This Colorectal Cancer Awareness Month, we can celebrate progress: Overall mortality rates for colorectal cancer are lower than ever. However, this overall decline is also masking a concerning new trend: a younger demographic being diagnosed with and dying from colon cancer.
A recent study, “Colorectal Cancer Mortality Rates in Adults Aged 20 to 54 Years in the United States, 1970-2014,” published as a research letter in JAMA last August, revealed that death rates among adults aged 20 to 54 had increased to 4.3 deaths per 100,000 people in 2014, which is up from 3.9 per 100,000 in 2004.1
But what does this really mean for the medical community? What actions need to be taken to address this changing landscape? And how can gastroenterologists best combat this new reality in the fight against colon cancer? Now, more than ever, every possible means of detection and colon cancer surveillance is needed. Here are a few points to for the medical community to consider:
Super Size Screening and Surveillance
Ultimately, screening clinically appropriate young adults and catching colon cancer early will continue to be crucial. If you find something in a young adult, they have a potential lifetime of clinical surveillance ahead of them. This surveillance might outlast your practice, they might move, or simply change gastroenterologists. Endoscopic tattooing provides a lifetime of confidence that you or another gastroenterologist is following up on the same disease you found when your patient was a young adult.
Endoscopic tattooing is a proven method for surveillance in colon cancer patients, and is society-recommended by the American College of Gastroenterology, the British Society of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Spot® Ex offers an easier to use, easier to find endoscopic tattoo,2 that has new expanded indications that support the ESGE’s updated clinical guidelines.3 With younger patients, the permanence of Spot® Ex Endoscopic Tattoo means the tattoo will be visible for the years of follow-ups and disease management ahead.
Research is also being done on whether colon cancer in younger people is, in fact, different. For example, the chief medical officer for the American Cancer Society, Dr. Otis Brawley, told The New York Times there is also evidence that young people are more likely to have precancerous polyps that are harder to see and remove during a colonoscopy both because of their location in the colon and/or because they are flat rather than tubular. By localizing and clearly marking lesions of any shape and size discovered during a colonoscopy with a dark, permanent tattoo, follow-up surveillance, or in the worst case, colon resection surgery, is easier.
Educate Early and Often
Education will be key. With younger patients coming to the forefront, medical professionals need to start educating this new demographic, ensuring that they are aware of their own personal risk and symptoms.
The situation is particularly challenging because no one knows yet what lifestyle, environmental or genetic factors are driving the increase, but the trend points to the urgency to identify more reliable ways to identify and manage this disease.
Because the contributing factors are still uncertain, family medical history continues to be an important indicator—whether they had colorectal cancer, or even benign polyps, which can be precancerous—and surveillance will be absolutely critical.
More Colorectal Cancer Research is Needed
There’s still a lot to learn about this trend and understandably, some medical professionals are hesitant to jump to conclusions and encourage more research. Dr. Michael Potter, a professor of family and community medicine at the University of California, San Francisco, spoke with The New York Times on the subject, saying, “It’s worth doing research in this area to determine whether lowering the age of colorectal cancer screening would yield more benefits than harms. These are not risk-free procedures.”
And in a recent post from the Cleveland Clinic, colorectal surgeon Dr. Matthew Kalady commented on the importance of weighing the risks as well, “It’s imperative to continually change our guidelines for colorectal cancer screening as we learn more about it. We must always balance our desire to screen patients with the risk of complications and cost.”
This Colorectal Cancer Awareness Month we’re helping to build awareness by helping doctors spread the word about endoscopic tattooing. Continue the conversation this National Colorectal Cancer Awareness Month and beyond by sharing the Tattoo You’ll Never Regret.
In the ongoing fight against colon cancer, strong surveillance that includes endoscopic tattooing will be key to the prevention and management of colorectal cancers. Learn more about the role of endoscopic tattooing in colon cancer surveillance and prevention here:
1 - Siegel, Rebecca L., et al. “Colorectal Cancer Mortality Rates in Adults Aged 20 to 54 Years in the United States, 1970-2014.” Jama, vol. 318, no. 6, 2017, p. 572.
2 - Spot Ex Luminosity Lab Results. Northwestern Biological Imaging Facility. Nov 2017
3 - Ferlitsch M, Moss A, Hassan C, et al. Colorectal polypectomy and endoscopic mucosal resection (EMR): ESGE Clinical Guideline. 2017.