Despite high survival rates among patients who regularly undergo screenings, approximately 38% of Americans older than 45 have not had a colonoscopy, despite 45 being the new recommended screening age.
In addition, CRC rates are on the rise among young patients. Early stage research has found that colorectal cancer rates have risen between 45% and 500% for people too young for routine screenings.
“Since we started colon cancer awareness month during the Clinton administration, we’ve seen a drop in CRC each year for 20-30 years overall; but the issue is we’re seeing a rise in CRC among young patients,” Peter Senatore, MD, a colon and rectal surgeon at Inspira Health in Vineland, N.J., told Becker’s. “For people over 55, rates are dropping about 1% a year. Unfortunately we’re seeing a dramatic increase in the rates of colon cancer and death rates in people under 55. Patients all the way down to their 20s. That’s the concerning thing.”
Dr. Senatore has been a practicing colon and rectal specialist for more than 36 years, and in that time he has continued to witness more concerning gastrointestinal symptoms in younger patients.
“We are seeing a lot of people in the young age group, and the biggest issue that we’ve been trying to emphasize with primary care providers is don’t take any symptoms lightly. In the past, someone in their 20s or 30s would present with some light rectal bleeding and we’d say, ‘Oh don’t worry, it’s probably hemorrhoids.’ Now, we never assume that,” he said. “And I have seen people in the younger age groups where they just have minor complaints and we end up finding an early tumor.
“We’re not sure why we’re seeing these growing numbers, this rise. A lot of it has to do with risk factors, and we see that risk factors are the same for colon cancer at any age. More sedentary lifestyle, higher obesity rates, smoking — a lot of these things seem to be risk factors, but we don’t have a good handle on exactly why we’re seeing a dramatic rise since 2014-2015.”
A 2024 study found that in people 20 to 24 years old, GI cancer cases increased by 185% from 0.7 to 2 per 100,000 people between 1999 and 2000. For people older than 25, the increases were smaller, with those ages 40-44 seeing the smallest increase of 45% (from 15 cases per 100,000 people to about 21 per 100,000).
Around 26% of adults older than 45 do not have any plans to ever undergo a colonoscopy. Close to one-third (29%) of patients cited feeling fear or anxiety about the CRC screening process as a reason for not getting screened.
“When I talk to people and give lectures, colon cancer is one of the most common cancers and is the second leading cause of cancer death, and it’s still puzzling to me why it’s that much of a problem we know the vast majority begins with beginning polyps and there’s a significant lead time between finding a polyp and having cancer develop — like 10 years,” Dr. Senatore said. “It should receive more attention, and the real reason is a lot of people aren’t getting any type of screening. And now when you talk about rising rates in younger people, it’s even more important to push people to get some screening and not ignore symptoms.”
There is a great deal of fear and anxiety for patients when it comes to the invasive nature of a colonoscopy. Around 20% of Americans said they are still putting off colonoscopies due to the preparation required leading up to the procedure.
Recently, new blood and stool-based CRC tests have hit the market, giving patients less invasive screening options. While physicians emphasize that these options are not as accurate as traditional colonoscopy, most agree that getting some form of screening is better than none at all.
“Obviously colonoscopy is the gold standard of screening, but any tool is important,” Dr. Senatore said. “Doing something is important. The big test that’s been coming down the pike is blood-based tests, which are basically looking for DNA from cancer cells in the blood, what we call circulating tumor DNA. That’s something that has been around for a few years, and we’re trying to use it in people that have had colon cancers.
“Now this test is being used as a screening tool. It’s something that hasn’t made its way into widespread use, but is very interesting and as more refinement of the blood test and parsing out DNA in the bloodstream occurs, it will make it a lot easier. A blood draw is something you can do with an annual physical and it’s very easy. It’s harder to get people to come back for another test or send in stool. That testing will hopefully provide another layer of protection when it comes to catching CRC cases.”
In addition to fear surrounding screenings, there is a lack of education. Dr. Senatore and Inspira Health are aiming to change that in New Jersey.
Currently, around 79% of Americans do not know the recommended age to get a colonoscopy. In addition, only 9% of patients know how to identify the signs and symptoms of colorectal cancer.
Inspira Health has partnered with the New Jersey Cancer and Early Detection program, which is designed to provide patients below the poverty line free screenings for the four most common U.S. cancers.
“It provides cost-free screening for low income people, and we’ve been working with them with new stool tests, and anyone who comes back positive we get them in for a colonoscopy. I have been doing a lot of colonoscopies for these patients,” Dr. Senatore said. “The NJCED program picks up costs of the procedure, so the state has done a great job reaching out to people who are financially strapped and trying to get healthcare. It’s still tough to get these people in the door, but the program is there and Inspira works hard to get people qualified and in and screened.”
Inspira also previously partnered with the American Cancer Society for a project, attempting to get 80% of patients in the at-risk age group screened. While the system fell short of that goal at the time, Inspira is still pushing toward that mark.
“The main thing is getting people some screening of any kind. It’s been a hard sell, which is strange considering the statistics,” Dr. Senatore said. “We know this cancer is completely preventable if we do screening and catch it, but it’s hard to understand why people aren’t. Some might be economic, some might be education. We’ve been working with the state, with the NJCED program, trying to do what we can.”
