ÎåÔÂÌìÊÓƵ

The untimelyÌýpassingÌý´Ç´ÚÌý²¹³¦³Ù´Ç°ùÌý,Ìý43,Ìý³ó²¹²õÌýmany people turning their attention toÌý·É³ó²¹³ÙÌýcausedÌýhisÌýdeath:Ìýearly onsetÌýcolorectal cancerÌý(CRC).ÌýIt’s important to understand the disease,Ìý·É³ó²¹³ÙÌýcausesÌýit, and whoÌýmayÌýface an elevated risk of developingÌýit.ÌýÌýÌý

ÎåÔÂÌìÊÓƵ’sÌýFeliceÌýSchnoll-Sussman, MDÌýisÌýdirector of The Jay Monahan Center for Gastrointestinal Health; an  associate  attending physician at theÌýNewYork-Presbyterian Hospital/ Weill Cornell Medical Center; and professor of clinical medicine at the Weill Medical College of Cornell University,ÌýandÌýAndreaÌýBeteshÌýMD,ÌýassistantÌýprofessor ofÌýmedicine,ÌýDivision of Gastroenterology and HepatologyÌýdiscussÌý·É³ó²¹³ÙÌýpatients need to know about colorectal cancer.Ìý

Ìý

How common isÌýearly onset colorectal cancer?ÌýÌý

Dr.ÌýSchnoll-Sussman:ÌýAlthough the overall incidence of colorectal cancer in the United States has been declining over the past few decades,Ìýin patients younger than 50,Ìýit has been climbingÌýbyÌýoneÌýtoÌýthree per centÌýa year.ÌýÌý

The patientsÌýactÌýdifferently thanÌýtheÌýaverage-onset colorectal cancerÌýpatient:ÌýtheyÌýoften do not have the typical risk factors such as a poor diet or a sedentary lifestyle. Their tumors behave differently, too; they’re more likely to be located in the lower portion of the colon, especially the rectum--present already with metastatic disease and are biologically differentÌýwithÌýmolecular differences.Ìý

Ìý

It is said that Black communities experience a higher incidence of colorectal cancer.ÌýWhat areÌýthe statistics associated with this,Ìýand what roleÌýdoÌýgenetics and family history play?ÌýÌý

Dr.ÌýSchnoll-Sussman:ÌýAfrican Americans haveÌýboth the highest incidence of colorectal cancerÌýandÌýthe shortest survival rate of any racial or ethnic group in the United States for most cancers. Nearly 20,000 new cases of colorectal cancer were expected in the United States among African Americans in 2019, with incidence rates 24 percent higher in black men and 19 percent higher in black women compared to other races, according to the  . Black colorectal cancer patients are also 15 to 20 percent more likely to die from the disease than patients of any other race.ÌýÌý

These grim statistics may be due to multiple factors,Ìýincluding the fact thatÌýBlacks are more are more likely to have anÌýaggressive subtype of colon cancer attributed to aÌýgeneticÌýmutation,Ìýand have right-sided cancers that may lead to a later diagnosis and poorer prognosis.ÌýÌýÌýÌý

Ìý

Are there any unique risk factors associated with early onset CRC?Ìý
Ìý

Dr.ÌýBetesh:ÌýThe most well-established risk factor for early onset CRC is family history.  If other members of your family had CRC, especially if they were diagnosed with CRC at a young age, you may have an increased risk of young onset CRC. ÌýÌýÌý

There are also some genetic syndromes (such as Lynch Syndrome and familial adenomatous polyposis) in which people are born with specific genetic mutations that increase their risk of developing CRC at a young age. ÌýWe don’t fully understand why there has been an increase in young onset CRC, but there may be other risk factors forÌýit--diet, obesity, smoking--however, this is still an area of active research. ÌýÌý

Ìý

WhatÌýaboutÌýlifestyle factors?Ìý

Dr.ÌýBetesh:ÌýAlthough there are early-onset patients who lead healthy lifestyles,ÌýthereÌýstill areÌýthingsÌýwe can do to decreaseÌýrisk.  Generally,Ìý·É³ó²¹³ÙÌýkeepsÌýthe body healthy overall alsoÌýisÌýgood for the colon:Ìýa healthy diet with lots of fiber in the form of fruits, vegetables, and whole grains; routine exercise;Ìýand maintainingÌýa healthy body weight. ÌýÌý

Smoking, drinking alcohol in excess, and eating a diet high in processed meatsÌýcan boost the risk.Ìý

Ìý
How do physicians screen for colorectal cancer? At what age should screenings begin, and should it be earlier or more often for some people?Ìý
Ìý

Dr.ÌýBetesh:ÌýColonoscopy isÌýthe best testÌýfor CRC.ÌýThe physician usesÌýthisÌýto closely examine theÌýlining of the colonÌýand lookÌýfor pre-cancerous polypsÌýwhile the patient is sedated.ÌýThe physician can remove polyps during the procedure, decreasingÌýtheÌýrisk of developing CRC.Ìý

Stool testsÌýalsoÌýcan screen for colon cancer. ÌýThese tests don’t prevent CRC,ÌýbutÌýcanÌýhelpÌýdetect it early, beforeÌýthe onset ofÌý²õ²â³¾±è³Ù´Ç³¾²õ. Stool-based screening tests must be done more frequentlyÌý(typically everyÌýone to threeÌýyears),Ìýdepending on the specific test.ÌýEarly detectionÌýmakes it easier to treat and potentially cureÌýCRC. ÌýÌý

For the general population,ÌýCRC screening should begin between age 45-50.  ForÌýBlack individuals,Ìýscreening should start at age 45. If there’Ìýs a family history ofÌýthe disease, screening should begin earlier, generally at age 40,Ìýor 10 years prior to the age at which the relative was diagnosed with CRC.ÌýÌýÌý

If you are screened with a colonoscopy, you may be able to do this once every 10 years.  Individuals with colon polyps or a family history of CRC may need toÌýundergo screeningsÌýmore frequently.ÌýIndividuals withÌýcertainÌýgenetic syndromes that increase the risk for CRC also should begin screening at a younger age.Ìý

Ìý

What are some of the symptoms that can be associated with colorectal cancer?Ìý

Dr.ÌýBetesh:ÌýPatients should look forÌýchanges in bowel habits, blood in the stool, or unintentional weight loss. If you experienceÌýany symptoms that you worry could be related to CRC,Ìýsee your doctor right away. The earlier you seek medical care,Ìýthe better. Ìý

Dr.ÌýSchnoll-Sussman: The most important thing to learn from this tragedy is that colorectal cancer is not a disease limited to older people.Ìý There is no age or gender or racial discrimination with this disease.Ìý Patients need to know their family history,Ìýbe in tune with their bodies and speak with their physicians if they start experiencing any signs or symptoms consistent with colorectal cancerÌýÌý