By Dr. Anthony Policastro
When I was a resident, one of the most common causes of pediatric admissions was treatment for leukemia. There were times when over half of our inpatients had leukemia. That was more related to their frequent hospitalizations for complications.
Most people think of cancer as being a disease of the older population. That is not true. While the rates may be higher, the disease is not limited to that population.
A recent study in the Journal of the American Medical Association looks at the young adult population. They looked at cancer deaths for the period 1990 through 2023. There were 1,267,520 deaths in individuals under 50 years of age during that period.
They also looked at effectiveness of treatment for that same period. Originally in 1990, the death rate was 25.5 deaths per 100,000 people. The rate had dropped 44 percent to 14.2 deaths per 100,000 people in 2023. That means that it was almost cut in half due to treatment advances.
They looked specifically at the five leading types of cancer in patients under 50 years of age. They included brain cancer, breast cancer leukemia and lung cancer. All of those had shown a continued decline over the last 10 years of the study.
However, that was not true for colorectal cancer. Death from it had increased every year of the study. In 2005, it was the fifth highest cancer killer of individuals under age 50. By 2023, it had become the number one cancer killer of individuals under age 50.
There are several lessons to be learned from this. The first is to recognize that for the average individual screening needs to be starting at a younger age. It used to be age 50. It has now been moved to 45 years of age. For those individuals with a family or genetic risk, the screening should be done even earlier.
The second is that this group of individuals should learn to not ignore the symptoms that go along with colorectal cancer.
Rectal bleeding is an obvious symptom. However, some people are quick to chalk that up to something like a hemorrhoid. It is important to remember that even people with hemorrhoids can get colorectal cancer. So a hemorrhoid is not an excuse to avoid screening.
New onset of abdominal pain can be a symptom. There is not a specific type of pain. However, if there is a new pain that does not go away, that is a concern. If it seems to be getting worse, it is more of a concern.
Changes in bowel habits can indicate an issue. New onset of constipation can be a symptom. New onset of loose stools can be a symptom. If there is a mass in the rectal area, it can make the stool become thin like a pencil.
Weight loss is a key symptom that something is going on in the body. That is especially true if there has not been an intentional change in diet. It is something to be concerned about rather than excited about weighing less.
Other GI symptoms like feeling full quickly after eating or nausea or vomiting can be a concern as well.
Iron deficiency anemia is unusual in adults. That is especially true in males who are not having monthly menstrual periods. However, even in women if they suddenly develop iron deficiency without an obvious change in menstrual flow, they may be losing blood in the intestine.
Unfortunately, denial is a powerful tool. People with symptoms will try to talk themselves out of it being something significant. However, anyone can have colorectal cancer. It is now the most common type of cancer in young adults. That is similar to leukemia being the most common type of cancer in children. We need to learn to pay attention to what our body is trying to tell us.