Colon-cancer rates are increasing among people in their 40s — and younger

Of the roughly 153,000 diagnoses of colorectal cancer that are expected this year, about 20,000 will be in people age 49 or younger, according to the report in CA: A Cancer Journal for Clinicians. (A spokesperson for the American Cancer Society said the researchers did not break down the number of estimated cases further, such as for the higher-risk age bracket of 45 to 49.) 

“It’s alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population,” Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society and the report’s lead author, said in a news release.

The overall number of colon- and rectal-cancer cases in the U.S. has dramatically declined over the past several decades. In 2019, the incidence rate was about 35 people out of every 100,000, compared with about 66 people out of every 100,000 in 1985. The researchers attributed that decline to lifestyle changes — today, fewer people smoke and more take nonsteroidal anti-inflammatory drugs, which may offer some protection against colon cancer — and to widespread screening.

To screen for colon cancer, people can get a colonoscopy or take an at-home stool test, like Exact Sciences Corp.’s
EXAS,
+7.28%
Cologuard or Laboratory Corp. of America Holdings’
LH,
-0.05%
ColoFit. Unsurprisingly, utilization of at-home tests increased during the COVID-19 pandemic, as fewer people wanted to visit medical facilities for cancer screenings.

Although Medicare has required coverage of colon-cancer screening for beneficiaries since 2001, there has been a push to cover screening for middle-aged Americans who don’t yet qualify for Medicare. About 61% of adults who were at least 50 years old had gotten a colonoscopy in 2018.

Late last year, the Centers for Medicare and Medicaid Services lowered the minimum age for colorectal-cancer screening by five years to age 45, citing the fact that colon and rectal cancers are a leading cause of death in the U.S. That decision follows a similar recommendation made by the influential U.S. Preventive Services Task Force in mid-2021. 

Exact Sciences told investors last month that it anticipates recurring revenue from screening kits for people between the ages of 45 and 49, who are expected to get screened every three years for the next 40 or so years.

There is no single cause of colorectal cancers, but the American Cancer Society researchers said about half of all cases and deaths can be attributed to lifestyle choices, such as smoking, poor diet, high consumption of alcohol, lack of exercise and excess body weight. 

The report also found that more people are now being diagnosed with advanced disease than in the 1990s. The highest incidence of overall disease in the U.S. is among people who are Alaska Native, American Indian or Black.