A new program in the Bay Area looks to address the colon cancer ‘epidemic’ in young adults

Colorectal cancer was once considered a disease of older people but is now the top cancer killer in people under age 50. 

Colon cancer rates for adults aged 30 to 49 have doubled over the last three decades, with little concrete evidence as to why. As researchers try to discover reasons behind this surge in cases, the way doctors treat the disease is adapting. 

University of San Francisco, Health launched a first-of-its-kind program on the West Coast dedicated to understanding and treating the colon cancer epidemic in young adults. 

Dr. Katherine Van Loon, a Gastrointestinal Oncologist with UCSF Health joined Vicki Gonzalez on Insight to explain more. 

This interview has been edited for length and clarity.

Interview highlights

Why has colon cancer long been considered a disease of older people?

Historically, the median age at diagnosis was in the 70s and it still is in the mid-60s, but if you recall from math, median is the middle number. So, that means half of patients who are diagnosed are older than 70 and half are younger than 70.

We're now seeing that shift [downward]. Our current median age is in the mid-60s and that is a result of the fact that we're seeing this increasing number of diagnoses happening earlier and earlier. 

When did you first start learning about or noticing the rising rates of colon cancer among younger people?

Clinically this has been something we've observed for a long time. We've always kind of shaken our heads when we see young patients in the clinic and said the patients seem to be getting younger and younger. So, in many ways this is validating data that is confirming we are in fact seeing a rise in incidents on the order of 2 to 3% per year in individuals under the age of 50. I saw a patient just this week who was 25.

Three of four younger patients are diagnosed at advanced stages of the disease. Is there a theory as to why that is? Is there a component that maybe someone who's younger might overlook symptoms?

Yes, absolutely. Public awareness and awareness of one's own body are actually really important and it's important to self-advocate when you do have the sense that something abnormal is happening with your body. There is, of course, sort of this infallibility complex that happens [when we’re young] and the presumption that [we’re] healthy and this will pass.

In particular, for colon cancer, I've heard over and over again the same story of a patient who presumed for a long period of time or was told by their provider that [their symptoms are] just hemorrhoids. And ultimately the symptoms were either dismissed by the individual or by the provider and never really evaluated until the cancer was very advanced.

What symptoms do you want people to keep in mind?

So signs and symptoms of colon cancer include blood in the stool. It can be mixed in the stool, it can be blood in the toilet. Iron deficiency is abnormal in a younger and older individuals. 

We get concerned about any persistent changes in bowel habits. Either alternating diarrhea or constipation. Or a sensation that you're not completely emptying your bowels when you do have a bowel movement. Unexplained weight loss and fatigue, and crampy abdominal pain all can be presenting symptoms.

In addition to a colonoscopy, are there other tests that someone could take if they're concerned? 

Yeah, I should say first that a colonoscopy is and probably will remain the gold standard for screening. It is the only test that allows direct visualization of the inside of the colon with a camera. We know that not every patient is open to getting a colonoscopy, so, there are alternatives. 

I would say if there's an absolute apprehension to getting a colonoscopy, then there are stool-based tests. FIT tests (fecal immunochemical tests) are the most non-invasive and low-cost test because they are simply looking for blood in the stool. That said, if you have a positive FIT test, you need a colonoscopy.

UCSF recently launched a young onset colorectal cancer program. It's a first of its kind on the West Coast. What is this program and why was it started?

I'd say what really prompted me and my colleagues to think about launching this program is our observation that younger patients cope differently with a cancer diagnosis.

When a younger individual faces an unexpected cancer diagnosis, it oftentimes intersects with a whole bunch of other facets of life: reproduction, preserving fertility, financial [stability], professional development, building a family, child care services. It's a huge host of different impacts I think this population experiences a little bit differently.

And so our intention is really to provide wrap-around care for these individuals who are facing not just their complex cancer diagnosis, but also all of the other aspects of life that are moving around the cancer diagnosis at that time. We also really are focused on research. There's a huge need to understand why this rise is happening and also what to do about it.

And the third pillar of our program is around patient advocacy. We really believe that at the core of this, raising awareness, is going to be important in terms of making sure that this population gets diagnosed on time.