As colon cancer rates rise among young adults, a push for early screening
At 34 years old, Jason Mehalic didn't fit the pattern of someone newly diagnosed with colorectal cancer.
Mehalic, now 42, was fit and healthy with no family history of the disease. He had never had a colonoscopy — most people start around 50 — before the one that led to his diagnosis.
Even as colorectal cancers decline in people over 55, cases like Mehalic's are becoming more common. The disease has increased sharply among young people during the last three decades, raising new questions about how doctors should look for the disease in younger patients, according to a recent study.
Colon cancer rates increased by 1 percent to 2.4 percent per year among 20- to 39-year-olds from the mid-1980s to 2013, according to the study, which was published in the Journal of the National Cancer Institute. Among 40- to 54-year-olds, the increase ranged from 0.5 percent to 1.3 percent per year from the mid-1990s to 2013.
Rates of rectal cancer, which is more difficult to recover from, have increased even more dramatically. Rectal cancer rates increased by 3.2 percent per year among 20- to 39-year-olds from 1980 or earlier to 2013 and by 2.3 percent per year in 40- to 54-year-olds from the 1990s to 2013, according to the study.
“None of this is really surprising to us, but it's compelling, for sure,” said Dr. James McCormick, chief of colorectal surgery for Allegheny Health Network.
McCormick said he is seeing more young patients with colorectal cancer than he used to. In 2015, about 10 percent of the system's 540 colorectal cancer patients were under 50, he said.
“That's obviously cause for alarm,” he said.
When doctors find colorectal cancer in young people, it is often after symptoms such as abdominal pain or bleeding have begun, he said. Young people often ignore the symptoms or their doctors mistake them for something else, and oncologists might not discover the disease until it is relatively advanced, he said.
The U.S. Preventive Services Task Force, a federal independent panel of experts, recommends people at average risk start colorectal cancer screening at 50 years old. Doctors consider colonoscopies the gold standard for screening, although some less-invasive options such as stool tests exist. Studies show benefits from getting a colonoscopy every 10 years for the average person — those with a family history of colorectal cancer should be screened earlier and more often, McCormick said.
“Hopefully it will be a red flag for primary care physicians (and) general internists to be now aware of the possibility of colon cancer developing in the younger population,” Dr. Edward Chu, interim director of the University of Pittsburgh Cancer Institute, said of the study.
Chu said he has noticed an uptick in young colorectal cancer patients, specifically in the last 12 to 18 months. The change warrants more research, he said, including looking more deeply at potential molecular differences between early-onset and late-onset varieties of the disease.
McCormick and Chu said the study likely will prompt organizations that develop screening recommendations to reevaluate the evidence for starting screening before 50.
Mehalic, who lives in Apollo, said his diagnosis of rectal cancer did not come as a complete surprise. A doctor had found polyps in his rectum when Mehalic was in his early 20s after he reported bleeding after workouts and other exertion. The doctor didn't recommend a colonoscopy, and Mehalic noticed few symptoms until he reached 34.
“It was a shock to hear it, but I think you just start to immediately evaluate how to go on,” he said.
He underwent chemotherapy, radiation and surgery at Forbes Regional Hospital in Monroeville and is now clear of the disease, although he gets a colonoscopy about once every three years. He is married and has a 3-year-old child and owns a landscaping and lawn-care business.
Doctors normally remove precancerous polyps during colonoscopies to help prevent cancer from developing. Not all polyps are precancerous, and it's unclear whether Mehalic's could have been a precursor to his cancer, said McCormick, who treated Mehalic.
“Had he been scoped a few years earlier ... that may have been a preventable situation for him,” McCormick said.
McCormick treats abdominal symptoms such as bleeding, pain, bowel obstruction and fatigue differently than he did a decade ago, performing colonoscopies more readily, he said.
“All of this thought process over the last 10 years has been evolving to a really more aggressive surveillance of these young people,” he said.
The study researchers wrote that they do not know what's causing the increase in the disease among young people. Genetics more often play a role in younger people getting colorectal cancer than they do in older people, but the majority of cases in young people are sporadic, according to the paper.
Obesity, unhealthy diets and limited exercise likely play a role, according to the study, which notes that alcohol consumption and cigarette smoking have gone down over the last three decades.
Chu said that linkages between colorectal cancers and diabetes — which also has become more common over the last three decades — should be explored.
The study notes that people under 55 are three times more likely to be uninsured than those over 55, which could make them less likely visit a doctor, delaying their diagnosis.
Even when young people catch symptoms early, colorectal cancers can be devastating. Christy Angelo, 31, of Brookline, visited a doctor after experiencing abdominal pain in July 2012. A doctor treated her for acid reflux disease, but the pain worsened, and a few weeks later a colonoscopy revealed colon cancer.
Angelo was in great health, said her mother, Clarice Angelo, even having completed the Pittsburgh Marathon that May. Her cancer was an extremely rare and aggressive form that killed Angelo on Christmas Eve of the same year.
Christy Angelo started an informal group called Team Semicolon to raise money for colorectal cancer research while still alive. Clarice Angelo, 62, of Brentwood now advocates for young people to pay attention to abdominal symptoms and insist their doctors consider colorectal cancer a possibility.
“The word is getting out,” Angelo said. “That's been our message, just to make sure that young people know.”
Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or firstname.lastname@example.org.