Early-age onset colorectal cancer (EAO-CRC) rates have been steadily increasing in the U.S.. EAO-CRC, defined as colorectal cancer (CRC) found in patients under 50, has more than doubled since the 1990s. The recently concluded Early-Age Onset Colorectal Cancer Summit hosted by the Colon Cancer Foundation gave global experts a platform to discuss the underlying factors behind this concerning pattern. Diet, lifestyle, early-life exposures, and the microbiome made up a majority of the conversation during one of the summit’s sessions, as these are all factors that play a role in EAO-CRC. Diet in particular is a factor that must be explored further. According to a prospective cohort study published in the Journal of the National Cancer Institute (JNCI) in May 2021, hyperinsulinemia, chronic inflammation, and gut dysbiosis caused by a poor diet can lead to CRC. 

The JNCI study investigated the potential link between poor diet and rising incidence of EAO-CRC. The study’s researchers analyzed the documented behaviors of participants in the Nurses’ Health Study II (NHSII). NHSII is the second generation of the Nurses’ Health Study, established in 1976 to investigate risk factors for chronic diseases in women. NHSII contains a cohort of young women with well-documented endoscopic histories and assessments of diet and lifestyle factors, which “provides a unique opportunity” to address the knowledge gaps in the potential link between diet and EAO-CRC. 

The study looked at the history of 29,474 women aged 25-42 from 1991 to 2011. Every two years, participants were given questionnaires on demographics, life factors, and medical diagnoses. This allowed the study’s researchers to distinguish between participants with colorectal adenomas and those without, an important distinction as colorectal adenomas are postulated to be precursors to EAO-CRC. The adenomas were then categorized by their malignant potential based on size and histology.

To procure information about diet, the researchers looked at the food frequency questionnaires (FFQs) participants filled out every four years. The FFQs revealed two dominant dietary patterns: 1) the Western diet, characterized by refined grains, processed meats, and high-sugar foods, and 2) the prudent diet, characterized by vegetables, fruits, whole grains, and seafoods. Three indices were used to determine overall food quality: Dietary Approaches to Stop Hypertension (DASH), Alternative Mediterranean Diet (AMED), and Alternative Health Eating Index-2010 (AHEI-2010). For all three indices, higher scores indicated higher diet quality. 

Results from statistical analyses showed that participants in the highest quintile of Western dietary patterns had an increased risk of early-onset adenoma compared to those in the lowest quintile. Additionally, adherence to the Western diet was positively associated with early onset high-risk adenomas in particular. Conversely, there was an inverse association between adherence to DASH, AMED, and AHEI-2010 and risk of early-onset adenoma. 

These findings indicate that poor diet quality contributes to the increase in EAO-CRC found in the U.S.. However, it is important to note that participants following the Western diet were also more likely to engage in unhealthy behaviors, e.g. smoking and being sedentary, compared to participants following the prudent diet, DASH, AMED, and AHEI-2010. These confounding variables display the necessity for further research into the link between diet and EAO-CRC. 

 

Billy is an artist that has created comics to get through his journey with colon cancer all the while raising funds for the Colon Cancer Foundation;

“Over the past six months, I’ve been dealing with Stage 2 Colon cancer. I decided at the time I wasn’t going to take this lying down. So I got together with some friends and started talking about my situation; and we decided that the best way to go about it was to raise money for a good cause. For research, and to put something together that we can do yearly. 

I’ve had 7 friends get colonoscopies from my experience and 2 came back with cancer. Seeing that was scary enough beyond my own diagnosis at 38, with that being said. This is the hill (beyond animal rescue) that life has given me. And I hope I can do a tremendous amount of good in that time.”

A huge thank you to Billy for sharing his inspiring story. If you are interested in starting your own fundraiser, learn more about it here: https://www.coloncancerfoundation.org/events/organize-your-own-fundraising-event/?fbclid=IwAR23xzwdF-K8j0t-WETp-gzIjj0j-LpXg49ywZ8g-YQjSM8vK722Mis4h-k

 

 

 

After losing her husband to Early-Age Onset Colon Cancer, Kelli decided to raise funds for the Colon Cancer Foundation and advocate for Colon Cancer awareness in memory of her husband until Colorectal Cancer is just as prominent in our minds as Breast Cancer: 

 

