What Younger Adults Need to Know About Colorectal Cancer Screening

By Paul J. Watkins

According to the National Cancer Institute, colorectal cancers accounted for an estimated 149,500 new cancer cases in the U.S. in 2021. Colorectal cancer is associated with older adults; however, younger adults can develop it as well. It’s been an ongoing challenge for healthcare providers to raise awareness among this population, whose members often believe they’re too young to be at risk. 

“When we say ‘younger adults,’ we’re referring to patients from age eighteen to forty-nine,” explains Shruti Pandita, MD, an assistant professor specializing in gastrointestinal oncology at Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center. She is board certified in internal medicine and medical oncology. “Previously, the first colorectal cancer screening was recommended at age fifty for people with an average risk of developing it. Recently, the American Cancer Society lowered that age to forty-five.”

If a younger adult has one or more first-degree family members – birth parents, siblings, children – who have been diagnosed with colorectal cancer, the recommendation is different, informs Dr. Pandita. That individual should have their first colorectal cancer screening ten years earlier than the age at which their youngest first-degree relative was diagnosed. For example, if that relative was diagnosed at age fifty, the younger adult should be screened at age forty.

Dr. Pandita adds that if there’s a concern of an underlying genetic predisposition based on a family history, a patient may choose to undergo genetic testing, which is typically done with a blood test or cheek swab. If the results show a genetic predisposition to developing colorectal cancer or other cancers, the patient should be screened earlier than an average-risk patient. Also, the results may encourage the patient’s other family members to get screened earlier as well.

“Colonoscopy is the gold standard for screening,” says Dr. Pandita. “We not only look for colon cancer and diagnose it but also screen for precancers, like polyps or abnormal growths. These haven’t become cancer yet, and we can remove them before they do.

“Other screenings include flexible sigmoidoscopy, which is like a colonoscopy, but it looks at the lower portion of the colon and rectum only. CT colonography, often called ‘virtual colonoscopy,’ allows us to find certain growths or polyps, and it can be used to screen for other abnormalities. If any are found, the patient will have a traditional colonoscopy to remove them.

“There’s the fecal immunochemical test, which is done by the patient collecting a stool sample at home and sending it to a lab for testing. If there’s blood detected in the sample, the patient will have a colonoscopy.

“The final screening for colorectal cancer is Cologuard®. It uses a patient’s stool sample to test for abnormal DNA and blood. The benefits of these previous two methods are that they’re non-invasive and can be done at home.”

If colorectal cancer is diagnosed, it’ll be treated – usually with surgery and sometimes chemotherapy and/or radiation. “After surgery is done with curative intent, with the goal of removing all cancer, a follow-up colonoscopy is recommended six to twelve months later. Depending on the results, the patient may have a repeat colonoscopy every three to five years.”

Dr. Pandita highly recommends patients make their primary care physician the first point of contact for colorectal cancer screening. They can discuss the ideal time to perform a test or colonoscopy based on the patient’s age and family history.

Another reason people should contact their primary care physician – and do so immediately – is if they notice any symptoms suggestive of colorectal cancer. These include unintentional weight loss, new fatigue or reduced exercise stamina; changes in bowel habits, including new diarrhea or constipation, or changes in stool size; a feeling of bloating, cramping, or pain; needing to strain to evacuate stool, and having a very dark-colored or bloody stool.

“Colorectal cancer is one of the most preventable cancers, especially in younger adults,” Dr. Pandita concludes. “Take ownership of your health and use preventive measures such as screening to keep problems from developing and growing.”

Please call (210) 450-1000 to make an appointment at Mays Cancer Center. Learn more at MaysCancerCenter.org.

Find additional information about colorectal cancer screening at cancer.uthscsa.edu.