The untimely deaths of actors Chadwick Boseman and James Van Der Beek, who both died of colorectal cancer in their 40s, have brought more awareness to the disease, which is impacting younger people at higher rates each year.
Colorectal cancer, which is the group name for colon and rectal cancer, is the leading cause of cancer deaths in adults under 50, and new research has found that rectal cancer deaths specifically are rising in adults in this age group — namely, millennials. According to NBC’s reporting, rectal cancer will be the top cause of cancer deaths in people under 50 by 2035 if the trend continues.
While rectal cancer is similar to colon cancer, the difference lies in where the cancer is located. “The rectum is considered a part of the colon … it is the end of the colon before the anus,” explained Dr. Jatin Roper, a gastroenterologist with Duke Health and associate professor of medicine at Duke University School of Medicine in North Carolina. “Because the tissue is biologically fairly similar, rectal cancer is often categorized with colon cancer under the name of ‘colorectal cancer.’”
“Rectal cancers are tumors that start in the rectum. They’re similar to colon tumors in many ways,” said Dr. Michael Foote, a gastrointestinal medical oncologist at Memorial Sloan Kettering Cancer Center in New York.
HuffPost spoke with doctors who pointed out the biggest warning signs of rectal cancer, along with guidance on what you can do to reduce your risk.
The most common signs of rectal cancer include bleeding and abdominal pain.
The most common symptom of rectal cancer is rectal bleeding. This red flag is particularly “much more common” in younger people with rectal cancer, Foote said. This could be blood in the stool or even maroon-colored stools, according to Roper.
The blood can range in color from bright red to dark red and can happen when you poop, or at random times throughout the day. The blood may appear in the poop itself or on the toilet paper when you wipe. This can cause some folks to confuse the bleeding for hemorrhoids or even menstruation.
Abdominal pain is also commonly reported. Additional symptoms include changes in bowel habits, constipation, thinner stool, fatigue and weight loss, Roper said. Anemia is also a sign of rectal cancer, he said.
Since rectal cancer happens at the end of the colon, it’s more likely that patients will experience thinner stools or blood in the stool, according to Roper.
“I think the key message is that any change in your gastrointestinal tract should not be ignored, and so any change in your GI function should be investigated by a doctor, and the most concerning signs that should prompt an investigation include any sign of blood in the stool,” Roper said.
In some people, though, rectal cancer has no symptoms, Roper said, which makes regular colorectal screenings even more crucial.
Rates of rectal cancer deaths are rising in younger adults.
Rectal cancer rates are currently rising in younger adults in their 30s and 40s.
Recent research published by the American Cancer Society shows that while colorectal cancer rates are declining in people 65 and older, rates are increasing in younger adults.
“We know that young people getting cancer, most of it’s on either the left side of the colon or especially in the rectum,” Foote said.
“The rate of rectal cancer is rising more quickly than the rate of colon cancer. We don’t know why,” Roper said. Historically, colon and rectal cancer were considered diseases of older individuals, according to Roper, but “it is now recognized that rates of colon and rectal cancer are rising dramatically in younger people. Such that it is unfortunately becoming common to diagnose cancers in individuals under the age of 50.”
Foote stressed that colon and rectal cancer are still overall rare in younger adults. However, cases are increasing more steeply in younger generations, Roper explained. The rate of rectal cancer in people born in 2001 (Gen Z) is higher than for millennials born in 1991, which is, in turn, higher than for the oldest millennials, born in 1981.
“Even in a recent report at a conference that looked at rates of colorectal cancer in teenagers ― very young individuals ― while the absolute numbers are quite low, the rate of rise is just remarkable,” Roper said.
Research shows that the rates of colorectal cancer in adults under 50 has increased by 63% since 1988, according to Foote. Eight out of 100,000 adults under 50 had colorectal cancer in 1988, and now that number is 13 out of 100,000.
While the overall numbers seem low, the increase is concerning “because it raises the possibility that there’s something in our environment or in our diet that we haven’t pinpointed that is increasing this risk in people that are younger, and until we identify what that is, it’ll be very hard to address it,” Roper said.
While research is ongoing, there are a few things experts think could be behind the increase in rectal cancer rates.
Obesity is a risk factor for colorectal cancer in both younger adults and older adults, both experts told HuffPost. “But, most of the people that have young onset colorectal cancer are not obese,” Foote said. Diabetes is also a risk factor, Foote added, but most younger people with colorectal cancer are also not diabetic.
“The rise in colorectal cancer in younger people started sometime between probably 1950 and 1990 … and [rates have] been increasing at a greater rate since,” Foote said.
It’s thought that something changed in our environment during that time; experts don’t believe the rate increase is simply because people are being screened more.
“It’s associated with a Western diet … high animal fat, high carbohydrates, relatively lower vegetables, red and processed meat, and … refined grains and processed sugars,” Foote said.
According to Foote, from 1950 to 1990, our food landscape changed. Fast food popped up across the country, preservatives became more plentiful and even plastic food containers ― which contain microplastics ― became commonplace.
“Other possible causes can include changes in the gut microbiome, or the bacteria that live in our intestinal tract,” Roper suggested. “That microbiome can be changing due to changes in our dietary habits in the last few decades or change in exercise habits. It’s a little bit unclear.”
There are steps you can take to lower your rectal cancer risk.
While there is no one way to totally erase your risk of developing rectal cancer, there are actions you can do to reduce your risk. First, it’s important to get your routine colonoscopy or a stool-based test, which both screen for colon cancer and rectal cancer.
For people at average risk, these start at age 45. “If the 45th birthday is coming up, plan one year in advance to get scheduled for one of these tests with the doctor,” Roper suggested.
For folks who can’t make time for a colonoscopy or don’t have someone to pick them up after the procedure, stool-based tests such as Cologuard and fecal immunochemical tests (FIT) are good options.
“And a positive FIT test or a positive Cologuard test means that you should get a colonoscopy to follow up to investigate that positive test,” Roper explained.
Those with a first-degree family history of colon or rectal cancer (a parent or sibling who had it) may be eligible to get a screening test before 45.
Beyond screenings, Roper recommended following a Mediterranean diet, which is low in animal fats, especially red meat, and high in soluble fibers such as many types of beans, veggies, fruits, seeds and whole grains.
“Try to avoid sugar-sweetened beverages,” Foote suggested. It’s also a good idea to limit your alcohol consumption.
“People are trying to avoid plastic containers more — I think that’s not such a bad idea,” Foot said, who added the caveat that data linking microplastics to colorectal cancer is not as clear.
“If you do have obesity or diabetes, think about trying medications or trying a lifestyle change to reduce your risk there as well,” Foote said. “And then talk to your doctor, get established with a primary care doctor early. A lot of young people don’t have access to primary care. They don’t prioritize it.”
Having a doctor you regularly check in with and who knows your personal history is an important way to manage your health. Don’t ignore symptoms of rectal cancer symptoms, either.
“I think this is a change in how the medical community looks at these symptoms over the last …10 to 20 years, because the incidence of rectal and colon cancers [is] rising so dramatically in younger people,” Roper said, before adding that the symptoms mentioned above deserve investigation but aren’t always signs of rectal cancer.
“If you’re having symptoms, don’t just sit on them,” Foote said. And if your doctor doesn’t take your symptoms seriously, don’t be afraid to escalate the problem.
