Too Young to Have Colon Cancer?

09 Mar 2018
By Sharon Stein

We all have that anecdotal story that changes our practice. We read the literature and pretend we are data driven until we have a patient with a complication, or see the crazy zebra diagnosis that makes us paranoid or concerned, and changes our practice.  

For me, as a colorectal surgeon, it was a gastroenterology colleague who was anemic.  A bit tired and run down, she eventually went to have a colonoscopy after several months.  The cancer in her colon had already spread to her ovaries. But she isn’t the only story…

How many times have I heard the story from a patient with rectal bleeding diagnosed with hemorrhoids without even a rectal exam?  How many times did the change in bowel movements get ascribed to irritable bowel disease rather than getting a colonoscopy? How many times did I need to see a patient under the age of 50 who waited months to be diagnosed with a symptomatic cancer?

The data is there.  An article published in Journal of the National Cancer Institute in 2017 demonstrates the incidence of colon and rectal cancer is increasing in younger patients.  In fact, while rates of rectal cancer decreased in those over 55 since the 1970’s, they doubled in patients under 55.  In patients under the age of 40, the rate of colon cancer increased from 1.0% to 2.4%. Compared to a patient born in 1950, the rates of developing colon cancer in someone born in 1990 are twice as high, and they have four times the risk of developing rectal cancer.   We have yet to fully understand why rates are increasing in this younger population, but the increased risks may be associated with obesity and increased smoking and alcohol use.   

Recommendations for screening have yet to evolve based on these findings, but patients with changes in bowel movements, bleeding per rectum and anemia are not eligible for screening colonoscopy – they need a diagnostic colonoscopy.   Insurance rules are different for people undergoing a diagnostic colonoscopy rather than a screening colonoscopy.  

The number of patients I see with delayed diagnoses because either they, or their physician, ignored potential signs of colon cancer, is heartbreaking.  

So, if you are caring for someone who has the signs, or if you, yourself, have signs that might be colon cancer, consider getting a colonoscopy this month.   Someday, if we stop ignoring signs, colon cancer may be preventable. When found early enough, colon cancer can be cured in up to 90% of patients. I for one, will be happy to be out of a job.

More information about the diagnosis and treatment of colon cancer can be found through the American Society of Colon and Rectal Surgeons at

Sharon Stein is a Associate Professor of Surgery and Program Director of Colon and Rectal Surgery at University Hospitals/Cleveland Medical Center.   She serves as Vice President of the Association of Women Surgeons. You can tweet at her @slsteinmd1.  

Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.

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