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Hinter dem Anstieg von Darmkrebs bei jungen Amerikanern

von NFI Redaktion

On May 15, 2024, despite the encouraging overall decline in colorectal cancer rates over the past two decades, one group stands out as an exception: Americans under the age of 45.

According to a new study presented at the Digestive Disease Week (DDW) 2024, the number of colorectal cancer cases between 1999 and 2020 has increased by a staggering 333% among 15- to 19-year-olds and by 185% among 20- to 24-year-olds, at the major medical conference in Washington, D.C.

As high as these percentages may seem, the number of cases in this age group remains low compared to rates among Americans over 45, said Loren Laine, MD, Professor of Medicine (Digestive Diseases) at the Yale School of Medicine, who co-moderated a press conference previewing the research.

„The trends are alarming [but] the actual number of cases of colorectal cancer in children and adolescents is not high enough to infer a need for comprehensive screening,“ agreed lead researcher Islam Mohamed, MD, an Internal Medicine resident at the University of Missouri-Kansas City.

For example, in 1999, one in 333,000 15- to 19-year-olds was diagnosed with colorectal cancer. By 2020, colorectal cancer occurred more frequently, with one in 77,000 teenagers being affected.

At the same time, the number of cases in young adults aged 20 to 24 increased from less than 1 to 2 per 100,000 in 2020.

Although the risk in absolute numbers is relatively low, experts are keeping an eye on the reasons for the rising rates. It is also about raising awareness. If someone under 45 experiences symptoms of colorectal cancer such as blood in the stool, abdominal pain, changes in bowel habits, or others, they should see a doctor, said Laine.

„If you have symptoms like rectal bleeding, do not take it lightly. It is still quite unlikely that you will develop colorectal cancer… but of course, it is not something to ignore either,“ said Laine.

„Colorectal cancer is no longer just considered a disease of the elderly,“ Mohamed said during the briefing. „It is important for the public to be aware of the signs and symptoms of colorectal cancer.“

Mohamed and colleagues examined colorectal cancer cases using data from the CDC Wonder database, a central database with public health information. They calculated the increases by comparing rates from 1999 to 2020.

Colorectal cancer is one of the most common cancer-related causes of death in the United States. It currently ranks third in terms of new cases and cancer-related deaths, excluding some types of skin cancer, according to data from the American Cancer Society.

Some risk factors can be changed

Colorectal cancer rates in younger people „have been steadily increasing. It could also be related to environmental factors, lifestyle factors, and genetic factors,“ said Mohamed. „It could also mean that we are doing better. Maybe we are conducting more screenings in patients, and maybe we are getting better at identifying patients at high risk for colorectal cancer in the younger population.“

There are ways to reduce your colorectal cancer risk, including weight loss.

„As we have seen, I think introducing a healthy lifestyle would be a great approach to curb the rising incidence of colorectal cancer. Metabolic syndrome is a major factor.“ Pay attention to a balanced diet, exercise regularly, and possibly limit alcohol consumption, said Mohamed.

„There is also a debate about the use of antibiotics and dietary supplements that may, but not necessarily, contribute to colorectal cancer risk,“ he said.

On the other hand, up to a third of early-stage colorectal cancer cases are related to factors that cannot be changed. Examples include a family history of colorectal cancer, the presence of inflammatory bowel disease, and certain cancers linked to genetic mutations. „When you think about it, most of these young people [with colorectal cancer] probably have genetic syndromes,“ said Laine. „The big issue honestly is finding better ways to identify families with genetic syndromes. That is probably the biggest message.“

Risk varies by age

In addition to the increases in the 15- to 19-year-old and 20- to 24-year-old groups, the rates in 2020 compared to 1999 showed:

  • 68% increase in the 25- to 29-year-old group
  • 71% rise in the 30- to 34-year-old group
  • 58% increase in the 35- to 39-year-old group
  • 45% increase in the 40- to 44-year-old group

„These results all underscore the urgent need for public awareness and personalized screening approaches,“ Mohamed said, „especially in younger population groups who experienced the most significant increase in colorectal cancer incidence that we have observed.“

The US Preventive Services Task Force lowered the recommended age for colorectal cancer screening from 50 to 45 in 2021. Mohamed suggested a more targeted screening for individuals under 45 with higher risk.

„I think it will be really helpful to stay informed about the increasing incidence and the latest research findings and recommendations on colorectal cancer prevention and early detection.“

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