Kevin Devries, now 39, had been having some intestinal symptoms for several years.
A couple of years ago, his doctor suggested a colonoscopy. But because Devries was far younger than the recommended age for a first colonoscopy — 50 for those with no family history, 45 for African-Americans — his insurer said it probably wouldn’t pay, and if it did, his high-deductible plan would leave him footing most of the bill.
Within the past year, however, his symptoms worsened, and there were a few extra ones. So he decided to go ahead.
He had the procedure in late November. Though he’d been expecting something relatively manageable — irritable bowel syndrome or polyps — the doctor said they were scheduling him for surgery.
“They told me I had cancer,” Devries said. “That was quite a shock.”
A shock for Devries, certainly, but not as big a surprise for doctors familiar with colon and rectal cancer. Several area physicians said they’ve been seeing more younger patients in recent years, both for colonoscopies and for treatment.
Though colorectal cancer rates have been declining overall and among older adults for decades, a study led by American Cancer Society researchers revealed last week that the incidence among those as young as their 20s, 30s and 40s has increased sharply. With age taken into account, people born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer of those born around 1950, when the risk was lowest, according to the organization. Results of the study, based on more than 490,000 cases in large cancer registries dating between 1973 and 2013, were published in the Journal of the National Cancer Institute.
The study already is prompting discussion about what’s driving the trend and whether screening should begin earlier. While that’s likely to continue for some time, local doctors stressed that the immediate takeaway is that people experiencing symptoms — blood in stools or changes in bowel habits, as well as unexplained weight loss or anemia — need to get them checked out.
“The most important message is you’ve got to get screened,” said Dr. Timothy Huyck, a medical oncologist and hematologist at Nebraska Cancer Specialists at Methodist Estabrook Cancer Center. “And you’ve got to talk to your physician about what’s appropriate for you.”
Dr. Sean Langenfeld, an assistant professor at the University of Nebraska Medical Center who specializes in colorectal surgery, stressed that the incidence among younger adults still is relatively small — one or two cases per 100,000 people a year. Age still is the No. 1 risk factor.
The number of new colorectal cancers this year is projected at more than 135,000 nationwide, with 90 percent of them among older adults. In Nebraska, more than 800 cases and 300 deaths are projected this year.
But Huyck said the increase among younger adults works out to about 10 extra people who will be diagnosed among the metro area’s roughly 1 million residents.
While the disease is very treatable and potentially curable if caught early, a diagnosis in a younger patient can take a particular toll. Younger patients often are in the prime of their careers and just starting families, or exiting their 20s and hitting their stride. Huyck estimated that he has 15 to 20 patients, including Devries, under age 40 who are either in treatment for colorectal cancer or have just completed it.
“It’s a life-altering diagnosis, and one that can be devastating,” he said.
Devries, a programmer and analyst, and his wife have a 3-year-old daughter and a baby on the way. His surgery removed the tumor and involved lymph nodes. He had his second chemotherapy treatment last week, a regimen that will continue for the next six months to eliminate any remaining cancer cells and help head off the possibility of recurrence.
Though he’s doing well following surgery, the treatment has brought on symptoms such as neuropathy, including tingling in his hands. Contact with anything cold feels like an electric shock.
While the rate at which new colorectal cancers occur in all age groups combined has declined in the United States since the mid-1980s, colon cancer rates have increased by 2.4 percent a year in those ages 20 to 29 and by 1 percent a year in those ages 30 to 39. The increase specifically for rectal cancer among younger adults has been steeper, with the proportion of those cancers in adults younger than 55 doubling in two decades.
“This confirms what we’re seeing on the front lines of gastroenterology,” said Dr. Grant Hutchins, a gastroenterologist with Midwest Gastrointestinal Associates. “Now we need to start thinking about why this is going on.”
The concerns with younger patients, he said, is that those with nonspecific symptoms may put colorectal cancer well down the list of possible causes. That means they may be diagnosed later, when the disease has grown or even spread.
Indeed, the study indicated that people younger than 55 are 58 percent more likely to be diagnosed with late-stage disease than older people.
Hutchins said it’s important for younger patients to take the symptoms seriously. The same goes for primary-care physicians. While there are other tests available, the colonoscopy remains the gold standard. It’s also a preventative measure — doctors remove polyps before they can develop into cancer. Indeed, screening is credited with reducing rates of the cancer among people over 50.
“Education works because we are screening more,” Hutchins said. “Hopefully, you could stop this trend in its tracks and have them go the way colorectal (cancer) rates have been going in older adults.”
Dr. Alan Thorson, a colon and rectal surgeon with Colon and Rectal Surgery Inc. and Colonoscopy Center Inc., said those with symptoms need to be persistent. That’s definitely been the message from the young survivors involved in the local Great Plains Colon Cancer Task Force, for which he serves as an adviser.
“Even if they seem minor, it’s a good opportunity to do an exam,” he said. “I’ve been more persistent in suggesting that they take that opportunity to get a colonoscopy.”
But Thorson said he doesn’t necessarily think doctors need to start screening people with no symptoms at age 40. Unless the emerging science shows benefits, the cost of such large-scale screening could be prohibitive.
“But at an individual level, its value is priceless,” said Thorson, a past president of the American Cancer Society. “If you have symptoms, get in and get checked.”
Cancer society officials have said they will be reviewing the data to see whether a change in screening recommendations is warranted.
Also unknown is what’s causing the increase.
Langenfeld, the UNMC surgeon, said one factor is that doctors, increasingly aware the disease can strike young, are being quicker with colonoscopies in those who come in with symptoms.
Researchers have suggested other possibilities. While the causes of colorectal cancer are complex, Thorson said doctors can’t overlook the fact that obesity is on the rise or that many Americans’ diets and activity levels still are lacking. Obesity and sedentary lifestyles are both associated with increased risk.
But even those factors probably won’t explain it all, Langenfeld said. “At the end of the day, it’s a little bit of a mystery.”
Be alert to colon cancer symptoms, and get screened
Doctors remind us to be aware of our bodies and get possible symptoms checked out when they occur. During March, which is National Colorectal Cancer Awareness Month, the Great Plains Colon Cancer Task Force is making free colon cancer screening kits available at locations throughout the metropolitan area. The fecal occult blood test (FOBT) is a simple test that can be done at home. For more information, visit coloncancertaskforce.org. For additional information about screening, go to cancer.org.
What to watch for: Many of the symptoms of colon cancer can also be caused by something that isn’t cancer, such as infection, hemorrhoids, irritable bowel syndrome or inflammatory bowel disease. But those with the following symptoms should go to the doctor to get checked:
» A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days.
» A feeling that you need to have a bowel movement that is not relieved by doing so.
» Rectal bleeding.
» Dark stools, or blood in the stool.
» Cramping or abdominal (belly) pain
» Weakness and fatigue
» Unintended weight loss
Source: American Cancer Society