Colorectal Cancer Awareness Month: What to Know

Colorectal cancer is the third most common non-skin cancer diagnosed in the United States and is a leading cause of cancer deaths in people younger than 50. Fortunately, colorectal cancer is highly preventable and treatable when caught early, and knowing early warning signs can help patients have more open discussions with their physician about concerning symptoms and screening options.

American College of experts are available to speak to media members to discuss the concerning rise of colorectal cancer in younger patients and what everyone should know about the disease.

Surgeons Available for Interviews

• Roberto Rodriguez-Ruesga, MD, FACS, colorectal surgeon at Texas Oncology
• V. Liana Tsikitis, MD, FACS, ACS Commission on Cancer state chair of Oregon and professor of surgery at Oregon Health & Science University
• Y. Nancy You, MD, MHSc, FACS, ACS National Accreditation Program for Rectal Cancer committee member and professor of colon and rectal surgery and director of the Young-onset Colorectal Cancer Program at the University of Texas MD Anderson Cancer Center

Essential Facts about Colorectal Cancer

• Two distinct diseases: Colon and rectal cancers are two separate diseases despite often being described as ‘colorectal cancer’ due to differences in treatment. Colon cancers account for about 73% of all cancers under the colorectal umbrella.
• Alarming increase in younger adults: People born in 1990 have about double the risk of colon cancer and quadruple the risk of rectal cancer compared with people born in 1950, and an estimated 10% of all new colorectal cancer diagnoses are early-onset cases. The reasons behind these increases are not fully understood, but research is ongoing into environmental, genetic, and lifestyle factors such as high consumption of ultra-processed foods.
• Screening saves lives: Screening with a colonoscopy can detect colorectal cancer at its earliest stage, when it’s most treatable, and can sometimes prevent colorectal cancer by detecting and removing precancerous growths called polyps. Increasing screening prevalence to 80% could reduce deaths from colorectal cancer by 33% by 2030, according to the Centers for Disease Control and Prevention (CDC). Screening can also detect cancer sooner, when it is easier to treat and survival rates are better.
• Know when to start screening: Most people should begin screening starting at age 45. People with a family history of colorectal cancer or other health factors (such as having inflammatory bowel disease) should talk to their doctor about screening earlier.
• Advocate for yourself: Although colorectal cancer does not always present symptoms until it is in more advanced stages, people of all ages should report changes in their bowel habits, such as bleeding or persistent bowel changes like diarrhea or constipation, to their primary care physician. Other symptoms to report include unintentional weight loss and pain when having a bowel movement.
• Healthy habits make a difference: The rise of colorectal cancer in younger adults is most likely multifactorial, encompassing environmental, genetic, and lifestyle factors, but people of all ages can reduce their risk of cancer by focusing on nutrition and healthy exercise habits.

National Cancer Database

The National Cancer Database (NCDB) is a clinical oncology database jointly operated by the American College of Surgeons CoC and the American Cancer Society. Capturing about 74% of all cancer cases diagnosed in the United States, the database is considered one of the most comprehensive for cancer care. Data is derived only from CoC-accredited hospitals but largely reflects the state of cancer care nationwide.

According to the NCDB:

• While colon cancer has traditionally affected older patients, there has been an increase in cases diagnosed in younger adults. Rates of colon cancer diagnoses in adults aged 18-44 have increased by 14.6% since 2004.
• By comparison, for adults aged 45-55, colon cancer cases increased by 3%, from 10,528 diagnoses in 2004 to 10,871 diagnoses in 2021.
• The risk of colon cancer is still far more prevalent in older adults (ages 56+). However, between 2004 and 2021, there has been a 20.5% decrease in colon cancer diagnoses in older adults, resulting in an estimated 16,000 fewer colorectal cancer diagnoses per year among patients over 50. Screening with colonoscopy may be one factor of many that has contributed to reduced cancer death rates and diagnoses among older adults.

