Should Young People Get a Colon Cancer Screening? It Depends on Their Risk

Research has shown an unexplained increase in cases of colorectal cancer in younger patients. A Michigan Medicine expert explains what that means and who should receive preventive screenings

1:00 PM

Author | Jessica Webster Sendra

image of guy with female doctor in doctor's office

This article was updated August 31, 2020.

Colon cancer is the third most commonly diagnosed cancer in America. The good news? It's also the most preventable, and overall diagnosis rates of colon cancer have been on the decline since 1990.

MORE FROM MICHIGAN: Sign up for our weekly newsletter

The bad news is that the incidence of colon cancer among people 45 and younger has been increasing by about 1.5 percent annually during the same time period. Also concerning is that these younger patients were more likely to be diagnosed at advanced stages.

Elena Stoffel, M.D., assistant professor of internal medicine at the University of Michigan Medical School and director of the Cancer Genetics Clinic at the Rogel Cancer Center, has spent her career working in colon cancer prevention and research.

She spoke recently about who might be most at risk at a younger age and how doctors can prevent or catch colon cancer earlier.

Routine colon cancer screening isn't usually recommended before age 45. How are you finding these younger patients?

Stoffel: Most of them are being diagnosed when they present with symptoms like rectal bleeding, abdominal pain, weight loss and anemia. We typically don't think of colon cancer in young people because we're so used to seeing it in older people.

I teach my GI fellows that when we see a young person in the clinic who is complaining of rectal bleeding, we can't just dismiss it as hemorrhoids. You have to think about what else this could be. They need to always think about the possibility that this could be a colon cancer in a young person. We know we're seeing it more often; we're just not thinking about it.

I think that's why a lot of the diagnoses in young people are made at later stages — we don't investigate these symptoms as quickly as we would in an older person. You can't just assume that young people don't get colorectal cancer.

How do you identify which populations have a greater risk of colon cancer?

Stoffel: We know that family history of colon cancer has a major impact on your colon cancer risk. We typically say that the average individual's lifetime risk for developing colon cancer is about 5 percent. If you have one first-degree relative with colon cancer, your risk is roughly double that. But if you have multiple relatives with colon cancer, and especially if those cancers were diagnosed at younger ages, then your risk is much higher.

There are certain genetic factors that increase your risk for colon cancer. The most common hereditary colon cancer syndrome is a condition called Lynch syndrome, and we know that approximately 3 percent of all colon cancers are attributable to Lynch syndrome.

But when you look at young people with colon cancer, we actually have found that this group is much more likely to have a genetic link. Roughly 1 in every 5 people under the age of 45 with colon cancer has a genetic predisposition to it.

Does this cancer derived from Lynch syndrome behave differently?

Stoffel: Yes. Your typical colon cancer takes 10 to 15 years to develop, so if the average person gets colonoscopies every five to 10 years, starting at the age of 45, we can remove polyps before they can grow into cancers.

SEE ALSO: Surgery vs. Polypectomy: Weighing the Risks and Benefits

But some cancers with a different molecular subtype can grow very quickly, developing from polyps in under three years, and Lynch syndrome cancers can do that. For this reason, we recommend colonoscopies annually for people with this genetic condition.

What percentage of the population has Lynch syndrome?

Stoffel: Recent data suggest these Lynch syndrome mutations are more common in the general population than we thought they were, such that 1 out of every 300 people has Lynch syndrome and doesn't know it. Not everybody with one of these mutations will get cancer, but these mutations increase your risk of developing cancer by orders of magnitude.

Should doctors start testing for colon cancer in younger patients, regardless of their risk?

Stoffel: I think it is important to emphasize that colon cancer is one of the most preventable cancers. The vast majority of colon cancers arise from polyps, and if we find these polyps and remove them early, we can prevent them from growing into cancers. In general, colon polyps are less common in young people.

Current guidelines recommend that individuals at average risk for colon cancer begin screening at age 45. There are several different types of colon cancer screening tests.

Colonoscopies are the gold standard test but are invasive and carry some risk for complications. For people who are at average risk for colon cancer, there are other ways to screen for colon cancer that are less invasive than colonoscopy. Stool DNA and fecal occult blood testing work well for finding cancers — but are not as good at preventing cancers.

Here at U-M, we're working to develop tests that find polyps that are less invasive than colonoscopies, which would enable us to get more people screened for colorectal cancer.

The question, though, is whether we should start screening at ages under 45. I think the important message is that people should have a conversation with their doctor about their family history of cancer to examine their risk for colorectal cancer and determine the best age to start screening. 

For questions about colorectal cancer screening or genetic testing for Lynch syndrome, call the Cancer AnswerLine at 800-865-1125.


More Articles About: Cancer Care Wellness and Prevention Cancer Testing Cancer and Genetics Colorectal Cancer Colon Cancer Cancer: Help, Diagnosis & Treatment
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories A family discussing their family's medical history at Thanksgiving
Health Lab
Why you need to discuss your family health history at Thanksgiving
The holidays are a great time to discuss your family's medical history. Learn the importance of discussing your family's health history & how to bring it up.
IV drip
Health Lab
Monitoring program flags cancer patients at risk of highly toxic chemotherapy side effects
Researchers from the University of Michigan Health Rogel Cancer Center have developed a monitoring system using a research genetics program to trigger alerts about cancer patients suspected to have the DPYD gene variant.
graphic drawing of colonoscopy scan with large intestine vials patient on bed doctor
Health Lab
Investment in free follow up colonoscopies will pay off
Free colonoscopies for people whose at-home stool tests (such as Cologuard and FIT) turn up signs of potential cancer are now covered by insurance, and a study shows this will save money.
Chlld holding vape container parent coming into room
Health Lab
E-cigarette exposure on the rise in young children: 6 things parents should know
Pediatrician: Just a few drops of liquid nicotine can be lethal in a toddler
DNA helix technology robotic cybernetic image
Health Lab
Metabolite tells cells whether to repair DNA
Findings from researchers at the University of Michigan Health Rogel Cancer Center, published in Cancer Discovery, show how a specific nucleotide metabolite called GTP controls responses to radiation and chemotherapy in an unexpected way.
people holding band-aid umbrella standing in the rain
Health Lab
5 things to know about health insurance right now
Open enrollment season for Medicare, Healthcare.gov Obamacare plans, work-related insurance is here – and Medicaid enrollment renewal is due for many. How to get help.