Colorectal Cancer and Millennials: Colon Polyps versus Colon Cancer – How Millennials Can Be Proactive

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By: Melissa Schenkman, MPH, MSJ

When I checked in for my first colonoscopy at age 38, the health journalist in me couldn’t help but ask the nurse this as my first question:

“Am I the youngest person you’ve seen in the waiting room today?” She nodded her head and responded, “Yes, you are.” My response: “I should not be. That’s a problem now isn’t it?”

It is a problem because colorectal cancer is predicted to become the leading cause of cancer-related deaths by 2030—less than 10 years from now—for people ages 20-49, according to a study published in the Journal of the American Medical Association in April 2021.

So, why are many millennials rolling the dice on their colorectal health when it comes to screening? It’s simply because so many of us do not really know any better due to lack of awareness and clarity of relevant information.

For me, I knew I had a parent who had a large colon polyp found on her first colonoscopy when she was just 40 years old and without removing it her doctor said she would not have been here at age 50. But what I did not know and only learned through my reporting over the years for YMyHealth, is that it meant that as her daughter I should have had my first colonoscopy at age 30.

Suneel Kamath, MD, is a medical oncologist who specializes in gastrointestinal cancers. He is passionate about treating and preventing these types of cancers in millennial- and younger-aged patients

My fellow millennial Suneel Kamath, MD, who is a medical oncologist specializing in gastrointestinal cancers at the Cleveland Clinic, breaks down colon polyps versus cancers, the roles of family history and health insurance, and tells us how we can be proactive about preventing ourselves from getting colorectal cancer.

YMyHealth: To begin, what’s the difference between colon polyps/adenomas and their various types versus colon adenocarcinomas?

Dr. Kamath: Polyps are outgrowths in the colon that can be benign and pre-cancerous. The pre-cancerous ones are often adenomas, especially the villous or sessile types and those that have what is called high grade dysplasia.

It’s important to remember that these are pre-cancerous, which means that later on they can turn into a colorectal adenocarcinoma, which is actual cancer.

YMyHealth: What’s significant about developing a colon polyp? How does having a family history of colon polyps affect you as a millennial and how does it change the timing of when you need to get screened for colorectal cancer?

Dr. Kamath: If you have polyps that are pre-cancerous, most often your gastroenterologist will remove it during a colonoscopy, but it means you can form more and usually you need a repeat colonoscopy sooner.

Most people don’t know that a family history of certain high-risk polyps also means you need to get screened for colorectal cancer at a younger age. How much earlier?

If you have a first-degree relative (parent or sibling) who has had a high-risk polyp, such as sessile serrated polyps, serrated adenomas, or hyperplastic polyps, you should be screened 10 years earlier than when your parent or sibling received their diagnosis of having a high risk-polyp.

It’s a guideline that many people are not aware of and are surprised by.

Many family members may not recall they had polyps removed, let alone tell other family members about it. So, I suspect most of us don’t know an accurate family history of colorectal polyps. If you don’t know, it’s time to find out!

YMyHealth: Does having a family history of colon polyps matter as much as having a family history of colon cancer? How does their potential impact differ?

Dr. Kamath: It doesn’t matter as much, but it still matters. The risk from a family history of colorectal cancer—meaning you could get it—is definitely higher than a family history of polyps. We are more likely to do genetic testing for family history of actual cancer as opposed to family history of polyps.

YMyHealth: With the rise in colorectal cancer in the millennial age group why can’t everyone ages 24-40 automatically get a colorectal cancer screening?

Dr. Kamath: Colonoscopies are not fully benign. Some patients will get perforations of the colon, infections, bleeding, or other complications. While these are rare, if we scoped everyone starting at age 24, the number of people who have complications will increase. And even though the rate of CRC in the young is rising, it is still low and makes it harder to justify screening everyone at such a young age.

YMyHealth: How can health insurance coverage play a role when it comes to millennials getting colonoscopies?

Dr. Kamath: Shockingly, insurances can deny colonoscopies and other medically necessary procedures. And these are not cheap. They should pay for any millennial to get a colonoscopy for concerning symptoms such as blood in the stool, weight loss, change in stool caliber, etc., but some may require patients to try stool softeners or other interventions first before approving a scope.

YMyHealth: Given the current environment we face—whether it’s uncertainty about our gastrointestinal symptoms, being under the care of physicians who don’t feel our symptoms warrant a colonoscopy at this point, or having a family history of polyps as opposed to colorectal cancer—what can those of us in our 20s, 30s, and newly minted 40-year-olds do to be proactive about preventing ourselves from getting colorectal cancer?

Dr. Kamath: Be aware that colorectal cancer is on the rise in the young. Know what symptoms to watch out for. Ask your family about its history of polyps or colorectal cancer.

I think you will be surprised how many people don’t know or don’t know exactly enough, so you should push them to get the full story as your life and the lives of other family members could depend on it.

If you develop concerning symptoms, advocate for yourself with your doctor as they may not be aware that colorectal cancer is possible in the young.

To learn more about colorectal cancer in ways that matter to those of us in our 20s, 30s and 40s, please visit our Gastrointestinal Health and Millennials and Cancer pages.

And watch YMyHealth’s Colorectal Cancer Episode to learn what the colon does, what a colonoscopy looks like, and hear from a millennial colorectal cancer survivor.

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