By Kiara Doyal, The Seattle Medium
Colorectal cancer is becoming one of the leading causes of cancer death among adults under 50, a shift that is raising concern among healthcare professionals and prompting updated screening recommendations that many people still do not know about.
According to Dr. Rotonya Carr, head of the University of Washington Gastroenterology Division, many adults are missing screenings for a highly treatable disease that often develops without symptoms. Colorectal cancer begins in the colon or rectum and typically forms from polyps, or growths, in the inner lining of the bowel.
Once considered more common in older adults, colorectal cancer is now increasingly affecting younger populations. This trend led the U.S. Preventive Services Task Force to update its guidelines in 2021, recommending that adults begin screening at age 45. Despite the change, many individuals remain unaware of the importance of early detection and routine screening.
Dr. Carr said all adults should begin colorectal cancer screening at age 45, regardless of family history or race or ethnicity. Individuals with a family history of colorectal cancer may need to start screening at an even younger age.
“Colorectal cancer is now the number one cause of cancer deaths in adults under the age of 50. So, we no longer think of this as a disease of aging,” said Dr. Carr. “Screening saves lives, but so many do not know that the screening guidelines have changed.”
Dr. Rachel Issaka, a gastroenterologist and director of the Population Health Colorectal Cancer Screening Program at UW Medicine and Fred Hutch Cancer Center, said screening and early treatment can significantly reduce colorectal cancer deaths.
“Colorectal cancers are one of the most preventable cancers,” said Dr. Issaka. “We have very effective ways to detect and remove polyps before they’re cancerous, as well as to catch cancer at its earliest stage when it’s easiest to treat.”
Because most colorectal cancers develop without symptoms, doctors emphasize the importance of routine screening even for people who feel healthy. When symptoms do appear, they can include warning signs that should not be ignored.
“Symptoms might include blood in the stool that may be persistent or intermittent, abdominal pain that is not otherwise explained, unexplained weight loss, or changes in bowel movements,” said Dr. Issaka. “Also, pay attention to abnormalities in blood lab work. Iron deficiency anemias are one of the common signs that we see in people who have colon cancer.”
A variety of screening options are available, allowing patients to choose what works best for them in consultation with their healthcare provider.
“Some visual tests, like colonoscopies, look directly at the colon. There are also non-direct tests, including stool tests that look for small amounts of blood in the stool or newer-generation blood tests,” said Dr. Issaka. “The frequency of screening depends on the test and the results. A completely normal colonoscopy needs to be repeated every 10 years. A stool-based test, if completely normal, needs to be repeated annually or up to every three years, depending on the type of test.”
Research also shows that colorectal cancer affects communities differently. The Black community and American Indian and Alaska Native populations are more likely to experience more severe outcomes compared with other groups.
“Black people, and American Indian/Alaska Natives, are more likely to be diagnosed with advanced stage disease and are more likely to die from colorectal cancer after being diagnosed compared to White individuals,” said Dr. Issaka.
Issaka said barriers to screening and healthcare access continue to affect many patients and can prevent early detection.
“There are barriers at the patient level [lack of knowledge], at the provider-level [not recommending screening], healthcare system-level [systems that are confusing for patients], and policy level [out-of-pocket expenses for patients],” said Dr. Issaka. “All of these barriers can result in patients deciding not to complete screening.”
In addition to increasing awareness about updated screening guidelines, Carr said stronger advocacy is needed to ensure patients can access care when they need it.
“We need strong advocacy at the state and national levels to prevent insurers from delaying this care. For example, we are seeing significant growth in insurance denials in the state of Washington when patients try to have their colonoscopy scheduled with their preferred health systems,” said Dr. Carr. “These denials can be the difference between timely diagnosis and late diagnosis for a cancer that can be prevented.”
