COLORECTAL CANCER: IT’S TIME TO A CALL FOR ACTION AMONG YOUNG ADULTS
Keywords:
COLORECTAL CANCER, YOUNG ADULTSAbstract
Currently, colorectal cancer (CRC) is the fourth most prevalent malignancy in both genders in United States of America, with approximately 150,000 new cases identified each year. However, over the past four decades, the overall incidence rate of CRC has considerably decreased (1, 2). Colonoscopy, the primary screening method for CRC, enables the identification and removal of colon polyps before they become malignant. The incidence rates of CRC in persons over 50 years have mostly been attributed to interrupting the adenoma-carcinoma sequence (3). Malignant colorectal malignancies could be found and removed at an early stage, together with the removal of the polyps, to reduce colorectal cancer mortality, by reducing the occurrence of precancerous lesions that would otherwise turn into cancer. In fact, studies using flexible sigmoidoscopy (18-26% in intention-to-screen analyses and 31-35% in per-protocol analyses, in RCTs), colonoscopy (68% in a meta-analysis of observational studies), and fecal immunochemical tests (10-22% in observational studies) have also shown decreased colorectal cancer incidence (4). In contrast, the prevalence of CRC in young patients has been progressively rising every year. In the past ten years, patients with CRC who were diagnosed while they were under 50 years old have formed the young-onset or early-onset CRC patient cohort. The term “young-onset” or “early-onset” colorectal cancer (CRC) refers to CRC that appears in individuals under 50 years who, until recently, did not meet the typical age criteria for average risk screening in the United States (3). This is concerning for a number of reasons. Firstly, this patient group is not routinely examined for colorectal cancer (CRC), as the conventional suggestion is for CRC screening to begin at age 50. Secondly, as we have learned over the past ten years, the concern extends beyond a delay in diagnosis and considers if there are several genetic and environmental factors that distinguish this group of young CRC patients (5).
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