Colorectal cancer (CRC) rates have dropped steadily for more than a decade, but younger patients are bucking the trend.

A new report from the American Cancer Society (ACS) analyzes incident CRC rates among adults aged 20-49 years using data from 13 Surveillance, Epidemiology, and End Results cancer registries across the country (Cancer Epidemiol Biomarkers Prev. 2009;18:1695-1698).

When people aged 50 years and older were included, rates declined 2.8% in men and 2.2% in women each year from 1992 to 2005. But among 20- to 49-year-olds, the rates rose each year by 1.5% in men and 1.6% in women.

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Rates also increased in each 10-year age group (20-29, 30-39, and 40-49 years), culminating in annual increases of 5.2% in men and 5.6% in women for people in their 20s. However, in terms of actual cases, 40- to 49-year-olds accounted for 73% of CRC patients younger than 50.

Current guidelines recommend routine CRC screenings begin at age 50. Do these rates mean you should start recommending test-ing for younger patients? Not necessarily, says Durado Brooks, MD, MPH, director of colorectal and prostate cancer at ACS.

“More than 90% of CRC cases occur in people age 50 and older, but there are certain younger people who need to be screened,” he says. And primary-care providers (PCPs) have a critical role in identifying them.

“A good family history has to be taken,” Dr. Brooks explains. Patients who have a family history of CRC, colon polyps, or other cancer should have colonoscopies in their 40s or even younger if the history warrants.

Younger patients who present with actual symptoms (e.g., rectal bleeding, blood in the stool, or vague abdominal pain) should be evaluated by colonoscopy.

Meanwhile, a National Cancer Institute report suggests PCPs carefully weigh benefits and risks when recommending colonoscopies for elderly patients (Ann Intern Med. 2009;150:849-857).

The risk of adverse GI or cardiovascular events is small, but it does rise with age, comorbid conditions, and the need for a polypectomy, researchers report.

Investigators drew a random sample of Medicare beneficiaries who had colonoscopies as outpatients. They used matched beneficiaries who did not undergo the procedure to isolate colonoscopy as a precipitating cause for an event vs. “what normally occurs in the elderly population.”

“The U.S. Preventive Services Task Force does not recommend CRC screening for persons age 75-85 and recommends against screening for persons age 85 years or older. Our findings support these recommendations,” the researchers conclude.