In this article, we explore the incidence of bowel cancer in younger patients, common barriers, and tips for primary care clinicians to support patients.
Incidence of cancer in younger people
The number of cancer cases in younger adults are rising.
Since the early 1990s, the incidence rates for cancer in young people have increased by around a quarter (24%) in the UK; with around 2,400 new cases every year, more than 6 every day (2016 – 2018), (CRUK, 2023). Rates are particularly high in those ages 20 – 24 (2016 – 2018). Cancer incidence rates in 25 to 40-year-olds in the UK increased by 22% between the early 1990s – 2018 (Gunn, 2023). Making this the biggest percentage change than in any other age group.
More recent research has identified a striking 79% increase in new cases of cancer among the under 50s around the world in the past the decades (1990 – 2019); with early-onset colorectal cancers having high DALYs (disability-adjusted life years) within the top five ranking for both men and women (Zhao et al, 2023). The epidemiological landscape of cancer incidence is therefore changing. While increasing age remains a major non-modifiable risk factor for cancer, the incidence of early-onset cancers, is increasing (Hamilton et al, 2023).
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Age alone should not ‘rule out’ for the disease
While it is recognised that GPs will come across very few patients with bowel cancer aged under 50, it is essential that a high index of suspicion should be maintained if the patient’s symptoms indicate suspected bowel cancer. Diagnosis in younger patients can be delayed if patients are considered too young or are initially misdiagnosed with other conditions more common in people of their age, such as IBS. Bowel Cancer UK’s research shows that younger colorectal cancer patients have a very different experience of diagnosis, treatment, and care; this can lead to late-stage diagnosis.
Complete a FIT
The Faecal Immunochemical Test (FIT) is particularly useful when investigating younger patients. NICE DG30 guidance recommends FIT for people who present to their GP with symptoms, but who are at a low risk of having bowel cancer.
Following the publication of an updated guideline from the Association of Coloproctology of Great Britain and Ireland and the British Society of Gastroenterology, FIT is now recommended for almost all patients who have concerning symptoms, including altered bowel habits, rectal bleeding and abdominal pain. This guideline is NICE endorsed.
Safety netting
It is essential that there is a robust safety netting pathway for patients to return if their symptoms do not improve, and that safety netting advice is explicit. A Symptoms Diary, developed by Beth Pervis and Bowel Cancer UK, can be used to help patients keep an accurate record of their symptoms.
If you suspect that your patient may have bowel cancer it is essential that the appropriate NICE and Scottish referral guidance are followed. FIT should be used to help assess younger patients who do not fit NICE NG12 guidelines for suspected cancer referral.
Testing high risk groups
Bowel Cancer UK’s Never Too Young Report identified some key issues in the earlier diagnosis of bowel cancer in patients under 50 years of age. Patients diagnosed with bowel cancer should be tested for Lynch syndrome. Many are still not being tested and access to regular colonoscopy, which can reduce the chance of dying from bowel cancer by 72% in people at high risk, is patchy across the UK.
