March is Colorectal cancer awareness month. The National Cancer Institute reported that in 2023 there were approximately 153,020 new cases of colorectal cancer in the United States (US) and over 50,000 deaths were attributed to this disease.1 It is the 4th most diagnosed cancer in the US and the 2nd leading cause of cancer deaths in this county.1 While the overall death rate from colorectal cancer has decreased over the last several decades in the US, this trend has been observed only in older adults.2 In adults less than age 55, death rates have been increasing approximately “1% per year since the mid-2000s.”2 Colorectal cancer is more common in men versus women and in people of African & Native American descent.1

Risk factors for colorectal cancer are age (>50) but as previously mentioned, the incidence rate has risen in individuals who are <55. Other non-modifiable risk factors are race, sex, family history, inherited syndromes like Lynch, inflammatory bowel disease, a history of adenomatous polyps, and a personal history of other cancer types (ovarian & uterine).3 Type 2 Diabetes Mellitus also increases the risk.3 Modifiable risk factors include: physical inactivity, obesity, smoking, and dietary influences.3 Various dietary risk factors have been identified including a high fat and low fiber diet, decreased fruit & vegetable intake, increased intake of processed and red meats, cooking meats at high temperatures, and alcohol intake.2,4 Low levels of serum Vitamin D have also been associated with an increased risk.2

So why is colorectal cancer increasing among younger individuals? Researchers are not completely sure but many of the above cited risk factors have been implicated and overall, it is likely an interplay between environmental and hereditary/genetic risks.5.6 Metabolic syndrome, insulin resistance, obesity, the typical “Western” diet, sugar-sweetened beverages, alcohol use, and intestinal dysbiosis have all had an association with increased colorectal cancer incidence in younger individuals.6 These factors increase the risk of inflammation which has also been implicated in general cancer pathogenesis but more research is needed and ongoing.5,6 Regardless of why this specific cancer type is diagnosed in younger individuals, the bottom line is nurse practitioners have a pivotal role in identifying these risks, educating patients about colorectal cancer, and advising on screening.

In 2021, the USPSTF recommended that colon cancer screening for people at average risk should begin at age 45 versus age 50, which was previously advised.7,8 This was due to the increased incidence of colorectal cancer cases diagnosed in younger adults. If an individual has a family history, screening should begin at age 40.8 Nurse practitioners and other health care providers (HCPs) also need to be cognizant that racial disparities are highly prevalent in cancer screening and given that colorectal cancer has a higher incidence in individuals of African and Native American descent, screening should be discussed earlier with these patients to improve overall outcomes.6,7,8 We should all make colorectal cancer education and screening a priority not only for this month, but in our daily practice.

References

1. Cancer Stat Facts: Colorectal Cancer. National Cancer Institute Surveillance, Epidemiology, and End Results Program. Accessed March 1, 2024. https://seer.cancer.gov/statfacts/html/colorect.html
2. American Cancer Society. Key Statistics for Colorectal Cancer. Accessed March 4, 2024. https://www.cancer.org/cancer/types/colon-rectal-cancer/about/key-statistics. html#:~:text=In%20the%20United%20States%2C%20colorectal,about%2053%2C010%20deaths%20during%202024.
3. Cancer.Net. Colorectal Cancer: Rick Factors and Prevention. Accessed March 4, 2024. https://www.cancer.net/cancer-types/colorectal-cancer/risk-factors-and-prevention
4. Centers for Disease Control and Prevention. Colorectal (Colon) Cancer. What Are the Risk factors for Colorectal cancer? Accessed March 4, 2024. https://www.cdc.gov/cancer/colorectal/basic_info/risk_factors.htm#:~:text=A%20diet%20low%20in%20fruit,Alcohol%20consumption.
5. Yale Medicine: Colorectal Cancer: What Millennials and Gen Zers Need to Know. January 4, 2024. Accessed March 5, 2024. https://www.yalemedicine.org/news/colorectal-cancer-in-young-people#:~:text=Nobody%20knows%20for%20sure%20why,been%20associated%20with%20the%20disease. 6. Dharwadkar, P, Zaki, TA, & Murphy, CC. Colorectal cancer in younger adults. Hematol Oncol Clin North Am. 2022;36(3): 449-170. 10.1016/j.hoc.2022.02.005
7. American Cancer Society Guideline for Colorectal Screening. Accessed March 4, 2024. https://www.cancer.org/cancer/types/colon-rectal-cancer/detection-diagnosis-staging/acs-recommendations.html
8. UCLA Health. Colorectal cancer screening guidelines have changed to address rise in cases among younger adults. Accessed March 4, 2024. https://www.uclahealth.org/news/colorectal-cancer-screening-guidelines-have-changed-address#:~:text=In%202021%2C%20the%20U.S.%20Preventive,growing%20cases%20among%20younger%20adults.