It is my pleasure to push for donations for colon cancer. In January of 2020, my husband(Frank) saw his dr for what we thought was a stomach virus. The doctor was not seeing any real big issue wrote it off as a long-lasting virus but put in an order for ultrasound in February if he wasn’t better by then. A few weeks later (and still having on and off stomach issues) he saw his headache doctor who ran some blood work. A few days later they called us concerned about his liver enzymes. They advised us to pick up a copy of the blood work and see his doctor immediately. His primary doctor was finally as concerned as we were and rushed the ultrasound. Two days later he had it done. I knew something was wrong when they asked him to stay while they called the doctor to gain permission for a CT saying the ultrasound showed “bubbles of gas”. A few hours later with no word we went home. At 10:30 that night his primary doctor called me. He explained that the ultrasound showed several masses and he wanted us to report to the ER for a CT, he hadn’t told my husband yet he called to warn me what was coming before he did. He then called and explained to Frank what the ultrasound showed. The next morning we got the kids to school and headed in for the CT. Dr. Ben (who was amazing)  at Chesapeake General got the unpleasant job of explaining he had cancer and it was not a small version but instead a very big one (stage four) and at the age of 38 with a wife and two kids. This being the spiral of colonoscopy, being moved to the top priority at the oncologist, a tumor sample surgery, and three different types of chemotherapy. The oncologist gave us lots of hope that he would beat it or at least reduce it to an operable size, he easily had about 5 years. Frank started chemo in late March that year and every two weeks he was in the chair for about 5 hours while I was stuck outside due to covid being announced and new policies. In December after no real change other than spreading to now 4 locations, he opted to take a month off. I fully supported him in that as his Birthday and Christmas were coming and he really wanted to go visit family. During December he had fewer symptoms since chemo had left him with neuropathy in his fingers and toes along with hair loss and severe reactions to cold. When we returned after New Years I immediately called the office to request a CT and restart of treatment. The CT revealed more spreading and growing tumors Frank restarted chemo immediately. A new addition to treatment was draining the fluid buildup from his abdomen every week. In the last six months, every genetic test available was run to try and find the cause of his cancer. They all came back with no issues in his genes. After four weeks of treatment and growing reactions, his oncologist called me to discuss his status. The ammonia was building up in his body as his liver was now shutting down and full of tumors. He let me know that Frank had 6-8 weeks left. We chose to call family and advise them to visit but not to tell Frank yet. The doctor ordered a permanent drain to go in. March 8th he had the procedure. On Tuesday he woke up with very diminished brain functioning. We had the hospice team come immediately- the same team that Frank refused for months. Their initial assessment was he had a week maybe two. His brain function cleared up mostly so it restored some hope of a longer time. Friday he was deteriorating again. I had taken care of him in every way in the last month but now he didn’t even have the strength to stand in the shower, or at all really. Sunday, March 14th he woke up with a bit more energy and was insistent on making homemade orange juice downstairs. So I helped him down, cut the oranges and he juiced one and a half before he was exhausted. He rested for a bit while drinking his juice then I helped him back up the stairs. The nurse came to check in and explained to me he was very rapidly slipping away so expect it in the next day or two. We spent that day watching Harry Potter as a family. He dozed on and off but was very clear when awake. Then suddenly he wasn’t. At 10:01 pm he took his last breath with the kids and I surrounded him in love. It was the worst day of our lives, telling him it was ok to let go and how much we loved him watching him slip away in mere hours after he was up and talking. 

He lived a year fighting his best fight and we spent it loving each other more than ever. 

He never had any indications before that thought to be stomach flu. Early testing has to become a routine thing and I plan to advocate and raise funds in his memory until it is just as prominent in our minds as breast cancer. No one should have to go through what we did as a family especially at such a young age.

 

A huge thank you to Kelli for sharing her inspiring story. If you are interested in starting your own fundraiser, learn more about it here: https://www.coloncancerfoundation.org/events/organize-your-own-fundraising-event/?fbclid=IwAR23xzwdF-K8j0t-WETp-gzIjj0j-LpXg49ywZ8g-YQjSM8vK722Mis4h-k

 

The Colon Cancer Foundation is very excited to announce our new class of 2021 interns. . Scroll through to learn more about our amazing team!!

 

Laura Banazek

Hi! My name is Laura Banazek and I am an Events Intern with the Colon Cancer Foundation. I am an upcoming graduate of California Polytechnic State University, San Luis Obispo earning a B.S. in Experience Industry Management with a concentration in Event Planning. During my last four years of college, I have been very involved with my major department and sorority. I served on my sorority’s executive board as the VP of Membership Education and Programming and am currently the Event Technology and Registration Lead for the 2021 Cal Poly Experience Industry Management Auction.

As an Events Intern with CCF I am excited to gain new experience in event logistics and brand partnerships! I am passionate about creating memorable experiences and building meaningful relationships. After graduation, I dream of working as an Event Planner in either a non-profit or corporate setting. In my spare time I love getting outdoors (going on walks or to the beach!) and spending time with my friends/family. I am so grateful for the opportunity to intern with CCF and am looking forward to the many projects to come!

 

Kyla de Guzman

My name is Kyla de Guzman and I am a new Public Relations Intern for the Colon Cancer Foundation! I am a Junior at Montclair State University, majoring in Public Relations and minoring in Creative Writing. I am involved in my school’s Drama club, a member of the National Society of Leadership and Success and a part time receptionist at Dumont Animal Hospital; while maintaining a 3.7 GPA. In my spare time I love making playlists, reading, creating TikToks, thrifting and hanging out with my friends.

I am so excited and proud to be a part of CCF’s Public Relations Intern! My career goal is to work as a public relations consultant for high end fashion brands. Thanks to CCF I am able to apply my public relation course in real world experience. I am pleased to be part of a small but mighty organization that wants to spread awareness as best we can.

 

Devyn Fatzynytz

Hello! My name is Devyn Fatzynytz and I am a Junior Communications Student with a minor in Psychology at The College of New Jersey, and I am very excited to start my position as a Summer PR Intern with the Colon Cancer Foundation.

I have always had a love for writing and creating compelling messages as a means of a creative outlet. This combined with my love for people and making meaningful connections with others drew me to public relations as my field of interest. I am particularly excited about my opportunity with the Colon Cancer Foundation because I can work for a cause with the meaningful mission of finding a cure for colorectal cancer, while increasing resources and screening for disadvantaged communities.Macintosh HD:private:var:folders:r5:fg89xtm552zg8y3b5t0rj1y40000gn:T:TemporaryItems:unnamed.jpg

A little more information about myself, I am from Jefferson Township, New Jersey. I am the oldest of three, and value my family and friends tremendously. Some of my hobbies include playing soccer, running and art. Over the summer I paint wall murals for small businesses and people’s home interiors as a side gig in my free time, and have waitressed for the past four years at a local diner in Wharton, NJ.

