3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510
3 Mount Elizabeth, #14-15, Mount Elizabeth Medical Centre, Singapore 228510
Posted By Dr. Ronnie Mathew, Senior Consultant and Director of Colorectal Care Specialists
Colorectal cancer is increasingly affecting younger adults. This concerning scenario has been noted for some time in the recent past (1-3). This is further highlighted in a recent article in December 2024 from Lancet Oncology (4), where there seems to be a worrying trend of rising cases sharply among those in their 20s to 50s: amongst Generation Z, Millennials, and Generation X.
Many of these individuals have no family history or traditional risk factors like obesity, making this trend especially concerning. This surge remains a perplexing medical mystery for clinicians (5), as noted in an opinion piece from the American College of Surgeons. Traditionally, family history/hereditary factors were the attributed factors causing colorectal cancers amongst younger populations. However, this persistent trend is unlikely due to familial/hereditary factors alone. There are likely to be more factors at play here for this global rise.
Although it could be due to the usual culprits of diet and lifestyle, etc., epigenetic factors may be more likely to be the cause. In simple terms, epigenetics refers to how behaviors and environment can cause changes that affect the way our genes work. An essential factor to note is that unlike genetic changes (mutations), epigenetic changes are reversible (in effect, they do not change the sequence of DNA bases). This reversibility potential gives hope that if we can find these factors, we could potentially halt or decrease this trend of rising colorectal cancers in our younger population.
Until then, it is prudent for the national population screening programs for colorectal cancer detection to start from an earlier age. Currently, most countries in the Western world start this at the age of 50. Dr. Ronnie Mathew, Director of Colorectal Care Specialists, is one of the proponents, amongst other global experts, calling on all colorectal societies/ associations globally to consider revising the guidelines for population screening age from current 50 years old to at least 45 years (or even 40 years for any particular country that has a higher statistic for cancer rise in even younger people).
In the meantime, we need to continue to reduce or modify the already known risk factors for colorectal cancers, such as:
In addition, those with higher risk need surveillance:
Symptoms such as rectal bleeding, abdominal pain, changes in bowel habits and weight loss, and feeling tired (if caused by low haemoglobin in the blood) are often overlooked or dismissed. This could lead to delayed diagnoses and more advanced stages of the disease. If any of these symptoms are present, it is advisable to see a doctor as soon as possible. Raising awareness about these red flags and encouraging timely action can save lives.
Notably, there are usually no symptoms in the earlier stages of colorectal cancer. Hence, early detection through screenings, like colonoscopies, or participation in national screenings (like stool occult blood/immunochemical testing) is essential.
Colorectal cancer is one of the few cancers that can often be prevented. Colonoscopy has consistently shown itself to be the ideal option among all interventions/tests to diagnose or reduce/avoid the risk of colorectal cancer. The latter is because most colorectal cancers develop from polyps, and such polyps can be found and removed at colonoscopy. Removal of polyps is essential before they have the chance to become cancerous.
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