Trend will likely lead to physicians ordering more clinical laboratory screening tests for cancer among all age groups, including young patients
Upticks in colorectal cancer cases among younger populations, as reported in recent news stores, is an issue that has implications for clinical laboratories. According to a study conducted at the University of Missouri-Kansas City (UMKC), the number of colorectal cancer cases in the US has increased greatly since 1999 with the “most dramatic jumps” seen in children, teens, and young adults, a Digestive Disease Week (DDW) news release reported.
“Colorectal cancer is no longer considered just a disease of the elderly population,” said lead researcher Islam Mohamed, MD, an internal medicine resident physician at UMKC. “It’s important that the public is aware of signs and symptoms of colorectal cancer.”
The researchers noted in the DDW news release that “colorectal cancer cases, over about two decades, increased by 500% among children, ages 10 to 14; 333% in teens, ages 15 to 19; and 185% among young adults, ages 20 to 24.”
“[The results of the UMKC study] means that there is a trend. We don’t know what to make of it yet. It could be lifestyle factors or genetics, but there is a trend,” lead researcher Islam Mohamed, MD (above), Internal Medicine Resident, University of Missouri-Kansas City, told NBC News. If proved, this trend could lead to increased demand for clinical laboratory screening tests for colorectal and other cancers among young people. (Photo copyright: Digestive Disease Week.)
0.6/100,000 children ages 10 to 14 (a 500% increase).
1.3/100,000 teens ages 15 to 19 (a 333% increase).
Two/100,000 young adults ages 20 to 24 (a 185% increase).
Albeit small numbers, the cases are growing at a rate that is troublesome, according to experts. As NBC put it, “any increase can take on a larger significance” when rates begin at low points.
The study also found incidence of colorectal cancer up in people in their 30s and 40s, reaching by 2020:
6.5/100,000 people ages 30 to 34 (a 71% increase).
11.7/100,000 people ages 35 to 39 (a 58% increase).
20/100,000 people ages 40 to 44 (a 37% increase).
Screening Guidelines May Need to Change
Further research based on UMKC’s study findings could lead to changes in cancer screening guidelines.
“We were screening people from the age of 60 for colon cancer. This has now been lowered to 55, and that is due to be lowered again to 50 over the next few months,” Jude Tidbury, RN, nurse endoscopist and clinical nurse specialist, gastroenterology and endoscopy, at the UK’s East Sussex Healthcare NHS Trust, told Healthline.
In the US, the American Cancer Society advises people of average risk for cancer to start screening for colorectal cancer at age 45. The test options ACS recommends annually include:
What is behind early-onset colorectal cancer among certain age groups? An international study led by Fred Hutchinson Cancer Center (Fred Hutch), Seattle, found “strong correlations” with consuming alcohol and being obese with early-onset colorectal cancer in adults under age 50, according to a news release.
The researchers set out to explore the common genetic variants and causal modifiable risk factors that are behind early-onset colorectal cancer, according to a paper they published in the journal Annals of Oncology.
To do so they used big databases, pulling out 6,176 early-onset colorectal cancer cases and 65,829 controls from sources including:
They focused on “lifestyle factors increasing risk” by comparing the genetic variations in those with colorectal cancer to healthy people, the Fred Hutch news release explained.
“It’s important to see that alcohol and obesity are linked to early-onset colorectal cancer. Also, insulin signaling and infection-related biological pathways. These are all really important to understand—it’s helping us to develop interventions,” said Ulrike Peters, PhD, Professor and Associate Director, Public Health Services Division, Fred Hutch, who co-led the research, in the news release.
Peters noted future research may aim to address data gaps relating to racial and ethnic groups.
More Colorectal Cancer Tests
As studies continue to explore the notion that cancer may not be a disease of aging,
clinical laboratories could see more primary care physicians and healthcare consumers using colorectal cancer screening tests, which require analysis and reporting by labs.
Medical laboratory leaders may want to proactively encourage lab sales and service representatives to educate physician office staff about using the lab’s available resources for screening young adults for colorectal cancer.
Doctors may begin ordering FITs in greater numbers, increasing the demand on clinical laboratories to process these home tests
All clinical laboratory managers and pathologists know that timely screening for colon cancer is an effective way to detect cancer early, when it is easiest to treat. But, invasive diagnostic approaches such as colonoscopies are not popular with consumers. Now comes news of a large-scale study that indicates the non-invasive fecal immunochemical test (FIT) can be as effective as a colonoscopy when screening for colon cancer.
FITs performed annually may be as effective as colonoscopies at detecting colorectal cancer (CRC) for those at average risk of developing the disease. That’s the conclusion of a study conducted at the Regenstrief Institute, a private, non-profit research organization affiliated with the Indiana University School of Medicine in Indianapolis, Ind.