Some of my on campus activities include TCNJ girl’s club soccer where I held a position as social chair, Delta Zeta sorority as intramural chair in 2019, and being a member of the Anti-Violence Initiates team dealing with dating abuse prevention.

This past Sprint semester I have been a research assistant, analyzing qualitative research data on the topics of gender disparities and women in leadership, while also being trained in comparing and contrasting results to identify themes in stories.

In terms of my background in Communications and Public Relations, I have taken several beneficial classes in interpersonal communications, strategies of public relations and interpersonal health communications among others. I also have prior PR internship experience with McNeil, Gray & Rice, a PR firm in Boston, MA.

 

Rachel Herrmann

My name is Rachel Herrmann, and I am excited to join the Colon Cancer Foundation’s team as its new Colorectal Cancer Prevention Intern. I am originally from Rochester, New York, and am a recent graduate of Cornell University where I majored in biology and minored in global health. Currently, I am pursuing a Master’s degree in public health through the London School of Hygiene and Tropical Medicine. During my time at Cornell, I worked as a research assistant at the Wilmot Cancer Center, so I am glad to be back working in the cancer field.

My career goal is to work for a nonprofit organization to implement public health initiatives in under-served communities, so I am thrilled to be starting my career with the CCF.

Throughout my internship at the CCF, I will be writing articles about current research in the colorectal cancer sphere in addition to working on the Early-Age Onset Colorectal Cancer Summit.

In my spare time, I love to play tennis as well as travel (I’ve been to twenty countries so far). I also love to play with my two-year-old Cavalier King Charles Spaniel, Charlie!

 

Carolene Kurien

Hello! I am Carolene, a Communications Intern at CCF. I received my Bachelor of Science degree from the University of Miami with majors in English and Neuroscience. I am passionate about CCF’s mission to lead the fight against colorectal cancer, and I strive to aid CCF’s mission by creating content that informs readers about the importance of colorectal cancer prevention, detection, and eradication. I am proud to be working towards such a worthy cause and I am excited about what lies ahead!

 

Laurel Levinsohn

My name is Laurel Levinsohn and I’m excited to be a part of the Colon Cancer Foundation! I’m a senior at Washington University in St. Louis, majoring in Cognitive Neuroscience with minors in Spanish and Children’s Studies, on the pre-med track. My career goal is to go into medicine, possibly as a pediatric specialist or as an OB/GYN. During my time with CCF, I hope to help the organization be equipped for success as it grows, and ultimately help work toward a world without colon cancer. I am excited to use my Spanish skills to help create resources that can reach a more diverse population, especially those who are often underserved in healthcare.

I love food, fitness, and working with kids. On campus, I am involved in Spoon University, a food publication, SODA: Student Organ Donation Advocates, and WashU Student Interpreters, through which I am gaining skills to serve as a medical Spanish interpreter. I hope that this position will be one way I can contribute to promoting preventive medicine and making healthcare more accessible.

 

Susan Pistone

My name is Susan Pistone; I’m one of the Colon Cancer Foundation Interns. I have a Bachelor’s Degree in Communications Studies and a minor in Public Relations. Currently, I’m pursuing a Health Promotion Management Graduate Degree from American University. In my spare time, I love the gym, kickboxing, and running. Previously, I have worked with other Public Health organizations such as Global Health Alliance to host virtual Public Health webinars. My goals would be to have a career in Public Health in roles preventing disease or corporate wellness. Public Health is my passion, and I want to spread awareness about various diseases in any future position.

Abigail Saathoff

My name is Abigail Saathoff and I am the Social Media Intern for the Colon Cancer Foundation! I am a rising junior at the University of Northern Iowa double majoring in Strategic Public Relations and Digital Journalism with minors in Business Communication and Marketing. I am actively involved in various organizations at UNI including; Alpha Delta Pi sorority, the Residence Hall Association, Panhellenic Council, and more. Outside of my student organizations and classes I love crafting, and fell in love with jewelry stamping just a few months ago! I also love reading and watching movies. 

I’m extremely excited for this opportunity to be CCF’s Social Media Intern. Right now, I’m still not 100 percent on what I want to do in my future, but know I want to help people, work for a non-profit and work in social media or public relations, so I think I’m in the perfect place! I’m excited to learn a lot all the while making graphics, writing posts and building our social media platforms that make a difference and raise awareness of Colorectal Cancer. I’m very proud to be working for such an incredible organization, and I look forward to my time here.

 

Rachel Veitch

Hello! My name is Rachel and I play an exciting role as a graphic design intern here at CCF! I spent almost 10 years working in office management before deciding what I wanted to be “when I grew up”, and now I am studying Graphic Design at Academy of Art University, where I earned my AA and am now finishing up my BFA. I love art and design and being creative and am so thankful to be able to pursue a second career in my dream job! I hope to go into either advertising or publishing, but I also do a lot of volunteering and love supporting causes I care about, like colorectal cancer awareness! I am learning a lot here at the Colon Cancer Foundation and love that I play a small part in helping to one day eliminate deaths from colorectal cancer. 

