New study outlines the warning signs

Colon cancer is increasingly hitting Americans under the age of 50, and a new study outlines the warning signs that these young patients first encounter.

The analysis was based on data from 80 different studies, involving almost 25 million patients under the age of 50.

In nearly half (45%) of cases, blood in stools was an initial symptom, followed by abdominal cramps (40% of cases) and alterations in bowel habits (27% of cases), according to a team led by Joshua Demb, a graduate student in gastroenterology at the University of California, San Diego.

It often took a long time to receive a diagnosis of early-onset colon cancer following these symptoms, however.

“Time from sign or symptom presentation to early onset colorectal cancer diagnosis was often between 4 and 6 months,” Demb’s team wrote.

The findings were published May 24 in the journal JAMA Network Open.

Colon cancer rates are on the rise among young Americans and Americans of color, so much so that the disease is now the leading cause of cancer death for men under 50 and the second most deadly cancer for women under 50.

The American Cancer Society released those statistics in its 2024 Report, causing many experts to call for better screening in younger patients.

The numbers are “alarming,” said Dr. Folasade May, a cancer prevention researcher and gastroenterologist at UCLA Health in Los Angeles. She also served on the President’s Cancer Panel on Colorectal Cancer in 2021.

“Since 1995, there has been a 45% increase in colorectal cancer diagnoses in people under the age of 50,” she noted.

The uptick in cases was so dramatic that in 2021 the influential U.S. Preventive Services Task Force lowered the recommended age of first screening from 50 to 45.

Red flags

More young Americans need to be on the alert for colon cancer’s warning signs—and push their doctors for action if and when they appear.

Bloody stools, especially, should be a red flag. Of course, blood in stools can signal any number of gastrointestinal issues, so cancer is not the only possible cause.

But Demb’s group found that bloody stools in people under the age of 50 was linked to a five-fold higher risk for colon cancer, compared to people without this symptom.

When symptoms do appear, younger people tend to delay seeking out medical advice, Demb and colleagues noted.

“Younger patients may experience ongoing signs and symptoms and delay seeking medical attention,” they wrote. “Potential reasons for these delays include a patient believing they are too young to worry about cancer or a lack of access to primary care or health insurance.”

Even when a doctor is consulted, “patients and clinicians alike may downplay symptom severity and fail to recognize key red flags and clinical cues that should trigger suspicion of colorectal cancer, ” the researchers said.

Too often, rectal bleeding in the young is attributed to more benign conditions such as hemorrhoids, the team said.

Avoid delays

Any delay in diagnosis can be costly, since the earlier a cancer is detected, the higher the likelihood of a better treatment outcome.

Overall, “delays in diagnostic workup after sign or symptom presentation are up to 40% longer in younger compared with older individuals with colorectal cancer,” the San Diego researchers said.

According to various studies, between 58% and 89% of colon cancer patients under 50 are diagnosed only when their disease reaches a late stage, compared to 30% to 63% of older patients.

To spot cancers early, “clinicians should work with patients to ensure concerning signs and symptoms undergo diagnostic evaluation to identify and resolve the underlying cause,” Demb and colleagues advised.

Of course, routine colon cancer screening—either via stool-based tests and/or colonoscopy/sigmoidoscopy—is crucial in spotting colon cancers early, experts say.

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