Early Onset Colorectal Cancer
What You Need to Know
A revised and interactive version of this has also been published on Cheeky Charity’s website, another non-profit that I work with. March is Colorectal Cancer Awareness Month, so there’s no better time to talk about this.
Early-Age Onset Colorectal Cancer: A Primer for Cheeky Charity
Carmen Fong, MD
Introduction
Early-age onset colorectal cancer (EAO-CRC), defined as colorectal cancer diagnosed before age 50, has been rising in incidence over the past three decades. EAO-CRC accounts for about 10% of all colorectal cancer diagnoses and is expected to account for 11% of colon cancers and 23% of rectal cancers by 2030. This alarming trend has prompted changes in screening guidelines and increased awareness efforts.
EAOCRC has also been called Early Onset Colorectal Cancer (EOCRC) or Young-Onset Colorectal Cancer (YO-CRC).
Risk Factors
While the exact causes remain unclear, several risk factors have been identified:
Lifestyle factors: Sedentary behavior, obesity, processed meat consumption, antibiotic use, alcohol consumption, diabetes mellitus, low dairy intake, and low fiber intake.
Microbiome alterations: Emerging evidence suggests gut dysbiosis plays a role.
Inflammatory conditions: Inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis.
Genetic predisposition: Lynch syndrome, familial adenomatous polyposis (FAP), and other hereditary conditions account for 20-30% of colon cancer diagnoses, but the majority of people with colon cancer and the majority of young people with colon cancer do not have a known genetic predisposition.
Sex and Ethnicity: While sex is not a known risk factor, ethnicity or culture may be associated with EAO-CRC and the risk in people of Hispanic origin is 2.4x that of the white population.
LGBTQ+: Individuals are less likely overall to receive screening or have less access to care. However, between gay and bisexual men and heterosexual men, gay/bisexual men are more likely to receive colon cancer screen than heterosexual men.
Diagnosis
Symptoms of EAO-CRC often include rectal bleeding, persistent changes in bowel habits, abdominal pain, and unexplained weight loss. Diagnosis is confirmed through colonoscopy with biopsy, followed by imaging such as CT or MRI for staging (determining if the cancer has spread).
Treatment
Treatment depends on the cancer stage but generally includes:
Surgery: Partial or total colectomy for localized disease.
Chemotherapy: Common regimens include FOLFOX or FOLFIRI for advanced disease.
Radiation therapy: Particularly for rectal cancer.
Targeted immunotherapy: Anti-EGFR, anti-VEGF agents, and checkpoint inhibitors for select cases.
Survival Outcomes
Despite younger patients generally having fewer comorbidities, EAO-CRC is often diagnosed at later stages, leading to poorer outcomes. Five-year survival rates range from over 90% for localized disease to below 15% for metastatic cases (where the cancer has spread).
Recent Celebrity Cases
High-profile cases have increased awareness of EAO-CRC. Notable individuals diagnosed include:
Chadwick Boseman (Stage IV, deceased)
James Van Der Beek (Stage III, diagnosed at age 47)
Alexa Morell – (Stage IV, diagnosed at age 29) a mother and colorectal cancer survivor who shares her story on social media, Morell has been actively advocating for awareness of the rising rates of the disease in younger adults.
Darryl Strawberry (Stage III, diagnosed at age 36)- Yankees baseball player
Colorectal Cancer Alliance’s "Never Too Young" Program Survivors – The Colorectal Cancer Alliance features numerous survivors under 50 who share their stories. Their Never Too Young initiative supports young-onset patients and highlights survivor stories, encouraging awareness, screening, and research participation.
There are many more real-life patients who are not in the news and were diagnosed with late-stage colon cancer in their twenties or thirties. Many more celebrities were diagnosed with and succumbed to colon cancer, but they were diagnosed after the age of 45 and were in the ‘normal’ risk group.
Prevention
Key prevention strategies include:
Regular screening starting at age 45 (or earlier for high-risk individuals).
Diet rich in fiber, fruits, and vegetables with reduced red/processed meat.
Increased physical activity and maintaining a healthy weight.
Avoiding smoking and excessive alcohol consumption.
References
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