At home (which is also the office) I have two kiddos and love to spend time outdoors with them or play with legos! I also love art and illustration and hope to illustrate a children’s book someday. I have been a military spouse for 11 years now, and we have gotten to live in so many places around the country! We are originally from New Mexico, which holds a special place in my heart. We hope to settle there when my husband retires from the service. I am also creating an art/children’s book about New Mexico.

 

Patricia’s story begins a bit differently than many Colon Cancer cases, when a tumor in her colon caused an infection, leading her to a diagnosis of Colon Cancer. Since her diagnosis, Patricia has made a great effort to spread awareness to people of younger ages, who seem to be diagnosed more and more often these days, and has raised over 1,000 dollars for the Colon Cancer Foundation;

“My story is I was diagnosed with colon cancer this past March 5th. (It was a) Very scary time for me. I am lucky that even though my tumor in my colon was very large I was fortunate that it did not spread to other organs or my lymph nodes. I had surgery on March 11.  I am currently going through chemotherapy. 

 I think it is important to spread awareness and as it seems, people are getting colon cancer at younger ages now. I am 55 but recently I have a friend and cousin who were diagnosed who are in their 40s. Hoping by putting this fundraiser out there my friends and family will consider getting colonoscopies. My case was not found through a colonoscopy but pain in my abdomen as the tumor caused an infection. Thank god for that infection.”

Thank you for your amazing contribution Patricia and we wish you the best of luck in your journey with chemotherapy. 

Inspired by Patricia’s story to start your own fundraiser for CCF? Instructions here: https://www.coloncancerfoundation.org/events/organize-your-own-fundraising-event/?fbclid=IwAR23xzwdF-K8j0t-WETp-gzIjj0j-LpXg49ywZ8g-YQjSM8vK722Mis4h-k

 

Joshua was diagnosed with Colon Cancer at the age of the 36, and since beginning to recover, decided to start a fundraiser that raised over 1,000 dollars for the Colon Cancer Foundation;

“I was diagnosed with Colon Cancer on 1/31/20 (at age of 36) in the hospital (after going into the ER on the Friday before on 1/24/20). I went in feeling like I had the Flu, but it was something else. After many tests, I ended up getting confirmation there was a blockage in my sigmoid colon and the biopsy said it was cancer.

The good news is I live in Chicago and my hospital is Northwestern and I was very lucky to find a great care team. I had my initial surgery the day after the Superbowl to see what they can do and with confirmation of the size being too large to remove we decided to give me a colostomy and 6months of chemo. I started that as soon as I was allowed to in late February and the last time in the hospital was on July 29th. With many more scans and a few weeks of rest after Chemo, I was ready for surgery on September 8th.

That surgery was a success and was out of the hospital on 9/11. They removed the tumor (stage 3) and 89 lymph nodes showing no signs of metastatic. She turned the colostomy into an ileostomy to continue to let the body heal in that area. Then I went back on December 12th for my reversal. It was an early Christmas gift to have all of this out of the way by the end of the year!

There is so much to talk about and I’m finally getting to that stage where I’m able to and really want to help spread the word as I don’t have a family history and I know how easy this can be to catch and then treat.”

A huge thank you to Joshua for sharing his story and for his contribution! Inspired to start your own fundraiser? Instructions to start your own here: https://www.coloncancerfoundation.org/events/organize-your-own-fundraising-event/?fbclid=IwAR23xzwdF-K8j0t-WETp-gzIjj0j-LpXg49ywZ8g-YQjSM8vK722Mis4h-k

 

Around this time in 2020, the novel coronavirus reared its ugly head. In response to the COVID-19 pandemic, all non-urgent surgical and medical proceduresincluding screening colonoscopieswere delayed, as recommended by The Centers for Medicare & Medicaid Services (CMS). This postponement resulted in a 90% decrease in colorectal cancer (CRC) screenings, a 32% decrease in CRC diagnoses, and a 53% decline in CRC surgical procedures in mid-April 2020 as compared to mid-April 2019, according to a new study published on JAMA Network Open. 

According to the study, the decrease in CRC screening has potentially nefarious consequences, such as CRC diagnosis delays and increased CRC mortality. Though colonoscopy is the primary CRC screening method in the U.S., many countries utilize fecal immunochemical testing (FIT), which tests for hidden blood in the stool, as their primary screening method. FIT is an inexpensive home health test that has an overall 95% diagnostic accuracy for CRC. Increasing FIT use in the U.S. can potentially  “limit the deleterious public health consequences of COVID-19 on CRC mortality,” according to the study’s researchers. 

The researchers estimated the three-year CRC outcomes for average-risk individuals by creating a simulation model with publicly available data. Using pre-COVID facts and figures from the American Cancer Society, they modeled the percentage of the U.S. population that was estimated to complete CRC screening by colonoscopy or FIT. Four CRC screening scenarios were considered, all of which varied with respect to two dimensions: the COVID-19 dispersion profile and the collective response to improving CRC screening. The COVID-19 dispersion profile refers to whether or not elective medical procedures were delayed due to national or local guidance, and the collective response refers to the effort (or lack thereof) to expand FIT screening due to decreased colonoscopy screening. 

