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Colorectal cancer death rates are rising in whites under 55

‚Äčnew ACS study finds that colorectal cancer mortality rates have increased in white adults under 55 since the mid-2000s after falling for decades, strengthening evidence that previously reported increases in incidence in this age group are not solely the result of more screening.

Published in the Journal of the American Medical Association (JAMA), the report says: "Although the risk of colorectal cancer remains low for young and middle-aged adults, rising mortality strongly suggests that the increase in incidence is not only earlier detection of prevalent cancer, but a true and perplexing escalation in disease occurrence. It is especially surprising for people in their 50s, for whom screening is recommended, and highlights the need for interventions to improve use of age-appropriate screening and timely follow-up of symptoms."

ACS investigators led by Rebecca Siegel, MPH, analyzed colorectal cancer (CRC) mortality among persons aged 20 to 54 years, by race, from 1970 through 2014, using data from the National Center for Health Statistics. 

The analysis included 242,637 people ages 20 to 54 who died from CRC between 1970 and 2014. CRC mortality rates among those ages 20 to 54 declined from 6.3 per 100,000 in 1970 to 3.9 in 2004, at which point mortality rates began to increase by 1.0% annually, eventually reaching 4.3 per 100,000 in 2014.

The increase thus far is confined to white men and women and is most rapid for metastatic disease.

Breakdown by age

  • Mortality remained stable in white individuals ages 20 to 29 from 1988-2014
  • Mortality increased 1.6% per year in white men and women ages 30 to 39 years, from 1995-2014
  • Mortality increased by 1.9% per year in white men and women ages 40 to 49 years, from 2005-2014
  • Mortality rates increased by 0.9% per year for white men and women ages 50 to 54 years, from 2005-014. The report notes that "Increased mortality is particularly unexpected among those aged 50 to 54 years, for whom screening has been recommended since the 1970s."  However, according to Rebecca Siegel, while screening prevalence has increased for all age groups over 50, it is lower in people 50 to 54 than in those 55 and older, 44% versus 62% in 2013.

Conversely, rates declined in black individuals in every age group

The authors note that these disparate racial patterns are inconsistent with trends in major risk factors for colorectal cancer, like obesity, which is universally increasing.

Breakdown for non-whites

  • Among black individuals, mortality declined throughout the study period, at a rate of 0.4% to 1.1% annually, from 8.1 in 1970 to 6.1 in 2014.
  • Among other races combined, mortality rates declined from 1970-2006 and were stable thereafter.

The study notes that CRC mortality overall is declining rapidly, masking trends in young adults, making this an area ripe for more examination. 

Signs and symptoms

Because young people can and do get colon and rectal cancer, it is important for them -- and their doctors -- to pay attention to signs and symptoms, and be educated about the importance of healthy lifestyles.

The most common signs and symptoms include:

  • A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days
  • A feeling that you need to have a bowel movement that is not relieved by doing so
  • Rectal bleeding
  • Dark stools, or blood in the stool
  • Cramping or abdominal (belly) pain
  • Weakness and fatigue
  • Unintended weight loss

You can lower your colorectal cancer risk by:

  • Eating lots of vegetables, fruits, and whole grains and less red meat (beef, pork, or lamb) and processed meats (hot dogs and some luncheon meats)
  • Getting regular exercise
  • Watching your weight
  • Avoiding tobacco
  • Limiting alcohol. The American Cancer Society recommends no more than 2 drinks a day for men and 1 drink a day for women. 

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