The incidence rates of colorectal and pancreatic adenocarcinomas have risen the most among young adults over the past 2 decades, suggesting the need for heightened awareness among clinicians for these diseases in this patient population, according to a report published by Bussetty et al in JAMA Network Open.
Study Details and Findings
The national retrospective cohort study used data from the Surveillance, Epidemiology, and End Results database; 275,273 cases of pancreatic adenocarcinoma and 215,200 cases of colorectal adenocarcinoma were identified over a 21-year period (2000–2021). Researchers found that the highest annual percentage change (APC) increase for both cancers occurred in the youngest age group, those between the ages of 15 and 34. For pancreatic adenocarcinoma, the APC for the 15-to-34 age group was 4.35, compared with 1.54 for the age group 35–54 and 1.74 for the age group of 55 and older. For colorectal adenocarcinoma, the APC for age group 15–34 was 1.75, compared with 0.78 for the age group 35–54 and –3.31 for the age group 55 and older.
Arvind Trindade, MD, Chief of Endoscopy at Robert Wood Johnson University Hospital and Director of Endoscopic Research at Rutgers Robert Wood Johnson Medical School (RWJMS), designed the study and served as the senior author of the article. Arvind Bussetty, MD, an internal medicine resident at RWJMS, was the lead author of the study. Dr. Trindade said he conceived of the idea for this study as clinically, he noticed he was diagnosing pancreatic adenocarcinoma more frequently among younger patients.
“Clinicians should be aware of this trend in younger age groups, so their suspicion is higher when patients present with symptoms,” Dr. Trindade explained. “Pancreatic cancer has traditionally been viewed a disease seen in older patients. However, this trend suggests the need for higher vigilance among providers when a younger patient is experiencing abdominal pain with other concerning symptoms, [as] that could indicate a more serious condition.”
Preventive Screening and Study Takeaways
Rising colorectal cancer rates among younger age groups led the U.S. Preventive Services Task Force to recommend lowering the screening age from 50 to 45 in average-risk, asymptomatic individuals in 2021. Colonoscopy continues to be the standard for detecting early colorectal cancer or precancerous polyps.
Dr. Trindade added that although there is no universal screening test for pancreatic cancer yet, endoscopic ultrasound (EUS) can be an effective screening test for high-risk individuals with high-risk genes, a family history of pancreatic cancer in first-degree relatives, or with pancreatic cysts.
“Every month our digestive health center detects early precancerous growths in the pancreas on EUS,” Dr. Trindade said. “This can be lifesaving if these lesions are detected early and removed surgically.”
The study did not identify root causes for the increase in cases, but Dr. Trindade believes a few factors may play a role. “Clinically, we are seeing younger patients diagnosed with pancreatic cancer, and this study supports our observations,” he noted. “It could be related to dietary changes, specifically the consumption of processed foods, stress, and environmental factors.”
He adds that younger patients with a family history of pancreatic cancer should consult a gastroenterologist. “The takeaway from this research is that symptoms such as upper abdominal pain in younger age groups should not be dismissed as benign without a complete gastrointestinal workup,” Dr. Trindade concluded. “And, of course, if [individuals have] high-risk genetics, a family history of pancreatic cancer, or a history of pancreas cysts, they need to be medically evaluated. Finally, patients who are at average risk should undergo guideline-recommended screening colonoscopy at age 45.”
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