The four scenarios are as follows:

  • Scenario 1: 
    • 3 months of normal screening (pre-COVID)
    • 3 months without any screening (peak of COVID)
    • 9 months where screenings would be 50% of pre-pandemic volume
    • 21 months where screenings would be 75% of pre-pandemic volume
  • Scenario 2: 
    • Assumed a similar reduction in screening like Scenario 1
    • 18 months where screenings would be 50% of pre-pandemic volume
    • 12 months where screenings would be 75% of pre-pandemic volume
  • Scenario 3: 
    • Mirrored Scenario 1, but included FIT-based screenings to account for the decrease in colonoscopy screenings
  • Scenario 4:
    • Mirrored Scenario 2, but included FIT-based screenings to account for the decrease in colonoscopy screenings

The estimated results were compared to a baseline and varied by scenario: 

 

Scenario 1 Scenario 2  Scenario 3 Scenario 4
Percent of patients who completed CRC screening compared to baseline -37.6% -42.9% -25.1% -29.0%
Percent of CRC cancer diagnosis compared to baseline -32.6% -37.6% -24.3% -29.7%
Percent of CRC cases detected by screening 92.3% 90.7% 89.9% 91.9%
Percent of CRC cases detected by symptoms 7.7% 9.3% 10.1% 8.1%

 

In regard to Scenario 3, increasing FIT-based screening is estimated to increase participation in CRC screening by 20% and cause an additional 12.3% increase in CRC diagnoses as compared to Scenario 1. In regard to Scenario 4, increasing FIT-based screening is estimated to increase participation in CRC screening by 24.5% and cause an additional 12.7% increase in CRC diagnoses as compared to Scenario 2. 

As a whole, this simulation model showed that 43% of eligible adults could remain unscreened for CRC due to the COVID-19 pandemic. However, by incorporating screening via FIT, the percentage of unscreened, eligible adults could be reduced to 29%. Therefore, it can be said that increased use of FIT can potentially alleviate the negative effects that the pandemic had on CRC screening. FIT is affordable, accessible, and widely scalable, and using FIT as a screening method could increase CRC screening, detection, and prevention even beyond the COVID-19 pandemic. 

 

It is finally here! The U.S. Preventive Services Task Force (USPSTF)’s final recommendation has lowered the colorectal cancer (CRC) screening age for average-risk adults from 50 to 45 years. This long-awaited final recommendation came a little over six months after the draft recommendation was released in October last year.

This is a B grade recommendation, meaning that there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Screening for 50–75-year-old adults remains an A grade recommendation, meaning USPSTF believes there is high certainty of substantial net benefit with screening that age group. The recommendations have also been published in JAMA.

Lowering the screening age from 50 to 45 years is great news for the CRC community because it will significantly influence the earlier diagnosis of CRC among the younger age group. To bring this into perspective, a recent paper in JAMA Network Openprojected that by 2040, CRC will be the second most common cancer in the 20-49 age group and it will be the leading cause of cancer-related deaths in that age group.

Ana Acuna-Villaorduna, MD, Department of Medical Oncology at Montefiore Health System, believes that the lowering of screening age could halt the alarming rise in early-age onset CRC, particularly among racial and ethnic minority populations. “Considering US-based population projections that foresee a continuous increase in racial/ethnic minorities and have higher frequencies and worse clinical courses of colorectal cancer among young patients, it is necessary to adopt a screening strategy aimed to halt this alarming trend,” Dr. Acuna-Villaorduna wrote in an email.

She believes that general practitioners and family physicians will be strategic players in implementing the new measures by educating patients in the community, along with gastroenterologists and medical oncologists. However, uptake of these recommendations by the primary care clinical community may be slow, depending on the messaging strategies that are utilized.

“As usual, it will take a while to get the message out,” Zuri A. Murrell, MD, FASCRS, Chair, Cancer Committee, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, told the Colon Cancer Foundation. “Having a media blitz will be helpful. Organizations like the American Cancer Society and the Colon Cancer Foundation will be the main people who will not only get the word out to providers, but to the community as well,” he added.

Dr. Acuna-Villaorduna thinks that the USPSTF recommendation will finally build a consensus across the various medical societies that have disparate CRC screening recommendations. She believes that some physicians may already have been screening average-risk adults at 45 years, so guideline uptake may be faster.

What Else Will Influence Uptake of the Guidance?

Another important question is whether our health care system has the capacity to onboard the 20-21 million adults in the 45-49 age group who are now eligible to get screened. While colonoscopy remains the gold standard, other screening options, including stool-based testing, could be used to conduct the initial screen. Whitney Jones, MD, Founder, Colon Cancer Prevention project, agrees. “While we cannot conduct colonoscopy in all the new population, we can definitely send them stool-based testing kits. That’s what health systems should focus on,” he said while speaking with the Colon Cancer Foundation.

The other issue is insurance coverage for CRC screening as a preventive care service for the 45-49 age group and making sure payers—both government and private—are aware of the updated guidelines and are integrating these within their policy.

Currently, most insurers will cover the cost of a preventive screening test for those 50 years or older, but the enrollee may have to share the cost of a diagnostic screening test if a polyp or tumor is found.

If historical trends are any indication, insurance coverage of colonoscopy will significantly influence increased screening in the younger age group. Evidence for this is stark in the Medicare population: colonoscopy rates jumped from 20% in 2000 to 61% in 2018 among those 50 and older after Medicare started covering colonoscopy screening for all beneficiaries in 2001.

