‘Disturbing’ rise in young-onset gastrointestinal cancers

‘You have bowel cancer’ are four words you don’t expect to hear when you’re young, but each year over 1500 young Australians do according to Bowel Cancer Australia.
 
Now experts are warning of a ‘disturbing’ trend among those under 50.
 
New Australian data published in Cancers this month shows a ‘significant’ increase in young-onset gastrointestinal adenocarcinomas over the past three decades.
 
Researchers from Flinders University and the University of California discovered the worrying trend by looking at South Australia’s long-term Cancer Registry and are now calling for greater efforts to understand and address the growing problem.
 
The team found that over a 27 year period between 1990 and 2017, there were almost 30,000 patients diagnosed with either oesophageal, stomach, colorectal or pancreatic carcinoma, and of those, 7.5% were aged 18–50.
 
Moreover, the incidence of these cancers in people under 50 progressively increased from 9.3 per 100,000 people to 12.89 per 100,000 people.
 
The trend observed in the young cohort was not mirrored in older individuals aged over 50 years, where the incidence rate sits in the order of around 200 per 100,000 people.
 
Speaking to newsGP, Chair of RACGP Specific Interests Cancer and Palliative Care Associate Professor Joel Rhee said ‘this is a worrying trend, especially from a population health perspective. The findings show that younger people are not immune from gastrointestinal cancers.’
 
The type of cancer that appeared to have the greatest change in incidence rate was colorectal adenocarcinoma.
 
There was also a notable gender difference overall, with incidence rates increasing by 1% each year for males aged between 18 and 50, making it ‘more pronounced in men compared to women’ according to lead author Associate Professor Savio Barreto.
 
The reasons behind the observed trends are unclear despite similar patterns emerging internationally.
 
‘The data seems to be pointing to colorectal cancer as the main reason for the increase, and especially in people aged between 40 and 49,’ Associate Professor Rhee said.
 
‘This could reflect a real increase in disease incidence, or it could be that we are investigating more. Or it could be a bit of both.
 
‘I think most GPs would agree that a younger person presenting with gastrointestinal [GI] symptoms would be more likely to get an endoscopy investigation [upper or lower or both] during the 2010s compared to the 1990s.
 
‘The authors [also] mention a few possible explanations, and I tend to think that the increasing prevalence of metabolic disorders, unhealthy diet, sedentary lifestyle and obesity might be contributing to this trend.’
 
In light of this new data, GPs need to ask themselves how it might change clinical practice.
 
While population-based screening exists for colorectal cancer, it is only available for those aged between 50 and 74.
 
The authors of the study say lowering the screening age to 45 instead of 50 years for average-risk individuals could lead to earlier detection in younger patients, but it would also carry significant new challenges.
 
Millions of individuals aged 45–49 would become eligible and need to be screened yearly, creating a significant burden on an overloaded healthcare system that is already experiencing significant delays in screening currently eligible patients due to the pandemic.
 
Associate Professor Rhee agrees and says GPs need to put the findings into perspective.
 
‘Despite the trend, GI cancers still remain relatively rare in younger people,’ he said.
 
‘As a GP, I need to ask myself this question: does an increase from nine out of 100,000 people to 13 out of 100,000 people over a time period of three decades justify a significant shift in how I respond to people aged 50 years or younger?
 
‘A careful history, physical examination and appropriate investigations remain the order of the day.’
 
He also says we need to continue encouraging and supporting patients to adopt healthier lifestyles.
 
‘In the context of GI cancers, this means no smoking, reducing alcohol consumption, being physically active, having a balanced diet with lots of fibre, and maintaining a healthy body weight,’ Associate Professor Rhee said.
 
Ultimately, he says it is important for GPs to remain as vigilant as they normally are for cancer and other serious diseases, and not to exclude them simply because their ‘patient is young’.
 
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