An expert from Yale Cancer Center discusses colorectal cancer among young people, screening guidelines, and more

Michael Cecchini, MD, Yale Cancer Center medical oncologist specializing in gastrointestinal cancers, is available to discuss several topics during colorectal cancer awareness month.

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Are colorectal cancer rates rising among young people, and if so, why?

"This is a very important question. There is a rising incidence of early onset colorectal cancer, which is generally defined as adults less than the age of 50. Historically this has been an age group that did not undergo screening, although within the last several years the screening guidelines have changed to recommend screening to all individuals 45 years of age and above. We do not have a great explanation for why there has been a rise in incidence, but it is likely related to lifestyle and environmental factors. There is a lot of work from researchers around the globe trying to better understand this rising incidence in early onset colorectal cancer so that we can take additional steps to reverse this trend." 

What are the top risk factors of colorectal cancer?

"The most common risk factors for colorectal cancer are a personal or family history of colorectal cancer, including inherited syndromes (i.e. Lynch Syndrome and Familial Adenomatous Polyposis Syndrome), age, prior radiation to the abdominal cavity, and a history of Crohn's disease or Ulcerative colitis. There are other risk factors, but these are the major ones."

Why is it so important not to skip colorectal cancer screenings?

"Screening is critical in this disease. First screening can diagnose cancer at an earlier stage before there is evidence of cancer spread, which are referred to as metastases. The earlier the stage at diagnosis the better the prognosis overall, and the higher the chance of cure. Second, colonoscopy as a screening method not only has the power to diagnose cancer at an earlier stage, but it also has the power to remove precancerous polyps before they even develop into the cancer. This second point I think really highlights the power of colonoscopy as a screening method."

Are there disparities in colorectal cancer in people of color, and what can be done about it? 

"There are definitely disparities in the outcomes and survival for people of color that are diagnosed with colorectal cancer in the US. These disparities are even more pronounced in younger patients, and it's a very important issue that deserves attention. More efforts to fund research to better understand these disparities and develop strategies to improve screening and access to care for people of color is imperitive. It is absolutely crucial that medical care for colorectal cancer screening and treatment is equitable." 

Why did the US Preventative Services Task Force lower the recommended age for first colorectal screening from 50 to 45, and why is this still important news?

"The recommended age for screening was decreased to 45 from 50 several years ago. This is an important first step to reducing the incidence of early onset colorectal cancer and improving outcomes for this age group. The incidence of colorectal cancer for adults > 50 has reduced over the past several decades, in large part due to effective screening. We need to now make a better effort to screen our younger adults, so it is important patient's and physician's be informed about the change in screening guidelines and get their colonoscopy or other approved screening test that may be recommended by their physician."

Dr. Cecchini is an Associate Professor of Medicine at Yale School of Medicine and Co-Director of the Colorectal Program in the Center for Gastrointestinal Cancers at Yale Cancer Center. Dr. Cecchini focuses on developing new treatments for patients with advanced gastrointestinal cancers. His specific research includes leveraging innovative DNA-damaging therapies as a strategy to enhance the immune response. He has participated as a principal investigator or sub-investigator in over 100 clinical trials.

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