*you do not have to donate*

Colorectal cancer is the second deadliest cancer in the United States — but it’s also one of the most preventable with regular screenings. That’s sounds promising and all, but not if you are under age 45, because most doctors will not offer screening if you are under the recommend age for screening, and most will deny your request. Because of this, young adults are more likely to get diagnosed with stage 4 colon cancer.

There are currently 4 screening options and none of them are offered to individuals under age 45, the most common being a Colonoscopy, The fecal immunochemical test (FIT), the immunochemical fecal occult blood test (iFOBT), cologaurd, and virtual colonoscopy, However, a colonoscopy remains the gold standard because it is used for early detection. A fecal occult blood test can be ordered by almost anyone. 

For those younger than 45, tailoring colorectal cancer screening approaches to each person based on their risk factors is called precision screening and some doctors will work with their patients. I believe that individuals that live a lifestyle that are in line with the factors that increase the risk of colorectal cancer, should be able to be screened and sometimes the age of those individuals are under age 45. However, young people are not taken seriously when they have concerns about colorectal cancer. We are gaslit and told that we are too young to get colorectal cancer, our digestive symptoms are not taken seriously, and we are not listened to until it’s too late. Because the screening guideline is recommended for those starting age 45 even young individuals believe that this is a cancer that they cannot get, or it doesn't even cross their mind. It is time to bring more awareness to this increasing diagnosis to the young population.

If the screening guideline is reduced to recognize individuals in their 20-30s then I believe that physicians will be more receptive to the idea of screening their young patients because right now they are not. It appears that the factors that increased the risk of colorectal cancer in those over age 50 are not as much of a concern because those individuals have slowly stop doing those things. However, for individuals in their 20s and 30s there is an increase in alcohol consumption, an increase in nitrate/nitrite cured meat/ deli meat /red meat consumption, lack of fiber, vitamin D deficiency, lack of physical exercise, increased smoking, lack of sleep, being an African American, increased irritable bowel diseases, and overall increased inflammation.

The main issue here is that insurance companies will not cover preventative screening for young adults because of these guidelines. Young adults have to pay 1,000-5,000 out of pocket for this screening if it is coded as diagnostic or even if it is coded as preventative. Those without insurance, those in low-income communities, and young adults will be hit the hardest with the cost of these screenings until we push for a lowered guideline which will make the insurance companies have to start covering the screenings for young adults.

The funding decisions for the U.S Preventive Services Task Force Agency:

The U.S Preventive Services Task Force is stated to be an independent volunteer group of national experts that are skilled in prevention and evidence-based medicine. This volunteer group makes recommendations about clinical preventative services such as counseling services, screening tests, and preventative medications. It is the job of The Agency for Healthcare Research and Quality (AHRQ) to provide scientific, support to the USPTF.

I reached out to The USPTF last year in 2021 and shared a ton of evidince based models and research on the increasing rates of CRC in young adults, with the hope that they would consider decreasing the screening age, and they told me that they were continuing to monitor the science, which is crazy but the science has been clear for the past 7 years on this increase. I then did a little bit more digging to see who funds the United States preventative service task force agency, and I found out that, their decisions and recommendations largely depends on their funding and their Evidence-Based Practice Centers. 

JAMA published a piece about the funding of the USPSTF, and they found that the USPSTF considers scientific evidence that is supported by a broad range of funders in making recommendations for clinical preventive services. So not only am I petitioning to the USPSTF, I am also petitioning their funding agency which is The Agency for Healthcare Research and Quality (AHRQ). Furthermore, the USPSTF also works with evidence-based practice centers (in Portland Oregon, Ottawa Canada, and Boston MA) whose job is to provide this research and evidence-based models to the task force so that they can make these informed decisions. So somewhere and somehow the ball is continuing to drop and fail us young individuals, because the rising cases of colon cancer in young adults have been known for some time now.

