Early-Onset Colorectal Cancer: Finding and Treating Polyps
Written By: Christine L.S. Molmenti, PhD; Michael A. Diefenbach, PhD - The Feinstein Institutes of Medical Research at Northwell Health
Colorectal cancer is now the leading cause of cancer death in men under 50 and the second leading cause of cancer death among women under 50. The most recent American Cancer Society Report indicates that cancer risk is particularly higher among young women compared to men.
It is not uncommon to find a patient in their 20s or 30s diagnosed with colorectal cancer today. Sadly, among individuals under 50, colorectal cancer is usually diagnosed at a later stage when treatment is more complex, and survival is lowest. When colorectal cancer is diagnosed in people under 50 years of age it is often termed “Early-Onset Colorectal Cancer (EO-CRC).” This is a growing topic of national and international concern.
Recently the United States Preventive Services Task Force (USPSTF) lowered the national screening guidelines for colorectal cancer from 50 years old to begin at age 45. This change in recommendation was in response to the alarming rise in EO-CRC cases and deaths in throughout the United States.
What causes early-onset colorectal cancer?
Risk factors and causes of early-onset colorectal cancer (EO-CRC) still elude scientists and clinicians. There is no consistent risk factor or cause for EO-CRC that has been identified. How an early onset tumor differs from a tumor diagnosed in a person over 50 is still under rigorous scientific investigation.
Colorectal polyp screenings are important!
Without any known risk factor or cause, our only known strategy for EO-CRC prevention is adherence to the national gastroenterology and oncologic guidelines. Developed by the United States Multi-Society Task Force (USMSTF) and the National Comprehensive Cancer Network (NCCN), the guidelines were put in place to guide clinicians on the appropriate surveillance intervals following colonoscopy and to communicate the ensuing risk for close family members based on the patient’s results.
For any patient diagnosed with colorectal cancer or advanced colorectal polyps, first-degree relatives should be screened at age 40, or 10 years before their advanced colorectal polyp diagnosis, whichever is earlier. When a colorectal cancer is diagnosed, close relatives are generally informed and take action to screen early heeding the guidelines.
The situation is different for patients diagnosed with advanced colorectal polyp during a colonoscopy. Close family members are rarely informed. In these cases, the guidelines are often not followed, leading to missed opportunities to prevent early colorectal disease among close family members.
What should be done after an advanced colorectal polyp is found?
Once a person has had an advanced colorectal polyp diagnosis, they need to call their brother, sister, and their children (if old enough). These close relatives are called first-degree relatives. If a 38-year-old man is diagnosed with an advanced colorectal polyp, the guidelines recommend that his brother, sister, and children should start colorectal cancer screening at age 28, with colonoscopy.
If the patient was diagnosed with an advanced polyp over 60 years of age, his first-degree relatives would begin screening at 40, and they can use any preferred screening method (e.g., colonoscopy, stool-based, virtual). Bottomline, an advanced polyp diagnosis confers earlier and more frequent screening among relatives.
What are advanced colorectal polyps?
Advanced colorectal polyps include advanced adenomas >=1cm, or any adenoma with villous features or with high-grade dysplasia, sessile serrated polyps >=1cm, or any serrated lesion with any grade of cytologic dysplasia, traditional serrated adenomas regardless of size. The clinician performing the colonoscopy will send all suspicious polyps for further examination to a pathologist, who will grade the polyp appropriately in the above-mentioned classifications.
How common are advanced colorectal polyps?
Approximately 10% of screening colonoscopies among average-risk adults will find advanced adenoma and 2-9% will find an advanced serrated polyp. With more than 15 million colonoscopies performed annually in the United States, the potential volume for finding these advanced polyps is significant.
Do I really need to tell my relatives about my colorectal polyps?
Yes, please do. It can be embarrassing and anxiety provoking to talk about something so personal. Informing your first-degree relatives and sticking to the earlier screening guidelines for close relatives of advanced colorectal polyp patients makes early detection of early onset colorectal cancer more likely (if it develops).
Following recommended cancer prevention recommendations is not embarrassing. To the contrary, it shows great responsibility to your health and to your family. So does informing your relatives of their risk. There are resources available that you can mention, such as the American Cancer Society National Advanced Polyp GI Brief and many peer-reviewed articles.
Be aware of the new colon cancer guidelines and get screened. If you have had an advanced colorectal polyp inform your siblings and children and ask them to get screened as well. Tell them about your experience with the procedure and remind them that prevention is better than treatment. It is time to take action to increase awareness and to prevent this highly preventable disease in our families and communities.
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