Rising Colorectal Cancer Rates in Younger Adults Prompt Earlier Screening Recommendations

Researchers from National Taiwan University Hospital have reported a troubling increase in the prevalence of advanced colorectal neoplasms among younger adults in Taiwan, indicating a need to rethink the age at which routine screenings for colorectal cancer should begin.

The findings, detailed in the journal Clinical Gastroenterology and Hepatology, are based on a comprehensive analysis of screening colonoscopies conducted on nearly 28,000 individuals aged between 40 and 54 from 2003 to 2019. Over this 17-year span, there was a notable rise in the occurrence of advanced neoplasms, including high-risk adenomas and colorectal cancers, particularly among those aged 45 to 49. The prevalence of these conditions in this younger cohort is now approaching levels typically seen in individuals aged 50 to 54, the age at which Taiwan has historically initiated population-wide screening since 2004.

The study indicates a significant generational shift, with individuals born after 1964 demonstrating a higher likelihood of developing early-stage colorectal lesions. This trend is thought to be associated with lifestyle changes linked to Taiwan's rapid economic and social development over recent decades, including dietary habits and levels of physical activity.

Advanced adenomas are precursors to colorectal cancer, which can often be effectively treated when detected early. However, if these growths are not identified and removed, they can progress to invasive cancer, a leading cause of cancer-related deaths globally, including in Taiwan.

In many countries within the Asia-Pacific region and Europe, routine colorectal cancer screenings are generally recommended to start at age 50. However, the authors of the study argue that this age threshold may be inadequate, as individuals may already have advanced adenomas or invasive cancer by the time they reach 50. Initiating screening at age 45 could significantly enhance early detection and prevention efforts.

Concerns regarding the increasing incidence of colorectal cancer among younger populations are gaining traction worldwide. In response, countries such as the United States and Australia have already adjusted their screening guidelines to commence at age 45. Given the substantial population size of Taiwan and the critical economic roles played by individuals in this age group, the importance of early screening is particularly pronounced.

After careful consideration of the rising incidence rates among 45 to 49-year-olds in Taiwan, which now surpass those observed in their U.S. counterparts, the Taiwanese government has decided to lower the screening age to 45, effective from 2025.

Experts emphasize the preventability of colorectal cancer with early detection. The research underscores the necessity for updated public health policies and a deeper investigation into the underlying factors contributing to the increased risk observed in younger generations.