If you would like to know more about the various agencies, please read https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/evidence-based-prevention-resource-nurse-practitioners

The Leading Cancer in 2030

In a paper published by JAMA Surgery in 2015, the researchers projected that by 2030, the incidence of colon and rectal cancer in 20- to 34-year-olds in the U.S. will increase 90 percent and 124 percent, respectively.

There has been an increasing disparity in the age-related incidents of colorectal cancer for the past 7 years. Research shows that there has been a steady decline of colorectal cancer in patients that are age 50 years or older but there is a steady increase in the rates of colorectal cancer in patients that are 20 to 34 years old. 

This is an unfortunate time for young adults, because currently the recommended screening guidelines are not favorable for young adults. The United States preventive services task force states that they are continuing to monitor the science while keeping the screening recommended age at age 45. 

It takes about 10 years for a colon polyp to turn cancerous and if individuals in their 20s are developing polyps, then their risk of colorectal cancer may be increased in their 30s which is still under the recommended guideline, if someone develops a polyp in their 30, and it turns cancerous in their 40s, that is still under the screening guideline. Either way we look at it, polyps need to be under surveillance and removed before turning cancerous. If the goal of the United States preventative services task force is truly that of prevention, then prevention starts with screening. 

Unfortunately, because the screening guidelines are still set to start at age 45, doctors tend to turn young adults away from colonoscopies and tell them that they're too young to develop colon cancer, well new flash, Cancer doesn’t age discriminate. 

In 2016 the Preventive Services Task force did not recommend regular screening for people under the age of 50 because the risk of having colorectal cancer was so low in that age group that the cost of screening would not outweigh the benefits. However since it is important to be progressive with screening guidelines, the data is constantly showing that there is an increased risk of colorectal cancer in younger people starting at age 24 which means that the development of CRC is changing through generations and it is not happening as slow as it use to. The incidence of colorectal cancer increased by 22% among young people under 50, what's even worrisome is that younger people are also more likely to die from this cancer.

Now that the research is clear on the increased risk of colorectal cancer in young adults the benefits of screening far outweigh the risk. Young adults are getting diagnosed with colon cancer when it's stage 4 because it's such a silent disease, if we had screening recommendations in place for younger age groups under 45 this would increase the awareness of colorectal cancer and even save more lives. Please sign this petition and share it so that we can make some noise and be heard.

One study concluded “Our study showed an increase in CRC incidence in adults aged 20–49 years in Europe. The largest increase in CRC incidence occurred among subjects aged 20–39 years. The incidence of colon cancer increased with 6.4%–9.3% annually; that of rectal cancer with 1.6%–3.5% per year. “ (Vuik, 2019)

Akimoto N, Ugai T, Zhong R, et al. Rising incidence of early-onset colorectal cancer - a call to action. Nat Rev Clin Oncol. 2021;18(4):230-243. doi:10.1038/s41571-020-00445-1

Bailey CE, Hu C, You YN, et al. Increasing Disparities in the Age-Related Incidences of Colon and Rectal Cancers in the United States, 1975-2010. JAMA Surg. 2015;150(1):17–22. doi:10.1001/jamasurg.2014.1756

Campos FG. Colorectal cancer in young adults: A difficult challenge. World J Gastroenterol. 2017;23(28):5041-5044. doi:10.3748/wjg.v23.i28.5041

Done JZ, Fang SH. Young-onset colorectal cancer: A review. World J Gastrointest Oncol. 2021;13(8):856-866. doi:10.4251/wjgo.v13.i8.856

Sifaki-Pistolla D, Poimenaki V, Fotopoulou I, et al. Significant Rise of Colorectal Cancer Incidence in Younger Adults and Strong Determinants: 30 Years Longitudinal Differences between under and over 50s. Cancers (Basel). 2022;14(19):4799. Published 2022 Sep 30. doi:10.3390/cancers14194799

 

Vuik FE, Nieuwenburg SA, Bardou M, et al. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut. 2019;68(10):1820-1826. doi:10.1136/gutjnl-2018-317592