Once the updated recommendations of CRC screening age are implemented, Dr. Murrell is hopeful that insurance companies will listen and hopefully start covering the cost of the simple preventive procedure. He also raised an important point about eliminating fear from the mind of the younger community. “I have coined a slogan that I always share with my patients: ‘You shouldn’t die from fear you shouldn’t die from embarrassment.’ This will be the first step in helping and encouraging people to get a colonoscopy,” he added.

Advancements in screening, diagnosis and treatment of colorectal cancer have come a long way in the past two decades, but the need to continue to spread awareness of the disease among young people and continued industry-wide collaboration and investment is necessary to offset the growth in incidence under the age of 50. Those were among the key topics of the 7th annual Early-Age Onset Colorectal Cancer Summit.

The three-day conference, which was held online in a virtual format because of ongoing Covid-19 precautions, concluded on Sunday, May 16. It was organized by the Colon Cancer Foundation, a New York-based 501(c)3 non-profit organization dedicated to reducing colorectal cancer incidence and death. (Presentations from all three days can be viewed online andCME and MOC credit will be available for 30 days.)

At the outset of the third day of the summit, a panel of distinguished experts addressed the case study of a 28-year-old colon cancer patient from a broad-spectrum approach, offering input on patient perspective, nurse navigation, genetics, medical oncology and new therapeutics, surgery, financial burden/toxicity, radiation oncology, psychological needs, pediatrics and palliative care.

The female patient in the opening panel discussion was described as presenting with a multi-year history of chronic constipation for which she took laxatives. Six months prior to visiting an emergency room, she started experiencing a change in symptoms with tenesmus, rectal pain, bowel urgency with intermittent rectal pressure deep in the pelvic region that worsened with prolonged standing.

At the ER, she had an abdominal/pelvic CT scan that showed presence of a moderate amount of stool in the ascending colon, a thick-walled appearance of the rectum about 6cm from the anal verge down to the anal canal/anorectal junction. Those abnormal symptoms prompted a colonoscopy that showed a non-circumferential mass in the distal rectum to the anal verge. A biopsy returned as invasive moderately differentiated adenocarcinoma.

The patient was described as healthy with a BMI of 22 and had no other medical history and was not taking any medications. The only colorectal family history she had was that her father had several polyps removed after the age of 50.

1. Spreading the message about early-age onset colorectal cancer to young people is crucial so symptoms aren’t overlooked or disregarded.

Often young people ignore or miscategorize their symptoms or are too busy to visit their doctor or aren’t concerned because of a lack of family history or because they lack general awareness about colorectal cancer. In some situations, the initial symptoms have disregarded after being attributed to hemorrhoids or other common benign conditions.

“About 70 to 80 percent of our patients that have colon or rectal cancer do not have a family history of the disease, even if someone in the family had a colonscopy and had polyps removed. I always think it’s important to get pathology of the polyps of family members and also to make sure the parents and siblings of the patients have had colonoscopies.”
Zsofia Stadler, MD, Associate Professor, Clinical Director, Clinical Genetics Service, Memorial Sloan Kettering Cancer Center

“It typically takes about 270 days from the onset of symptoms to diagnosis in young patients because. Most of the time, their symptoms are dismissed as something benign like an upset GI tract that everyone has. As a result, they usually are not given the medical attention that they deserve.”
Manju George, MVSc, PhD, Scientific Director, Paltown Development Foundation.

2. The top priority with younger colorectal cancer patients is curing the cancer, but there other quality-of-life issues are critical.

An ensuing pelvic MRI confirms a tumor that arises from the right lateral wall at the level of the levator. The distal edge of the tumor is at 2cm from the anal verge and the tumor abuts the internal sphincter. It is at clinic stage III (mrT3aN1b). In this kind of case with a distal tumor, sphincter preservation is very unlikely, and local recurrence is higher for distal tumors than for proximal tumors.

All three modalities of treatment would likely be considered for this patient: chemotherapy because she’s at risk of distant spread, radiation for local control and the distal location and an abdominal perineal resection surgery to maximize disease control. But quality of life priorities that must be considered include maintaining fertility and avoiding a permanent colostomy.

“This is a great case because it’s so illustrative of so many issues, but it’s also a terrible case because when you see cases like this you know the discussions are going to be very difficult and there is no perfect solution and compromises are going to need to be made.”

Harvey Mamon, MD, PhD, Associate Professor, Radiation Oncology, Harvard Medical School, Director of GI Radiation Oncology, Brigham And Women’s Hospital, Chief, Division of Gastrointestinal Radiation Oncology

3. Fertility preservation options should be discussed as soon as possible after diagnosis.

When a patient has more time to consider egg harvesting or freezing sperm, they can consider it and accomplish it without significantly delaying the onset of their cancer treatments.

“We do want to see these patients as soon as possible, not only because it gives them more options and more time for options. When we talk to patients about fertility preservation, we want them to take a more bird’s-eye view instead of just whether or not they want to freeze their eggs or sperm. They also have to answer questions about whether they can carry a pregnancy after radiation treatment or do genetic testing in the case of a genetic mutation.”

— Terri L. Woodard, MD, Associate Professor Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center

4. Early psychological and social support is necessary for young colorectal cancer patients.

Early referral for a psycho/social assessment is especially important for adolescent and young adult colorectal patients who will have to transition to a permanent colostomy. Reducing the anxiety and depression related to the necessary changes in daily life, family, jobs, social interaction and more

“As clinical social workers and oncology social workers, the No. 1 goal is making sure we meet that patient where they are at and get a sense of who they are, who their support is, if they have any barriers to care based on their socioeconomic status and understanding workplace issues.”

