Collaboration and Early Onset Colorectal CancerJun 15, 2021
In recent years doctors have seen an alarming rise in colorectal cancer in patients younger than 50 which is why Chris Lieu, MD, was not surprised when the recommended colorectal cancer screening age was lowered to 45 for people at average risk. “Those of us who are in the clinic are shocked by the number of young patients who are perfectly healthy — they aren’t obese, they don’t have underlying diabetes, or high blood pressure — but they’re developing cancer" says Dr. Lieu.
Of particular concern to Dr. Lieu is the rise of colorectal cancer cases in patients from underrepresented populations. For example, incidences among younger African Americans are nearly double the number in the young white population. Through his research, Dr. Lieu emphasizes the importance of studying biological causes of early-onset colorectal cancer disparities while keeping in mind how social determinants of health, from health care access and systemic inequities to poverty and chronic stress, contribute to the problem.
“There may be multiple things going on, we get so focused on the science that sometimes we forget about some of these other environmental and systemic and institutional topics. It’s a good reminder to be a little bit more holistic in the way we look at things" says Dr. Lieu.
While genetics play a large role in early onset colorectal cancer Dr. Lieu emphasizes the fact that there are other factors outside of the body that are just as important, if not more so. "How do race, gender, even insurance coverage, and general health impact the biology and development of early-onset colorectal cancer? How much of what we’re seeing is delayed care because of health care access? What resources are available in a community? Does a community have good primary care for younger individuals?” says Dr. Lieu.
Although we may not have the answers to all of these questions right now, increased information sharing and collaboration are an important first step in determining the cause of early onset colorectal cancer and identifying ways our physicians and researchers can impact on an individual level and a more macro level. The other part of the solution is as simple as raising awareness surrounding colorectal cancer in younger patient populations.
“There has been data published that shows that in older adults, patients may have symptoms for a month before being diagnosed with colorectal cancer; in younger adults, they sometimes have symptoms for more than a year" says Dr. Lieu. “The longer patients wait to establish a diagnosis, the more likely it is they’re going to have an advanced stage at the time of diagnosis."