Increasing Need to Cover Colorectal Cancer Screenings for Young People

Colorectal cancer is on the rise in young adults. Nearly double the number of young people under 55 are being diagnosed with colorectal cancer compared to ten years ago, and more are passing away from the disease each year. 

Colorectal cancer, colon cancer for short, is a disease where cells in the colon or rectum grow out of control. A few signs that could signal colorectal cancer include a change in bowel habits, rectal bleeding, and ongoing belly cramps.  

The alarming rise of colon cancer in younger adults led the U.S. Preventive Task Force to lower the recommended screening age for colorectal cancer from age 50 to age 45 in 2021. However, health plans are not yet mandated to cover screening for people under 45, which could leave this age group vulnerable. As more data emerges, the current screening guidelines may need to shift even more to accommodate the younger population.

The Rise of Colorectal Cancer in Young Adults 

There’s a clear uptick in colorectal cancer in younger generations. Studies suggested that 20% of colon cancer diagnoses in 2019 were in patients under age 55, approximately double the rate in 1995. 

Rates of advanced-stage colon cancer have also been increasing around 3% annually in people younger than 50. If this trend continues, it’s predicted that by 2023, 19,550 diagnoses and 3,750 deaths will be in people younger than 50. 

While health experts are not exactly sure what’s causing the rise in colon cancer diagnoses among younger adults, poor diet and a sedentary lifestyle could be part of the reason. Researchers found that approximately 55% of all colon cancer cases in the U.S. are attributable to lifestyle factors, such as an unhealthy diet, lack of physical activity, high alcohol consumption, and smoking. 

Causes of Colorectal Cancer

Some of the most common risk factors of colon cancer include the following:

• Inflammatory bowel disease such as Crohn’s disease
• A personal or family history of colorectal cancer or colorectal polyps
• A sedentary lifestyle
• A low-fiber and high-fat diet
• A diet high in processed meats
• Obesity
• High alcohol consumption
• Tobacco use

It’s important to note that though 30% of people diagnosed with CRC have a family history of the disease, experts have not been able to use genetics to explain the surge of diagnoses among younger individuals. 

However, researchers have found some evidence to suggest that obesity, a sedentary lifestyle, a low-fiber diet, and other environmental factors could have contributed to the uptick in early-onset colorectal cancer among young people. 

Understanding the Current Screening Guidelines

Based on the growing colon cancer cases among younger adults, the US Preventive Services Task Force, an independent volunteer panel of national experts in disease prevention and evidence-based medicine, issued a new recommendation in 2021 that colorectal cancer screening should start at age 45 instead of 50.

Plus, the Affordable Care Act (ACA) mandates that private insurers and Medicare cover the costs of colorectal cancer screenings. This, coupled with the recent recommendation from experts, means individuals aged 45 and over have access to preventative measures against colon cancer without any out-of-pocket expenses. But still, for those under 45, colon cancer screenings may not be free. 

The Challenges in Access to Screening

While the new recommendation to start screening at age 45 has helped millions of people gain access to free colon cancer screening, it still leaves many young adults at risk for undetected colon cancer. Today, many people younger than 45, even in their 20s and 30s, are being diagnosed with colon cancer that has already developed to its late stage.

Unfortunately, the lack of knowledge about the importance of screening, coupled with concerns about the invasive nature of colonoscopy and the overall stigma surrounding the disease, has kept many young individuals from seeking preventative care. Plus, comprehensive insurance coverage for colon cancer screening is often scarce for those younger than 45, which means they may be responsible for out-of-pocket costs.

The Benefits of Early Detection

Colon cancer is preventable. The earlier it is detected, the higher the chances of survival. When colorectal cancer is found at an early stage, the 5-year relative survival rate is about 90%. 

Unfortunately, only 40% of colorectal cancers are found at this early stage since symptoms can be subtle or even non-existent during the onset of the disease. Once the cancer has spread outside the colon or rectum, survival rates drop substantially to around 13%. 

Besides higher survival rates, detecting colon cancer early on will also help you avoid the exorbitant treatment costs and the physical and emotional toll of advanced-stage diseases. 

Current Detection Methods

Here are some of the most common forms of tests and detection methods used to diagnose colorectal cancer: 

1. Colonoscopy: During a colonoscopy, the Gastroenterologist will insert a flexible tube into the rectum to examine the entire length of the colon and rectum.
2. Stool tests: Stool tests check for hidden blood in the stool, which can be a sign of cancer.  The at-home fecal immunochemical test (FIT) and the guaiac-based fecal occult blood test (gFOBT) are two common types of stool tests. And since stool tests are non-invasive, they can be a viable alternative for those concerned about invasive methods like Colonoscopy. 
3. Flexible Sigmoidoscopy: Similar to a colonoscopy, this procedure uses a flexible tube to detect colorectal cancer.However, it only examines the lower part of the colon instead of the entire organ. It also does not require sedation or anesthesia. 
4. CT Colonography (Virtual Colonoscopy): This test uses a CT scanner to produce detailed pictures of the entire colon, which are displayed on a computer screen for the doctor to analyze.

The costs of colorectal cancer screenings can be anywhere from a few hundred to over a thousand without health insurance. If you’re under 45, check with your health insurance provider to see what your deductible, coinsurance, and other out-of-pocket costs look like. 

Approaches for Prevention and Treatment 

It’s difficult to predict whether the screening age for colorectal cancer will continue to be lowered in the future, especially since the number of screenings performed will need to prevent enough cancers to justify the costs and risks associated with the tests. 

But while we may not be able to control changes in screening ages, we can all take proactive steps to reduce our risk of developing colon cancer. If you’re over 45, get screened regularly. Even if you’re younger than 45 and do not have any symptoms, it’s still a good idea to keep an eye out for signs of colorectal cancer, especially if you have a family history of the disease.