Krista Nelson, LCSW OSW-C BCD FAOS, President of the Association of Community Cancer Centers

“In my experience working with younger patients, it is such an enormous adjustment and really impacts their quality of life and body image and conversation with family and friends and dating and so many different layers of life. Providing support and psychotherapy around anticipating the adjustment and then making the adjustment to life with a colostomy is hugely important.”

Hadley Maya, MSW, LCSW, Center for Young Onset Colorectal Cancer Clinical Social Worker, Memorial Sloan Kettering Cancer Center

For additional topics addressed in Session IV, view the full presentation online.

Other highlights of Day 3 included breakout sessions about “Understanding and Addressing Disparities in Early-Age Onset Colorectal Cancer” and “Integrating Music Therapy in Cancer” followed by the conference-concluding Session V, a panel discussion titled “How Did This Happen? Investigating the Causes of Early Onset Colorectal Cancers.”

Moderated by Stephen Gruber, M.D., that session addressed the future of early-age onset colorectal cancer that included discussions about mining electronic health record data and integration with large-scale genomic analyses, the international colorectal pooling project, how microbiome interactions contribute to the rise of early-age onset colorectal cancer and how diet, smoking and obesity, as well as maternal obesity and gestation growth.

Gruber stressed the need for continued collaboration and specific investment to help further the fight against the increasing trend of colorectal cancer in younger people.

“This is not a rare disease anymore but at each center there’s a relatively small number of cases,” Cynthia Sears, MD, Professor, Johns Hopkins University School of Medicine. “.  If I can dream, we would create a network, a center of communication and a way to contribute, maybe similar to the TCGA Data Portal – a big data set and some parallel sample collection that would allow, hopefully, the exposure questions to really be pursued. I do think it’s the epidemiology, exposures and sufficient population that we need and it’s hard to get it at one institution.”

In closing remarks, Cindy Borassi, president of the Colon Cancer Foundation, thanked the nearly 300 conference attendees and 50 medical professionals who participated in the seventh annual Early-Age Onset Colorectal Cancer Summit. Sponsors for the summit included Quest Diagnostics, Walgreens, Exact Sciences, Colon Cancer Coalition, Colon Cancer Prevention Project, Taiho Oncology, Daiichi-Sankyo, BRACCO Group, DuClaw Brewing Co. and Squatty Potty

“We invite you to join the discussion, collaborate with thousands of health professionals who are interested in solving the early-age onset colorectal cancer issue,” Borassi said. “I would encourage everyone to tell others to watch the videos on the platform, especially primary care physicians as we all know they are a bit part of the key to solving this issue.”

Day 2 Highlights

Day 2 included the Keynote Address of Stephen Gruber, MD, and Session II, a panel discussion called “The Dimensions of the EAO-CRC Problem: Do We Have Accurate, Regular, Up to Date Measurement of Key Metrics Describing the Early Age Onset Colorectal Cancer Public Health Crisis.” That session included an update about the rising early-onset CRC trends and racial disparities, the impact of COVID-19 on CRC screening and an under-19 incidence and mortality report. Session III was a panel discussion that explored “Risk Assessment/Family History Ascertainment” and included discussions about CRC screening guidelines, increased access to genetic testing and patient access to appropriate care.

Day 1 Highlights

On Day 1, Dr. Whitney Jones, MD, founder of the Colon Cancer Prevention Project, moderated an Session I, a panel discussion about “Improving Earliest Possible Diagnosis and Treatment through Timely Recognition of the Symptoms and Signs of Sporadic Young Adult CRC” with additional topics related to the echo chamber of cyclical discussions, incidence rates and mortality rates by 2040, primary care in improving early diagnosis and a colorectal cancer patient testimonial case study.

To watch any of the presentations, register for the Early Age Onset Colorectal Cancer Summit and access the recorded programs.

Suggesting a call to action for a more comprehensive and collaborative effort against the rise of colorectal cancer in patients under 40, Stephen B. Gruber, MD, PhD, MPH, presented the Keynote Address of the seventh annual Early-Age Onset Colorectal Cancer Summit on Saturday, May 15.

Gruber’s lecture was the highlight of Day 2 of the three-day conference, which is being held online in a virtual format because of ongoing Covid-19 precautions. It is organized by the Colon Cancer Foundation, a New York-based 501(c)3 non-profit organization dedicated to reducing colorectal cancer incidence and death.

Gruber, the vice president of the City of Hope National Medical Center in Duarte, Calif., began his presentation with the story of a young patient, who at age 28, was diagnosed with colon cancer that led to metastatic disease and ultimately her death despite having had no known risk factors for colon cancer.

Despite all of the best efforts to understand how she developed colon cancer at such a young age, it wasn’t possible to trace her disease back to any specific genetic or environmental causes. Unfortunately, that’s the status quo for early age onset colorectal cancer as of 2021, Dr. Gruber said. Although overall incidence rates of colorectal cancer have declined over the past 30 to 40 years, the incidence rate has increased substantially since the mid-1990s in adolescents and young adults.

According to the American Cancer Society, colorectal cancer is the third leading cause of cancer-related deaths in men and in women in the U.S., and the second most common cause of cancer deaths when men and women are combined. It’s expected to cause about 52,980 deaths in the U.S. in 2021. The overarching etiology of the disease has not been established; there is no definitive cause of colorectal cancer.