Disparities in Colorectal Cancer

There are significant disparities in colorectal cancer screening and outcomes among different patient populations:

• Less than half of eligible Hispanic adults have been screened for colorectal cancer. This under-screening means colorectal cancers aren’t detected until a later stage, when they are less survivable.
• Latinos aged 20-29 have seen one of the largest increases in early onset, later stage colorectal cancers.
• Black people are about 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups.
• Early onset colorectal cancer diagnoses (those under 50), is higher for Black people compared to other groups.

Screening Options

Screening for colorectal cancer saves lives, and should begin at age 45 for people at average risk of developing colorectal cancer, according to guidelines issued by the U.S. Preventive Services Task Force. People with a family history of colorectal cancer should be screened 10 years earlier than the youngest age of diagnosis in their family.

Unfortunately, the CDC estimates that only about 70% of U.S. adults aged 50 to 75 are up to date on their screening, and much of the population may not be aware of all the screening options available to them.

There are several options available for colorectal cancer screening:

• Visual exams: Colonoscopy is considered the gold standard for colorectal cancer screening. With this test, physicians use a flexible tube called a colonoscope to see the inside of the entire colon and rectum. During this test, physicians can remove suspicious growths to biopsy (test) them for cancer. They can also remove pre-cancerous polyps that have the potential to develop into cancer. A colonoscopy should be performed every 10 years or more frequently, depending on the results of the test and if there’s a family history of the disease.
  • Other visualization tests include a CT colonography (virtual colonoscopy) or a flexible sigmoidoscopy, which looks at the lower colon and rectum. These tests should be performed every 5 years.
• Stool-based tests: Stool-based tests include the fecal immunochemical test (FIT)and guaiac-based fecal occult blood test, which detect hidden blood in the stool. Stool DNA tests can detect blood in the stool and abnormal changes through DNA analysis. These tests should be performed every one to three years depending on the type of test used.

American College of Surgeons experts recommend that colonoscopy remains the gold standard of screening options for colorectal cancer, but overall, choosing any screening option is better than not getting screened at all.

Treatment Options

Treatment for colorectal cancer is tailored to the individual, considering factors like cancer stage, tumor location, and overall health.

Younger adults with colorectal cancer are often diagnosed at later stages when the cancer is harder to treat and outcomes tend to be worse, but there are still several options available to them, including surgery, chemotherapy, and newer immunotherapy treatments that have shown promise in younger patients.

Additionally, younger patients may require more counseling about fertility preservation options and survivorship services that provide emotional support and counsel on sexual function and other health issues that may be impacted by treatment.

How to Find Quality Cancer Care

There are many options for where to receive care after a colorectal cancer diagnosis. Patients should look signifiers of quality such as:

• Commission on Cancer accreditation: CoC accreditation means a cancer center has undergone a rigorous evaluation and is committed to providing high-quality cancer care by demonstrating compliance with the CoC standards.
• National Accreditation Program for Rectal Cancer (NAPRC) accreditation: Programs accredited by the NAPRC have demonstrated compliance with the NAPRC standards, which are focused on facilitating a multidisciplinary, holistic approach to treating patients with rectal cancer.

These two accreditation programs are among the many ACS Quality Programs through which hospitals can become an ACS Surgical Quality Partner. The ACS Surgical Quality Partner diamond is a signifier that can help patients seek out hospitals committed to delivering the highest quality of care.

Recursos en Español

Instituto Nacional del Cáncer - Cáncer colorrectal

Cáncer de colon o de recto

References

1. Cotler J, Chan K, Zhu X. Colorectal cancer statistics, National Cancer Database, 2024.
2. American Cancer Society. Cancer Facts & Figures 2024. Atlanta: American Cancer Society; 2024.
3. Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal Cancer Incidence Patterns in the United States, 1974–2013, JNCI: Journal of the National Cancer Institute, Volume 109, Issue 8, August 2017, djw322, https://doi.org/10.1093/jnci/djw322
4. “Key Statistics for Colorectal Cancer.” American Cancer Society, January 29, 2024, https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics.html
5. “Health and Economic Benefits of Colorectal Cancer Interventions.” Centers for Disease Control and Prevention, December 21, 2022, https://www.cdc.gov/pcd/issues/2023/23_0071.htm