The overall incidence of colorectal cancer in the United States decreases, but increases significantly among young people. We spoke about this topic with Dr. Antonino Spinelli, Head of Colorectal Surgery in Humanitas Cancer Center.

Increased juvenile colorectal cancer: It is a study by the MD Anderson Cancer Center in Houston, Texas, published by Jama Surgery that raises the alarm: the number of cases of colorectal cancer in the United States drops in the over 50s, but it is growing rapidly among young people. The study also predicts a significant increase in diagnoses among 20-34 year-olds within the next five years (plus 37.8 percent) and more than 90 percent by 2030.

The decrease in the over 50 age group, the researchers explain, is attributable to a considerable increase in screening and control tests in the United States, aimed at providing a preventive plan among the population, in particular through the use of colonoscopy. The current guidelines recommend screening with a colonoscopy at the age of 50. The causes for young people still need to be investigated, also in the light of a lack of screening programmes and possible misbehavior.

“This tumor, which is very frequent, arises in the large intestine, that is in the colon and in the rectum – explains Dr. Antonino Spinelli – and it is caused by the uncontrolled proliferation of the cells of the mucosa, that is of the internal lining of the intestinal wall. The cancer develops most often in the colon (about 70% of cases) and less frequently in the rectum (30%). It is a tumor that can be prevented or cured if diagnosed early. In most cases, in fact, the tumor is determined through the initial formation of so-called adenomatous polyps, lesions due to altered cell proliferation but initially benign and only over time able to evolve into cancer.

“The causes of the increase in the incidence of colorectal cancer among young people may depend on the environment, personal habits, and type of nutrition,” comments Dr. Spinelli, who adds: “However, in Italy, according to data from the Italian Association of Cancer Registries, the number of cases found in people under 50 does not show growth.

“Prevention remains fundamental”, says Dr. Spinelli. “Correct the eliminable risk factors (diet, lack of physical activity, smoking, alcohol…) is the first weapon to be added to the screening for the over 50 age group: in Italy there are in fact specific programs for the prevention of colorectal cancer, which are based on the search for hidden blood in the feces. If the test is positive, it is indicated (mandatory) that a colonoscopy is performed to exclude cancer as the cause of the positive test. Humanitas Cancer Center is the reference center for the Lombardy Region for the execution of colonoscopy as part of the screening program. “For the under 50 age group – concludes Dr. Spinelli – special attention should be paid to those who have family history with this type of cancer (i.e. cases of colorectal cancer in first-degree relatives). The international guidelines in force recommend that these people anticipate the execution of the first colonoscopy at the age of 40”.