Hear
For some it is “alarming” and “disturbing”. Others consider it a “global problem” or a “global alert.” Scientists consulted by the BBC warn about the increase in cases of colorectal cancer in the population under 50 years of age.
This tumor, which affects the large intestine (colon) and rectum, is one of those that has the greatest impact on the health and quality of life of patients. And in recent decades, a trend has caught the attention of experts.
In some parts of the world, cases of Colorectal cancer have remained relatively stable among older people, who proportionally continue to represent the majority of those affected by this disease.
But elsewhere cases began to rise rapidly among patients under 50 years old.
“If current figures are compared with the rate we had 30 years ago, some studies even point to a 70% increase in incidence of colorectal cancer in young patients”says clinical oncologist Paulo Hoff, president of Oncología D’Or, an oncology care network in Brazil.
These statistics have already caused some changes in public health policies: in the United States, one of the first countries to identify the phenomenon, the minimum age for early detection examinations for colorectal tumors was lowered from 50 to 45 years.
Colorectal cancer is the third most common cancer worldwide among men and the second among women, explains the Pan American Health Organization (PAHO).
On the American continent it is the fourth most common cancer, where approximately 246,000 new cases and around 112,000 deathsindicates the PAHO report titled “Colorectal cancer screening in the Americas”.
The study indicates that the incidence of colorectal cancer has increased in Latin America and the Caribbean in recent decadesmainly due to “demographic changes such as increases in life expectancy, changes in lifestyles and dietary patterns and other factors.”
He United Nations Global Cancer Observatory (balloon) has detected an increase in the incidence and mortality rates of colorectal cancer in patients under 50 years of age since the 1990s in 9 Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, Mexico and Uruguay.
“We went from the era of infectious diseases to that of chronic diseases and a lot has to do with him people lifestyle”, explains Dr. Mauricio Maza, PAHO regional advisor on cancer prevention and control, to BBC Mundo.
The expert assures that “the trends of obesity, smoking, alcohol consumption and type of diet are changing” and affect the incidence of this type of cancer, with a sustained increase in recent years that is repeated in all countries in the region.
Last year, research presented at the Argentine Congress of Gastroenterology and Digestive Endoscopy revealed that mortality rates from colorectal cancer in people aged 20 to 54 increased steadily in Argentina, with an increase of 25% between 1997 and 2020.
Meanwhile, in the US, a report from the American Cancer Society (ACS), published in early 2023, estimated that 20% of colorectal tumor diagnoses in 2019 were made in patients under 55 years of age.
This rate doubles that observed in 1995. The authors of the research calculate that the detection rates of this disease in the advanced stage have grown around 3% each year among people who have not yet turned 50 years of age.
The ACS cancer statistics report released in January noted that by 2024, colorectal cancer is expected to be common among people under age 50. the number one cause of cancer death among men and the number two among women.
Meanwhile, a global study published in 2022 in the journal Nature Reviews Clinical Oncology which analyzed data from 44 countries, noted that since the 1990s the average annual increase in colorectal cancer cases in young adults was around 2% in the United States, Australia, Canada, France and Japan. In the United Kingdom it reached 3% annually while in Korea and Ecuador it was approximately 5% annually.
Data like these represent a “global alert” for Brazilian oncologist Samuel Aguiar Jr., leader of the Colorectal Tumor Reference Center at the AC Camargo Cancer Center in Sao Paulo.
“We see this reality in our daily lives and it is alarming.. It has become normal to see young people of 35 or 40 years old come to the consultation with a diagnosis of this tumor,” she says. The specialist recommends being attentive to the symptoms that something is wrong in the intestine, regardless of age. “If you have blood in your stool, any change in your bowel rhythmyou suffer from abdominal cramps or any other discomfort in your digestive system“It is important to go to the doctor and investigate.”
“These symptoms should never be ignored, even if you are young”.
For his part, oncologist Alexandre Jácome assures that the increase in these cases in those under 50 years of age is “worryingsince the impact of colorectal cancer on a young person is very great.”
“We are talking about people who are of age to stabilize in employment, to get married, to have their first child. In other words, there are a series of dreams that have not yet been realized,” says Jácome, who is a member of the Lower Gastrointestinal Tumors Committee of the Brazilian Society of Clinical Oncology (Sboc).
