March is Colorectal Cancer Awareness Month, and last week many twenty- and thirty-somethings were made aware that their risk for colon cancer is “rising sharply,” “surging,” “soaring,” and even “skyrocketing” – as various media outlets put it in their headlines.
Washington Post: Colorectal cancer rates rising sharply among Gen X and millennials
USA Today: Colon and rectal cancers surge among Millennials and Generation X
NBC News: Colorectal cancer rates soar in younger people
KSHB Kansas City: Colon, rectal cancer rates skyrocketing for millennials, Generation X
Many of us don’t think much about colorectal cancer until we hit the half-century mark, which is when current guidelines recommend most Americans undergo their first colorectal cancer screening test. Are we tuning in decades too late?
The headlines are unambiguous and they bridge the gender divide.
It’s “The Health Issue Young Women Aren’t Paying Enough Attention to,” according to Refinery 29, which strives to be “the #1 new-media brand for smart, creative and stylish women everywhere.”
Men’s Health, meanwhile, warns its male readership: “If You’re Under 30, Your Risk For Colon Cancer Just Doubled.”
Just how big a risk are we talking about? The New York Times gives some specifics about the new study that’s sparking the headlines:
The risk of colon cancer for individuals who were born in 1990 was five per million people in that birth group, up from three per million at the same stage of life for those born in 1950. And the risk of rectal cancer for those born in 1990 was four per million, up from 0.9 per million for those born in 1950.
“There is no mistaking these dramatic increases, especially for rectal cancers,” an expert quoted in the Times piece says.
How much should we worry about a two-in-a-million increase?
Maybe those increases are “dramatic” from the standpoint of an epidemiologist who follows colon cancer. But does the average millennial who’s reading the article have reason to start worrying, as other story headlines suggest they should? Richard Hoffman, MD, who directs the Division of General Internal Medicine at the University of Iowa, was surprised at the tenor of the coverage.
“The point is that the numbers are small,” he says. “The NYT article quotes an expert as being concerned about a risk increase of 2 cases per one million people. According to a quick Google search that’s about the risk of being struck by lightning” (pegged at around 1 in 700,000 per year in this Scientific American fact sheet).
The increase is real, Hoffman says, but he questions whether it’s worth frightening millions of young people given the lottery-ticket odds that they might be affected.
Moreover, while most stories put factors like poor diets and obesity at the top of their suspect list, Hoffman says it’s not clear whether there really are more cancers in younger people or whether doctors are just getting better at finding them.
“One explanation could be that there is more recognition that a family history of colorectal cancer—and actually polyps—warrants screening with colonoscopy at an earlier age (age 40 or 10 years before the index diagnosis, whichever comes first),” he said. “This message could be accounting for the increase, particularly in the 40 year olds. Based on my experience I would agree that more diagnostic colonoscopies are being performed to evaluate GI symptoms. This could lead to more cancers—particularly early stage—being diagnosed.”
Hoffman cautions that diet, obesity and other factors might also be playing a role, but that a lot more research will be needed to tease out what’s happening.
Some stories framed the results more cautiously
Some of these stories did make the point that the overall increase is very small and probably not worth worrying about for the average person in their 20s. NPR stands out for providing informative, contextualized coverage starting with its inquisitive headline (“Why are more young Americans getting colon cancer?”) and including an early acknowledgment that “the numbers are small.” Quoting an independent expert source, Dr. H. Gilbert Welch, NPR also spins a scenario, similar to that envisioned by Hoffman, where this “seemingly glum cancer trend is in fact good news.”
…what look like additional cancers in people under 50 may simply be cases that are being diagnosed earlier than they would have been. Some people are getting colonoscopies for reasons other than cancer screening these days, and doctors are surely coming upon early cases of colon cancer they might not have turned up so soon.
CNN also reached out to Welch, who told the news outlet that “The numbers are too small to warrant the attention this trend is getting.” Unfortunately, this context comes long after the story hypes cancer rates that are “sharply rising” and leading to “twice the risk of colon cancer.” What’s more, says CNN: “Because routine screening is generally not recommended for most people under 50, these cancers are often found in more advanced stages, too.”
That was a point Rebecca Siegel, MPH, an American Cancer Society researcher and the lead author of the study, placed particular emphasis on in a phone interview. She said that diagnosis in young people can be delayed for years “because their physician in most cases is not going to be thinking, ‘This person might have cancer.’” She believes media coverage can help change that.
And while she acknowledged that some of the headlines were “over the top,” she was steadfast in her conviction that this is an issue that deserves more attention. Despite the low absolute numbers, she said, “the fact that more young people are being diagnosed is very concerning because they will carry that risk forward with them. It’s a bellwether of future disease burden.”
I don’t disagree with Siegel. This is important research that merits attention and additional study. My concern is with framing and context in news reports targeted at the general public. If a “doubling” of risk is reported, news outlets need to make it clear that the risk is still incredibly small. A slow drip that turns into a trickle should not be framed as a “surge.”
And let’s face it: someone like Siegel, who has devoted her life to cancer prevention and works at a cancer research and advocacy organization, may not be the best person to provide that context. That’s why I’ve always found that internists such as Hoffman and Welch are great at providing perspective. They see almost everything there is to see in health care, and can help patients differentiate what they need to worry about versus what’s best left for discussion in medical journals.
Too soon to talk about “a push for early screening”
One more reason why this is important: distorted media reports on this study could pollute the public discussion about cancer prevention policies such as screening.
The issue of expanding screening to younger people was mentioned as the logical next step at the conclusion of several stories, reflecting the researchers’ claim that the new evidence might justify screening before age 50. A Pittsburgh Tribune-Review story had the issue front and center in its headline: “As colon cancer rates rise among young adults, a push for early screening.”
As with many similar-themed stories, the Tribune-Review lacks perspective on the numbers and focuses heavily on two individual cases of colon cancer in younger adults — one of which was has responded to treatment and another which proved fatal.
Here is some context that wasn’t mentioned in the Tribune-Review or, indeed, in any of the stories that I looked at:
The story doesn’t address cost, or delve into the potentially multibillon-dollar implications of its headlined “push for early screening.”
It didn’t note that there is no conclusive evidence that colonoscopies, touted in the story as the “gold standard” for screening, are saving lives even when they are administered at the current age cutoffs (where they’d be much more likely to show a benefit than in younger people).
The story didn’t discuss how many young people might be harmed, some seriously, by colonoscopies in order to help the small number of people who might benefit.
Let’s keep in mind that this study also found a sharp decrease in the number of colorectal cancers diagnosed in people over 50 – and the decline in older people dwarfs the increase found in younger people.
Many stories mentioned the decline among older people several paragraphs into the coverage. But apart from the LA Times, I found no coverage that found the much larger decline in older people worthy of headline attention.
Most stories put the emphasis squarely on young people, their “soaring” risks, and the need to screen more aggressively.
We should all be asking ourselves why that’s the case.
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