From 2013 to 2017, incidence rates dropped by about 1 percent each year. But that downward trend is mostly in older adults and masks rising incidence among younger adults since at least the mid-1990s. From 2012 through 2016, it increased every year by 2 percent in people younger than 50 and 1 percent in people 50 to 64.

“The reasons remain unknown. We don’t know why cancer is increasing in this group,” Dr. Gruber said. “As we think about all of the possible explanations, including Western-style diet, obesity, physical inactivity, antibiotic use, especially in the early life period of time, it’s not clear why this increase incidence and epidemic of early onset colorectal cancer is being observed.”

Dr. Gruber presented regional findings from his experience and research at the City of Hope National Medical Center in Duarte, Calif., work from the USC Norris Comprehensive Cancer Center in Los Angeles, as well as numerous other national and international studies to help understand some of the reasons that might be contributing as to why the disease is increasing in younger people.

He presented papers that outlined risk factors classified into systems and institutions, including screening policies within healthcare systems that contribute to early diagnosis or fail to diagnose. He questioned how microbiome changes within family environments could impact the change in incidence of the disease, and highlighted papers that explored the possibilities of germline genetics.
He referenced two papers based on studies of colorectal cancer patients under the age of 40 and under the age of 35 that showed relatively low relationships to genetic predisposition based on incidence rates of germline mismatch repair mutations (Lynch Sydrome) bi-allelic MutYH mutations or Li-Fraumeni Syndrome.
“These data are actually quite consistent, whether or not from a single institution or whether or not it’s from a large national family registry over a longer period of time, what we’re actually recognizing is that much of what we actually see is not easily explained by mendelian cancer genetic syndromes,” Dr. Gruber said.
He also explored whether or not population genetics is a likely explanation for the rising incidence of early age onset colorectal cancer. Gruber pointed out that polygenic risk scores — which can identify numerous, individual loci across the human genome that contribute modest risk of colorectal cancer — can ultimate help measure genetic susceptibility. But he said doubts that any singular genetic factor has influenced the rise in adolescent and early adult incident rates.
Dr. Gruber put a lot of his emphasis on the need to address modifiable risk factors as possible correlations to the rise of early-age onset colorectal cancer risk. He highlighted a paper that presented factors that decreased risk (including aspirin, physical activity, statins, vegetable consumption) and those that increased risk (alcohol consumption, Body Mass Index, smoking, processed meat consumption).

He also specifically highlighted coffee consumption and the risk of colorectal cancer and highlighted a study conducted by Stephanie Schmit of the Cleveland Clinic that showed the more coffee people drank, the lower their risk of colorectal cancer. He also pointed out that decrease in coffee consumption and the slight rise of energy drinks over the past decade or so might have led to a microbiome change that might have led to increased risked, but he said it would be hard to postulate that any single risk would be hard to correlate that to the rise in early onset colorectal cancer incidence.

Dr. Gruber also acknowledged and expressed concern about the significant factor that systemic racism plays in the inability to address these disparities in incident and survival rates. He pointed out that the survival rates for those who have early onset colorectal cancer are lowest among individuals with lower socioeconomic status, while the highest survival rates are associated with the people with the highest socioeconomic status.

Ultimately, more questions than answers still remain in the fight against the rising tide of early-age onset colorectal cancer.

“I think it’s actually less likely to be polygenetic risk than it is poly risk, which will include things like medications, physical activity, diet and other trends and changes in risk factors that hopefully we will be able to explore with the same specificity that we are now understanding through genetic studies,” Dr. Gruber said. “It is going to take our collaboration and a lot of work to answer the question that we do not yet understand: Why is there an epidemic of early age onset of colorectal cancer? We have an obligation and an opportunity to understand why the risk of colorectal cancer is rising in early age onset individuals.”

Other highlights of Day 2 included Session II: “The Dimensions of the EAO-CRC Problem: Do We Have Accurate, Regular, Up to Date Measurement of Key Metrics Describing the Early Age Onset Colorectal Cancer Public Health Crisis.” That included an updated about the rising early-onset CRC trends and racial disparities, the impact of COVID-19 on CRC screening and an under-19 incidence and mortality report. Session III was a panel discussion that explored “Risk Assessment/Family History Ascertainment” and included discussions about CRC screening guidelines, increased access to genetic testing and patient access to appropriate care.

To watch Friday’s or Saturday’s presentations, register for the Early Age Onset Colorectal Cancer Summit and access the recorded programs.

The Early-Age Onset Colorectal Cancer Summit continues on Sunday, May 16 with Session IV: a moderated panel discussion titled, “How to Provide Timely, Effective, Quality of Life & Fertility Preserving Treatment: What Are Key Elements of Coordinated Care for Early Onset Colorectal Cancer?” at 10:30 a.m. ET. A panel of experts will offer input about patient perspective, nurse navigation, genetics, medical oncology and new therapeutics, surgery, financial burden/toxicity, radiation oncology, psychological needs, pediatrics and palliative care.

That will be followed at 1 p.m. ET by breakout sessions about “Understanding and Addressing Disparities in Early-Age Onset Colorectal Cancer” and “Integrating Music Therapy in Cancer” before the conference concludes with Session V at 2:25 p.m. ET, a program titled “How Did This Happen? Investigating the Causes of Early Onset Colorectal Cancers.”