent rectal bleeding, blood in the stools, abdominal pain and bloating, loss of appetite and unexplained weight loss may all point to the presence of CRC and should prompt a swift referral for specialist assessment.

Anyone with either one close relative diagnosed with CRC under 50 years of age or with two close relatives who were aged 60 or older at diagnosis should be considered high risk, as should anyone with inflammatory bowel disease or genetic conditions such as familial adenomatous polyposis (FAP) or Lynch syndrome.

“Screening is an effective way of preventing bowel cancer in high-risk individuals, but there is an inconsistent approach to this across Europe,” says Prof. Jones. “Some gastroenterologists are recommending that people at the highest risk of developing bowel cancer should have colonoscopies at 1- to 5-year intervals from as young as 25 years. Those at moderate to high risk should be seen every 5 years between 50 and 75 years of age.”

UEG would like to see a more consistent approach to the screening of high-risk young people across Europe. It is marking European Colorectal Cancer Awareness month by highlighting the work of EuropaColon’s ‘Young Voices Unite Against CRC’ (http://yvu.europacolon.com/), which supports young people who have been diagnosed with CRC.