Raising Awareness for Colorectal Cancer, On the Rise in Younger Adults

During Colorectal Cancer Awareness Month, Dr. Shyam Thakkar discussed rates of this disease in young adults: © Suttipun - stock.adobe.com.

During Colorectal Cancer Awareness Month, CURE sat down for an interview with Dr. Shyam Thakkar to discuss a wide range of topics related to the disease, including its rising rates in younger adults, the potential role of artificial intelligence and disparities that currently persist among this patient population.

Thakkar is a professor and director of Advanced Therapeutic Endoscopy in the Department of Medicine, Division of Gastroenterology and Hepatology, at West Virginia University, in Morgantown.

CURE: What is the importance of recognizing Colorectal Cancer Awareness Month for patients?

Thakkar: Colon cancer is the second leading cause of cancer-related deaths in the United States. Approximately 150,000 people are diagnosed annually and there are approximately 50,000 deaths annually. When it comes to colorectal cancer, it is a completely preventable disease.

It is important for patients to understand that with a colonoscopy screening, they can undergo a procedure whereby a flexible tube with a camera integrated into it essentially can be inserted while they are asleep. The entire colon can be inspected, and polyps — which are the precursors to colon cancer — can be identified and removed at that time, in effect preventing colon cancer from happening.

Can you speak to the rise of colorectal cancer, especially in younger people, and what do you believe may be contributing to this rise in incidence?

Colon cancer has been increasing in the population under the age of 50. With our screening processes and modalities, it has been decreasing in populations over the age of 50. However, that increase in the population under the age of 50 is one of the reasons why the screening age for patients without a family history, without any other risk factors, is at age 45 — that age was dropped from 50 to 45 several years back.

Now, why is it that we are seeing an increase in the incidence of colon cancer in the younger population, early-onset colorectal cancer, as we can call it? What we believe are some of the risk factors related to that are Western diets, diets high in red meats, obesity, lack of physical activity or exercise, smoking, and heavy alcohol consumption. These are all potential risk factors, and then genetics, that we are seeing as causes for the rise in the incidence of colorectal cancer in the younger-age populations.

What clinical trials do you currently have your eye on in colon cancer care?

There is a lot of research going on in colorectal cancer right now, especially towards minimizing the impact of colon cancer that has already developed or later-stage colorectal cancer by understanding tumor biology and the oncologic therapies that are available to help reduce progression and induce remission of disease. Many of the specialty cancer centers have access to these clinical trials.

Now, there have been some landmark trials when it comes to screening colonoscopy in and of itself. One area that I would like to bring to attention is trials around artificial intelligence, so essentially using what we call computer-aided detection to help us identify polyps at the time of colonoscopy. There was a wonderful study that was published in *The New England Journal of Medicine* that essentially looked at adenoma detection rate. Adenomas are the precursor-type polyps that can develop into cancer. And what we know from that study is that endoscopists who had a higher adenoma detection rate had a lower interval colorectal cancer development in their patient population for patients who underwent colonoscopy. … The higher your basically adenoma detection rate was, the less chance of a patient developing colorectal cancer in your population. That is one of the reasons why artificial intelligence helps us so much.

What we know from the studies around artificial intelligence is that it can take anyone's adenoma detection rate and essentially give it a bump up. We have seen this bump typically being about a 10% to 15% increase in their adenoma detection rate, and the increase in adenomas per colonoscopy that are detected is up to 50% more. So, the long and short of it is that when it comes to recent research that has been really impactful in screening colonoscopy, I would have to say, research around and the development around artificial intelligence to help endoscopists find polyps and maximize the application of colonoscopy to minimize the risk of colorectal cancer developing in a patient who has already had a colonoscopy.

How do disparities in access to screening and treatment impact colorectal cancer outcomes? What steps can be taken to improve equity in care?

Diversity, equity and inclusion are really important when it comes to treating patients that have colorectal cancer or patients that are trying to access colonoscopy screening. We do everything we can as providers to be as inclusive as possible for these patients. [However], we have certainly seen that certain populations have a higher incidence of colorectal cancer, partly because they have less access to screening colonoscopy, and partly because they are a race, as an example, that has an increased risk of developing colorectal cancer.

African American and Hispanic people typically have higher colorectal cancer rates. Inner city populations have a higher risk of colorectal cancer than suburban populations. And so, some of the things that we're trying to do to improve outcomes in these populations are, of course, increasing awareness amongst these different populations, and increasing awareness of screening opportunities for these patients, and then also communicating the importance that screening isn't for patients with symptoms. Screening is for patients that are completely asymptomatic – it's for a patient that has no symptoms, so by helping individuals understand that with colorectal cancer, the most common symptom of it is no symptom at all, that it's so important for them to get their screening done when they turn 45 or sooner, depending on their risk factors and genetic predisposition.

Transcript has been edited for clarity and conciseness.

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