The researchers published their findings in the Annals of Internal Medicine (AIM), a journal published by the American College of Physicians (ACP). The team reviewed data from 31 previous studies. They then analyzed the test results from more than 120,000 average-risk patients who took a FIT and then had a colonoscopy. After comparing the results between the two tests, the researchers concluded that the FIT is a sufficient screening tool for colon cancer.
FIT is Easy, Safe, and Inexpensive
As a medical laboratory test, the FIT is low risk, non-invasive,
and inexpensive. In addition, the FIT can detect most cancers in the first
application, according to the Regenstrief Institute researchers. They recommend
that the FIT be performed on an annual basis for people at average risk for
getting colorectal cancers.
“This non-invasive test for colon cancer screening is available for average risk people,” Imperiale told NBC News. “They should discuss with their providers whether it is appropriate for them.”
FIT is performed in the privacy of the patient’s home. To
use the test, an individual collects a bowel specimen in a receptacle provided
in a FIT kit. They then send the specimen to a clinical laboratory for
evaluation. The FIT requires no special preparations and medicines and food do
not interfere with the test results.
Thomas Imperiale, MD (above), is a Lawrence Lumeng Professor of Gastroenterology and Hepatology at Indiana University School of Medicine, and a research scientist at the Regenstrief Institute. He led a study which concluded that FITs are as effective as colonoscopies at detecting cancer in average risk patient populations. Should these conclusions become widely accepted, doctors may begin ordering FITs in greater numbers, increasing the demand on clinical laboratories that process the tests. (Photo copyright: Indiana University School of Medicine.)
‘A Preventative Health Success Story’
The FIT can be calibrated to different sensitivities at the
lab when determining results. Imperiale and his team found that 95% of cancers
were detected when the FIT was set to a higher sensitivity, however, that
setting resulted in 10% false positives. At lower sensitivity the FIT produced
fewer false positives (5%), but also caught fewer cancers (75%). However, when
the FIT was performed every year, the cancer detection rate was similar at both
sensitivities over a two-year period.
“FIT is an excellent option for colon cancer screening only if it is performed consistently on a yearly basis,” Felice Schnoll-Sussman, MD, told NBC News. Sussman is a gastroenterologist and Professor of Clinical Medicine at Weill Cornell Medicine. “Colon cancer screening and its impact on decreasing rates of colon cancer is a preventative health success story, although we have a way to go to increase rates to our previous desired goal of 80% screened in the US by 2018.”
The FIT looks for hidden blood in the stool by detecting protein hemoglobin found in red blood cells. A normal result indicates that FIT did not detect any blood in the stool and the test should be repeated annually. If the FIT comes back positive for blood in the stool, other tests, such as a sigmoidoscopy or colonoscopy should be performed. Cancers in the colon may not always bleed and the FIT only detects blood from the lower intestines.
Patients are Skipping the Colonoscopy
Approximately 35% of individuals who should be receiving colonoscopies do not undergo the test, NBC News noted. The American Cancer Society (ACS) lists the top five reasons people don’t get screened for colorectal cancer are that they:
fear the test will be difficult or painful;
have no family history of the disease and feel
testing is unnecessary;
have no symptoms and think screening is only for
those with symptoms;
are concerned about the costs associated with
screening; and
they are concerned about the complexities of
taking the tests, including taking time off from work, transportation after the
procedure, and high out-of-pocket expenses.
“Colorectal cancer screening is one of the best opportunities to prevent cancer or diagnose it early, when it’s most treatable,” Richard Wender, MD, Chief Cancer Control Officer for the ACS stated in a press release. “Despite this compelling reason to be screened, many people either have never had a colorectal cancer screening test or are not up to date with screening.”
Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. The ACS estimates there will be 101,420 new cases of colon cancer and 44,180 new cases of rectal cancer diagnosed this year. The disease is expected to be responsible for approximately 51,020 deaths in 2019.
New cases of the disease have been steadily decreasing over
the past few decades in most age populations, primarily due to early screening.
However, the overall death rate among people younger than age 55 has increased
1% per year between 2007 and 2016. The ACS estimates there are now more than
one million colorectal cancer survivors living in the US.
The ACS recommends that average-risk individuals start
regular colorectal cancer screenings at age 45. The five-year survival rate for
colon cancer patients is 90% when there is no sign that the cancer has spread
outside the colon.
Clinical laboratory professionals may find it unpleasant to
test FIT specimens. Opening the specimen containers and extracting the samples
can be messy and malodorous. However, FITs are essential, critical tests that
can save many lives.
