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Johns Hopkins Health - Early Warning

Winter 2013
Issue No. 19

Early Warning

Date: January 17, 2013

Despite its reputation as an older person’s disease, colorectal cancer is increasing among young people


The rise of poor eating and exercise habits permeates the news these days and, as a result, many illnesses traditionally affecting older people are now appearing in the young. One startling example is colorectal cancer; doctors are seeing an increase in cases among people younger than 50, which is the typical age to begin screening.

“Nobody knows for sure why,” says Sandy Fang, M.D., a colorectal surgeon at Johns Hopkins, “but it’s probably a combination of things.” Fang points to many culprits as possible risk factors: a family history of colorectal cancer, inflammatory bowel disease, and lifestyle patterns such as low-fiber diet, excessive intake of red meat, obesity and lack of exercise.

Colorectal cancer rates have been declining in older populations, but the disease is on the rise in people ages 18 to 49, with rates having gone up more than 2 percent between 1998 and 2007, according to the National Cancer Institute. Fang says younger people are often misdiagnosed because the symptoms of colorectal cancer—rectal bleeding, abdominal pain and change in bowel habits to name a few—can point to many other disorders, and doctors don’t always consider colorectal cancer because of the patients’ age.

When the disease is diagnosed it is usually advanced, because the younger person hasn’t sought care quickly or because symptoms might not have been recognized or acknowledged. Thus, the treatments are more extensive and costly.

Fang urges people who have signs of colorectal cancer, regardless of their age, to be proactive with their care. When she sees symptoms in people who have a family history of the disease, Fang says she tends to do colonoscopies sooner rather than later.

Minimizing Your Risk
Johns Hopkins recommends that most men and women get their first colonoscopy screening for colorectal cancer at age 50. There are, however, certain factors that can place younger people at higher risk and necessitate earlier screening:

  • Rectal bleeding, abdominal pain, diarrhea, changes in bowel movements, or anemia. Talk to your doctor about when to start screenings.
  • A family history of colorectal cancer. Start screening 10 years before the diagnosis of the youngest affected family member.
  • Lynch syndrome. If you are at risk for this hereditary cancer of the digestive tract, start colonoscopies at age 21 and continue every one to three years.
  • Familial adenomatous polyposis. This disease is characterized by benign growths that will likely develop into cancer. Get a colonoscopy every one to two years, starting as early as the teen years.

Know your Risk of Colon Cancer
Awareness of symptoms and risk factors are important in detecting colon cancer early. Johns Hopkins colorectal cancer experts, gastroenterologist Francis Giardiello, M.D., and colorectal surgeon Susan Gearhart, M.D., discuss risk factors, symptoms, the importance of early screenings and current treatment options in the video: Colon Cancer: Know Your Risk.

For more information, appointments or consultations, call 877-546-1872.