What explains this scenario? Why are colorectal tumors increasing so much among young people, to the point of attracting the attention of experts around the world?
“There are some hypotheses and theories, but none of them have been confirmed so far,” says specialist Paulo Hoff.
“The first of them is related to the dramatic change that has occurred in recent decades, after going from an agrarian and rural civilization to a predominantly urban society,” explains the doctor. “This has altered several aspects of life, with the advance of a diet based on ultra-processed productswith less presence of natural foods and more sedentary lifestyle”.
“If this hypothesis is confirmed, we would be facing a worrying situation, since industrial products have become the basis of modern foodincluding children’s school lunches”says Aguiar Jr.
In addition to lifestyle aspects, researchers also have other suspicions. “We also cannot rule out the impact of some practices, such as the indiscriminate use of antibioticswhether directly to treat people or in livestock production, in poultry and cattle,” highlights Jácome.
In the case of this tumor, there are two main tests that can be used: fecal occult blood test and colonoscopy.
The first option reveals whether there is blood in an individual’s stool. Although the presence of red fluid is not a direct sign of cancer (it could be indicative of a simpler ulcer, for example), it raises a yellow flag for further analysis.
Colonoscopy, on the other hand, involves inserting a cannula with a camera through the anus. This approach allows the specialist to see the interior of the intestine in real time and detect any abnormalities in the walls of the organ.
During this procedure it is also possible to remove polypslesions that can develop and become cancer in the future.
But which test is better? Depending on your point of view. “Colonoscopy is the best test because it has greater sensitivity, that is, a greater capacity to detect lesions accurately,” says Jácome. “In addition, it is able to immediately eliminate some of these injuries,” he adds.
But in many countries there are some problems such as limited availability of equipment and professionals capable of performing this procedure. In addition, it must be taken into account that this test requires a lot of preparation, since the individual remains sedated for a few hours.
“It is virtually impossible for any country in the world to implement a colorectal cancer screening program based solely on colonoscopy,” argues Hoff. “The fecal occult blood test is very cheap, easy to perform and, if done once a year, can detect early signs of the diseaselike bleeding,” says the oncologist.
“Even in large population screening programs in Europe, which offer free colonoscopy, people’s adherence is very low. Less than 20% of the population undergoes this exam regularly,” Aguiar Jr. estimates.
Following this line of reasoning, experts propose a funnel scheme: fecal occult blood testing should be recommended to all people over 45 years of age, as a kind of screening.
Those who do not show changes are discharged and return for a new check-up a year later. Instead, people who have blood in their stool should be referred for further evaluation, with a colonoscopy.
“On average, 5% of the population will have a finding in the fecal occult blood test and will need a colonoscopy, that is, this strategy is capable of postponing this second examination for the remaining 95%,” estimates Aguiar Jr.
And let’s be clear: The finding of blood in the stool does not mean that those 5% have cancer. According to experts, this only indicates the need for further evaluation.
In the opinion of doctors, this would be a way to save resources and do more expensive tests only for patients who need them.
Despite concerns about rising cases among younger people, the good news is that prognosis for colorectal cancer has improved.
This was only possible thanks to advances in surgical techniques, which are the first treatment option in initial cases. Medications that help deal with the disease in more advanced cases have also been launched on the market, such as some drugs that belong to the class of chemotherapy and the immunotherapy.
“When this tumor is detected in time, the chances of cure exceed 95%”says Hoff.
In more severe cases, where the disease has already spread to other parts of the body in a process known as metastasisthe success rate decreases, but has improved considerably in recent decades.
“Even when it is not possible to seek a cure, the life expectancy of patients with this tumor is three to four times greater than what we had 20 years ago,” says Hoff.
“In the 1990s, being diagnosed with metastatic colorectal cancer It was practically a death sentence. Today we have a considerable number of patients who have been cured. There is a total change of perspective,” says the doctor.
For his part, Dr. Mauricio Maza recalls that to prevent the risk of suffering from this and other types of cancer, PAHO recommends maintaining a healthy diet and monitoring body weight, exercising, avoiding smoking and undergoing early diagnostic tests.
