Colorectal cancer remains the second most common cause of cancer deaths in the U.S., despite the overall number of incidences decreasing since the 1980s.
While colorectal cancer—which refers to both colon and rectal cancer—is most common in people 50 or older, a concerning trend is emerging in younger populations. The number of incidences has increased by about 2% per year in people younger than 50, while the death rate in the same population has risen 1% annually.
“Younger people are at increased risk compared to what they were," said Doug Corley, MD, PhD, chief research officer for The Permanente Medical Group. Colorectal cancer “is a substantial problem, and it causes a lot of mortality … and morbidity.”
The Permanente Medical Group is a part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Dr. Corley discussed the growing concerns about colon cancer in younger people, as well as how The Permanente Medical Group is helping these populations in a recent episode of “AMA Update.”
Lowering recommended screening age
Dr. Corley stated researchers cannot pinpoint the exact cause for the rise of colon cancer among younger populations. Obesity or being overweight increases the risk of many types of cancer, he said, as does decreased exercise. Changes in the bacteria within a person's gut can also influence cancer risk.
What he can explain is why the total number of colorectal cancer cases is decreasing. The answer, Dr. Corley said, is because older populations are getting screened regularly. Those screening efforts are helping lower the percentage of cases diagnosed in people older than 50.
"If we weren't doing screening, we would probably be seeing an increase in older people too,” he said. “As people get screened, we find and remove pre-cancerous polyps. That decreases their future risk of cancer.”
Dr. Corley suggested that people have been trained to start getting screened for colon cancer beginning at 50 years old. However, the American Cancer Society now recommends people at average risk of colon cancer begin to get screened at 45 years old.
Now more than ever, it’s important to help increase awareness about that lower age recommendation, Dr. Corley said. “The most effective thing we have is screening.
“It's so impactful compared to most other medical interventions,” he added, noting “our study suggests that timely, regular screening decreases the risk of death from colon cancer by about 50%. I mean, that's incredible."
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An alternative to colonoscopies
Dr. Corley and his colleagues within Kaiser Permanente recognized a large number of their patient population was not up to date with screenings. The team began a large outreach push, and that initiative took the percentage of up-to-date patients from 40% to 80%, he said.
A common form of colon cancer screening is with a colonoscopy, which provides doctors with a direct look inside the colon. The test does require patients take a day off to prep their bowel, and they are also sedated for the procedure.
Kaiser Permanente offered patients an alternative: a Fecal Immunochemical Test (FIT screening).
"This is a test that looks for small amounts of blood in the stool," Dr. Corley said. "It's very helpful because it's noninvasive. It can be done at home. This provides multiple different modes of screening and increased patient choice."
The FIT screening allows for more patient flexibility. By sending FIT screenings in the mail to patients, Kaiser Permanente is also able to connect with patients who may live in more rural settings or who do not regularly communicate with their care team. The latter is particularly relevant for younger populations, he said.
"They just don't have as many other health problems," Dr. Corley said of younger people. "They're not coming in for high blood pressure screening, or they're not coming in for treatment of other things."
Most people are advised to complete the FIT screening every year, he said, while the standard interval for a colonoscopy is every 10 years. Anyone who is at higher risk of colorectal cancer, such as someone with a close family member who had the disease, is encouraged to have a colonoscopy rather than the FIT screening.
If a patient has a positive test on their FIT screening, then they need a colonoscopy. Colonoscopies appear to be better at decreasing cancer incidence, Dr. Corley said, by finding more pre-cancerous polyps. But having the option to have either a colonoscopy or the FIT screening increases the screening prevalence.
"In most settings where colonoscopy is the only option, you tend to get screening rates of maybe 60% or 70%," he said. "But when you increase the number of options, then there's going to be people who choose the alternative rather than colonoscopy or who don’t get screened at all."
Proof of effectiveness
In 2024, Dr. Corley co-published a study in JAMA Network Open™ that highlighted the benefits of FIT screenings and the impact they have on patients. The study focused on the Kaiser Permanente patient population in Northern California, which is about 4.5 million people.
Within that population, Dr. Corley and his colleagues looked at patients who received FIT screenings in the mail and then studied who died from colorectal cancer and who did not.
The study found that people who had at least one FIT screening within the previous five years were about one-third less likely to die from colorectal cancer.
"A one-third reduction is a pretty substantial decrease in mortality," Dr. Corley said. "We would anticipate it to be even stronger over time or with more frequent screening, such as the recommended once a year screening with FIT.
“For the second most common cause of cancer death in the United States, to be able to have that type of reduction was a really exciting finding and supported the program,” he added.
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