What millennials need to know about colon cancer: Q&A with Dr. Jon LaPook

Colon cancer rates continue to rise in younger age groups, according to a new study out this month.

The report from the American Cancer Society shows colorectal cancer is increasingly being seen in younger individuals, and cases are being detected at more advanced stages, when it’s more difficult to treat. The study found 60% of new cases in 2019 were advanced-stage disease. 

“Shockingly, 1 in 5 people who will be diagnosed presently are younger than 55 years of age, which is quite young for colorectal cancer,” says American Cancer Society CEO Dr. Karen Knudsen. The study showed the increase in ages ranging from 20 to 49, which includes the millennial generation. 

Colorectal cancer is the third deadliest form of cancer in the United States. The American Cancer Society anticipates 153,020 new cases this year, and 52,550 deaths. 

We spoke with CBS News chief medical correspondent Dr. Jon LaPook, who is also a gastroenterologist at NYU Langone Health, to get answers to some common questions:

Q: What’s driving the rise in cases?

LaPook: “We don’t really know. There are a lot of suspects, but the actual villain isn’t clear. Is it the fact that we are more obese? Because obesity is a risk factor. More sedentary? Something in the environment? Something we’re eating or drinking? Or fascinating to me is the microbiome, the trillions of bacteria, thousands of species, in our colon. Our microbiome is changing and that may be contributing to the increase.”

Q: Are there steps people can take to reduce their risk?

LaPook: “You can get screened. That is why they have dropped the age that you first get screened, if you’re at average risk, from 50 down to 45.”

If you’re at increased risk, which includes having a family history or inflammatory bowel disease, talk to your doctor about being screened earlier. 

LaPook also says to be aware of the Centers for Disease Control and Prevention’s list of risk factors, which includes:

• lack of regular physical activity
• a diet low in fruit and vegetables
• a low-fiber and high-fat diet, or a diet high in processed meats
• overweight and obesity
• alcohol consumption
• and tobacco use

Q: What are the red flags that someone should get an exam?

LaPook: “If you are younger than the recommended age for a screening, look out for symptoms including:

• change in stool
• rectal bleeding
• weight loss for unexplained reason
• abdominal cramping
• and iron deficiency or anemia. 

“If you’re told of a low iron and there’s no obvious explanation, then that’s something that your health care provider should help evaluate. And you know, one of the things you can do is do a test to see if you have invisible blood in the stool.” 

That means if you have low iron levels levels, don’t just assume it’s just from menstruating, and “if you have rectal bleeding, don’t just write it off to hemorrhoids,” he adds. 

Q: Colonoscopies can be daunting. What words of encouragement do you have for readers who are hesitant or nervous to get this screening?

LaPook: “Whether you have symptoms or not, it can be intimidating to do a colonoscopy and just the thought of an instrument going into your colon can be can be daunting, but the hardest part is truly the prep, and even that can be made tolerable. … The risks are extremely low here, and this is an extraordinarily effective procedure that has already very significantly decreased the risk of colon cancer over the last five decades and could save your life.”

If people are still uncomfortable with that screening option, there are also at-home tests available.

Q: Any other takeaways? 

LaPook: “The main thing is to just be aware of symptoms and understand that this is a no-embarrassment zone. It’s very hard for people to talk about rectal bleeding and anything to do with their stool, but we have to use our words. … It’s very important to have a relationship with a health care provider where you can be absolutely honest … and you tell that person everything that’s on your mind, including if you have what could be construed as embarrassing symptoms.”