Colorectal cancer progresses in people under the age of 50. However, no screening is organized before this age in France and the symptoms are too often misinterpreted, which delays diagnosis and treatment.
American actor Chadwick Boseman was only 43 when he died of colorectal cancer on August 28 . A drama that illustrates a situation well known to doctors.
Indeed, the number of cancers of the colon and rectum in adults under the age of 50 has " markedly increased " in recent years, recognizes Professor Jérémie Lefevre, visceral and digestive surgeon at Saint Antoine hospital in Paris.
+ 50% among young Americans
In the United States, since 1994, the number of colorectal cancers in people under 50 has increased by 50%. This age group now represents 11% of colon cancers and 18% of rectal cancers. The trend is similar in France, where specialists have observed a 3% increase per year in those under 50, for 10 or 15 years.
" Globally, this cancer is decreasing a little in overall incidence thanks to better screening , but is increasing in parallel among people under 50 in all Western countries " regrets Professor Lefevre. And the majority of 35-50 year olds affected by this cancer have no particular risk factor, no family history or genetic disease.
The "lifestyle" involved?
So how do you explain this phenomenon? For the time being, no specific cause has been identified but several tracks are retained, according to Professor Lefevre. The main factor involved is " lifestyle ".
In a caricature, women and men affected before the age of 50 " are quite sedentary , consume red meat , alcohol , few vegetables and few fibers " illustrates the surgeon. Other avenues involving the microbiota and inflammation of the intestine are also being studied.
For early detection
Problem, colorectal cancer is still considered rare in people under 50. No screening is organized before this age in France and the diagnosis is therefore often late.
If the American Cancer Society recently advanced the recommended age for first screening to 45 instead of 50 in the United States, France has not yet taken the plunge. " It would suffice to bring the screening forward by five or 10 years " regrets Professor Lefevre, who does not necessarily recommend a colonoscopy in this case, but rather a FIT (for Fecal Immunological Test or fecal immunological test in French).
The latter consists of looking for the presence of blood in the stool in the laboratory . It is " very sensitive, not expensive, not aggressive, painless and fast " unlike colonoscopy, " a rather heavy examination which requires anesthesia ", recalls the specialist. And, if the FIT is positive, then you will need to schedule a colonoscopy to detect the presence of a polyp or tumor .
Recognize the symptoms
Without systematic screening, it is the occurrence of unusual symptoms that should prompt patients to consult a doctor, and doctors to order a screening exam.
These symptoms, what are they? At 35 and 50 years old, they include the presence of red blood in the stools or black stools, smelly stools, a change in transit , abdominal pain and long-term anemia .
Multiply colonoscopies
" By reflex, doctors still too often think of a functional colopathy or hemorrhoids in the face of these symptoms " laments Professor Lefevre. But one should not conclude to hemorrhoids without having made an investigation and without having made sure that there was no problem higher up in the colon.
Colon cancer is unfortunately not exceptional before the age of 50, concludes the specialist, who therefore calls on his colleagues to " have colonoscopy easier " in the face of young patients. Especially since it is generally a cancer that is treated very well if it is diagnosed early, assures the doctor, in particular thanks to " a very well regulated surgery " and to " a chemotherapy which works extremely well.