Red Flags for Early Onset of Colorectal Cancer

Researchers at Washington University School of Medicine in St. Louis have discovered four key indications and symptoms that indicate an increased risk of developing colorectal cancer at an early age. These warning signs could lead to earlier detection and diagnosis of colorectal cancer in young individuals. In recent years, the number of young adults diagnosed with colorectal cancer has nearly doubled.
The researchers discovered that abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia all indicate an increased risk in those under the age of 50 when they studied de-identified health insurance data on over 5,000 patients with early-onset colorectal cancer (cancer that occurs before the age of 50).

They discovered that having just one of the symptoms nearly doubled the risk; having two symptoms increased the risk by more than 3.5 times; and having three or more increased the risk by more than 6.5 times.

The findings were published in the Journal of the National Cancer Institute on May 4th.

“Colorectal cancer is not simply a disease affecting older people; we want younger adults to be aware of and act on these potentially very telling signs and symptoms—particularly because people under 50 are considered to be at low risk, and they don’t receive routine colorectal cancer screening,” said senior investigator Yin Cao, ScD, an associate professor of surgery in the Public Health Sciences Division, and a research member of Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine.

“It’s also crucial to spread awareness among primary care doctors, gastroenterologists, and emergency medicine doctors,” Cao said. “To date, many early-onset colorectal cancers are detected in emergency rooms, and there often are significant diagnostic delays with this cancer.”

Cao believes that two symptoms in particular—rectal bleeding and iron deficiency anemia, a condition in which there are insufficient healthy red blood cells to deliver oxygen—indicate the necessity for prompt endoscopy and follow-up.

Cao and co-first author Cassandra D. L. Fritz, MD, an assistant professor of medicine in the Division of Gastroenterology, and co-first author Ebunoluwa Otegbeye, MD, a general surgery resident, used the IBM MarketScan Commercial Database to analyze cases of early-onset colorectal cancer and matched controls.

“It usually takes about three months to get a diagnosis from the time a person first goes to the doctor with one or more of the red-flag signs and symptoms we’ve identified,” Fritz said. “But in this analysis, we found that some young adults had symptoms for up to two years prior to their diagnoses. That may be part of the reason many of these younger patients had more advanced disease at the time of diagnosis than what we normally see in older people who get screened regularly.”

Individuals born in 1990 have a twofold risk of colon cancer and a fourfold risk of rectal cancer when compared to young adults born in 1950. The National Cancer Institute, American Cancer Society, American Gastroenterological Association, and other professional associations have prioritized research on identifying risk factors and increasing early detection as a result of this development. The United States Preventive Services Task Force reduced the recommended age for colorectal cancer screening from 50 to 45 in 2021.
Cao, who is also an associate professor of medicine, leads a research team that is looking for risk factors and molecular differences in colorectal cancer that appears early in life. Her research group is among the first to suggest that obesity, prolonged sitting, metabolic syndrome, diabetes, sugar-sweetened beverages, and other risk factors may be contributing to the increased prevalence of colorectal cancer.

According to the American Cancer Society, while the death rate from colorectal cancer in older adults has been declining for several decades due to regular colonoscopies and improved treatment, more younger people are being diagnosed with the disease at advanced stages, and many are dying as a result.

Such a shift implies the importance of recognizing symptoms as soon as possible.

“Since the majority of early-onset colorectal cancer cases have been and will continue to be diagnosed after symptom presentation, it is crucial to recognize these red-flag signs and symptoms promptly and conduct a diagnostic work-up as soon as possible,” Cao said. By doing so, we can diagnose the disease earlier, which in turn can reduce the need for more aggressive treatment and improve patients’ quality of life and survival rates.

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