According to a review article published in The New England Journal of Medicine.
In addition, there is a delayed diagnosis in younger individuals and the presentation of advanced disease that researchers say brings with it a need for awareness about early colorectal cancer.
In the review, author Frank A. Sinicrope, MD, described the importance of screening patients for the disease by addressing educational needs, overcoming barriers to screening, and increasing screening compliance.
Earlier diagnosis of colorectal cancer can help reduce mortality, he said.
Patients with early-onset colorectal cancer present with advanced disease, and it is associated with increased mortality rates.
While there are clear benefits to colorectal cancer screening, only 68.8% of patients 50 years of age or older who are recommended to be screened do so.
“It is essential that individuals are aware of recent colorectal cancer recommendation changes [CRC] screening. We know that early screening and intervention can save lives,” said David DeRemer, PharmD, BCOP, FCCP, FHOPA, clinical professor in the University of Florida College of Pharmacy, in an interview.
“Despite this fact, approximately 69% of eligible patients in the US are screened. The recommendation for those over 50 who have not received a CRC screening modality is to seek one now,” DeRemer said.
“The preferred modality is a colonoscopy, but others, such as a flexible sigmoidoscopy, stool-based testing such as fecal immunochemical test (FIT), multi-targeted stool DNA and [computed tomography] colonography are also options. As many know, COVID-19 had a significant impact on screening for several other cancers, such as breast, lung and prostate cancer,” said DeRemer.
“The broader message should be that all patients consult health professionals about adhering to recommended guidelines,” he said.
There are multiple options for patients, including colonoscopy, the FIT, a guaiac test, multitarget stool DNA testing, and sigmoidoscopy alone or in combination with FIT. Although the most invasive method of screening, colonoscopies remain the standard for colorectal cancer screening.
It is important to recognize that the reason for this could be barriers affecting patient access, including lack of access to healthcare providers, lack of knowledge of the benefits of screening, or reluctance to undergo screening. Unsurprisingly, the rate of screening is low among uninsured patients, lower-income individuals and minorities.
Previous recommendations indicated that individuals over the age of 50 should begin screening for colorectal cancer.
However, given the rise of early colorectal cancer, the US Preventive Service Task Force has recommended that individuals ages 45 to 49 should also begin screening for colorectal cancer, the review said.
“The incidence of colorectal cancer has been steadily increasing in industrialized countries since the late 1980s. In fact, patients under the age of 50 represent 10% of all new colorectal cancer cases,” DeRemer said.
“Several organizations, including the American Cancer Society, the National Comprehensive Cancer Network and the US Preventative Task Force, are now recommending that intermediate-risk individuals begin regular screening at age 45 rather than 50. Colorectal cancer is best treat if it’s found earlier, so this earlier detection will save lives,” DeRemer said.
“In addition, colonoscopies can prevent cancer because precancerous adenomas can be removed during the procedure,” he said.
However, this has been a controversial recommendation, due to the increase in the incidence of early-onset colorectal cancer in individuals under the age of 45, Sinicrope said.
Therefore, it may not be as effective to recommend lowering the screening age to 45 years.
In addition, increasing the number of individuals undergoing screening could create more barriers for patients who already have limited access to screening and for those who would benefit most from screening, Sinicrope said.
Another recommended approach is earlier screening of individuals with a family history of colorectal cancer.
The recommendation is that those who have a first-degree relative with colorectal cancer or an advanced adenoma diagnosis or 2 first-degree relatives with colorectal cancer by age 60 should be screened at any age. They should have a colonoscopy at the earliest at age 40 or at any age 10 years younger than the age of the family member diagnosed with colorectal cancer.
However, this can present a new barrier as some individuals may not know their family history.
The factor that most influences adherence to treatment is a doctor’s recommendation, Sinicrope said, adding that a doctor should adjust screening recommendations for patients, including with noninvasive stool-based testing.
In addition, doctors should obtain and update family history, as it is essential for identifying patients at high risk for colorectal cancer, he said.
Sinicrope also noted new approaches that could increase screening rates, including germline multigene panel testing for early colorectal cancer and universal colorectal cancer testing for Lynch syndrome.
Another new screening approach could be the assessment of circulating tumor DNA in blood plasma, which is in clinical trials and has the potential to increase screening rates.
However, access to care still needs to be addressed, Sinicrope said.
Educational campaigns are needed to raise awareness of early-stage colorectal cancer and increase the number of screenings.
In addition, ongoing prospective studies may examine exposures in early life, Sinicrope said.
Further studies are needed to determine if and how environmental factors may play a role in cancer risk, including the microbial composition and function of the gut before neoplastic development.
Data also suggest that there is an overlap with risk factors for later-onset colorectal cancer, including a Western diet, which can alter the microbial makeup of the gut, Sinicrope said.
This can lead to dysbiosis and chronic inflammation.
In addition, a healthier, plant-based diet may produce a more beneficial gut microbiome that may help reduce the risk of colorectal cancer.
Sinicrope FA. Increasing incidence of early colorectal cancer. N Scary J Med. 2022;386:1547-1558. doi:10.1056/NEJMra2200869