This tweet came across my feed recently:
I did not know March was National Colorectal Cancer Awareness Month, but apparently, it is.
My experience was not as bad at Horror Lawyer’s, but a non-cancerous polyp was found for me. I was told to come back in 5 years (as opposed to 10 years, which those with a clean colonoscopy are told).
Frankly, the experience was not as bad as I thought it might be. Yes, the prep clears you out, but I’ve had worse cases of abdominal problems. It’s a pretty nice nap through the procedure.
But, most importantly, there’s been a bad trend lately in colorectal cancer deaths, and I’m here to tell you about that. There’s also been a longer-term trend that’s been bad — but unfortunately, not sure what to say about it.
Long-term trend, 1999-2023, U.S.
Let’s just start with the number of deaths:
This is just to show the number of deaths to begin with, to give an idea of the magnitude of the issue, before I switch over to rates.
The recommendation for screening for colorectal cancer is ages 45 - 75, via a variety of methods (colonoscopies are not the only method), but we shall see there have been some worrying trends at younger ages.
People at ages older than 75 may start having issues with the common screening test of colonoscopy, but also from the issue of having problems should cancer be found. In some cases, to be blunt, there is not much point given the current state of treatment — it would be too harsh for people who are old and fragile.
Colorectal cancer death rates, 1999-2023
Let’s look at the death rates for the age groups all together, and then focus in.
As I explain here, you need to ignore that spurious spike in rates in 2021 for the older age groups.
In this overall graph, one can see the improvement in death rates in recent decades, but it does look like there may have been a flattening in the pandemic, and it is difficult to compare the younger ages’ trends because of magnitude differences. So let’s look more closely at them.
Focusing solely on the under-45 groups, it’s obvious that the 35-44-year-old group has an increasing trend in colorectal cancer death rates. It was about 3 per 100,000 in 1999 and was about 3.8 per 100K in 2023.
It’s difficult to see what’s going on with the 25-34 years old group until we focus in even more:
You can see there is a lot of volatility year-to-year as only 200 - 400 people in this 25-34 age group die from colorectal cancer each year (and this is a top cancer type). However, there is a general upward trend, with colorectal cancer death rates increasing from around 0.7 in 1999 to 0.8 in 2023.
Indeed, for 1999-2023, the ages 25 to 54 showed increasing death rates from colorectal cancer, why the age groups over age 55 showed decreasing death rates.
The overall age-adjusted death rate from colorectal cancer decreased by almost 40% from 1999 to 2023, as the death rates for the oldest age groups decreased greatly over this period, counteracting the relatively large increases seen in the under age 55 groups.
During the pandemic: short-lived disruptions?
When we look at how death rates from colorectal cancer changed for these age groups in the U.S. since 2019, we see these younger age groups still have concerning trends.
However, the age-adjusted rate, which is influenced by the very large rates from the oldest age groups, much saw a wash when it came to how much has changed.
As seen in the longer-term trends, the oldest age groups had strong trends of reducing death rate trends due to colorectal cancer, and that may have continued through the pandemic. However, an alternative explanation can occur: older cancer patients are vulnerable to dying from COVID.
On the other hand, we already saw a longer-term trend of younger age groups with increasing cancer rate trends. Ages 25 - 54 already had a long-term increasing death rate since 1999.
Early Onset Colorectal Cancer
This is a worldwide phenomenon:
Early-onset colorectal cancer: A review of current knowledge
Abstract
Colorectal cancer (CRC) is one of the most prevalent malignancies worldwide. Although most prevalent among older people, its incidence above 50 years old has been decreasing globally in the last decades, probably as a result of better screening. Paradoxically, its incidence in patients below 50 years old [early-onset CRC (EO-CRC)] has been increasing, for reasons not yet fully understood. EO-CRC’s increasing incidence is genre independent but shows racial disparities and has been described to occur worldwide. It follows a birth-cohort effect which probably reflects a change in exposure to CRC risk factors. Its incidence is predicted to double until 2030, which makes EO-CRC a serious public health issue. Both modifiable and non-modifiable risk factors have been identified - some are potential targets for preventive measures. EO-CRC is often diagnosed at advanced stages and histological features associated with poor prognosis have been described. EO-CRC presents some distinctive features: Microsatellite in-stability is common, but another subtype of tumours, both microsatellite and chromosome stable also seems relevant. There are no age-specific treatment protocols and studies on EO-CRC survival rates have shown conflicting data. Due to the higher germline pathological mutations found in EO-CRC patients, an accurate genetic risk evaluation should be performed. In this review, we summarize the current evidence on epidemiological, clinical, histopathological and molecular features of EO-CRC and discuss the contribution of genetics and lifestyle risk factors. We further comment on screening strategies and specific dimensions to consider when dealing with a younger cancer patient.
As discussed in the paper, broad screening by lower the recommendation for screening ages will likely not help.
When one reads up on the aspects to prevent CRC (colorectal cancer), that’s for preventing CRC at typical ages, like 60. Not having stage-III cancer at age 35. It sounds like aspects of CRC presenting at young ages are very different than the bulk of CRC that appears later, and that was true well before the pandemic.
Interesting.
I can totally relate to your experience. I am not waiting on 5 years, 3 is my preference for a follow up.