What is the Most Effective Way to Identify Young Patients With Colorectal Cancer?

The prioritization of symptomatic early detection over asymptomatic screening serves as a critical strategy for managing the rising incidence of young-onset colorectal cancer (CRC) in patients under age 45, according to Yoanna S. Pumpalova, MD.

During a site visit, CancerNetwork® spoke with Pumpalova, an assistant professor of medicine and a medical oncologist at the Columbia University Herbert Irving Medical Center. She previously published studies evaluating the cost-effectiveness of gastrointestinal cancer screening practices in nations with varying resources, such as the Dominican Republic and South Africa.^1,2

In these global contexts, the clinical focus is centered on identifying symptomatic patients at the highest risk for CRC and facilitating their expeditious movement through the diagnostic pipeline. Pumpalova noted that a similar shift is necessary for the under-45 population in the US, as standard-risk screening guidelines are unlikely to drop below the current age threshold due to cost-benefit and cost-effectiveness analyses. Consequently, the clinical emphasis for this demographic must transition toward symptomatic surveillance and public education.

The efficacy of this early detection model is rooted in the correlation between diagnostic speed and disease stage at presentation. Data suggests that even in symptomatic individuals, a rapid diagnostic turnaround is associated with lower-stage detection, which has significantly improved clinical outcomes and long-term survival. By optimizing the pathways between symptom onset and specialist referral, multidisciplinary teams can improve the prognosis for younger patients.

Transcript:

CancerNetwork: Your work in South Africa and the Dominican Republic addresses colorectal cancer and other diseases in diverse settings with varying resources. How have these global experiences informed your perspective on what can be done differently in the US to improve early detection in younger cohorts?

A lot of my work in both of those countries focuses on early detection vs screening, especially in South Africa, where the public health care system isn't set up to be able to do screening of asymptomatic individuals. We focus on identifying which patients who do have symptoms are at highest risk for being diagnosed with colorectal cancer and trying to move them through the system in an expeditious manner. I think that applies for our younger population here in the United States. It’s unlikely that we see the screening age for colorectal cancer go much lower than 45 just from a cost-effectiveness/cost-benefit analysis [perspective]. It’s likely not going to be a recommendation that happens anytime soon, if ever. The focus, just like in other countries with no screening for this population, has to be on identifying symptoms early and getting the word out to the public on what those symptoms are, then helping patients move through the system more quickly so that they’re diagnosed. We do know that even in symptomatic individuals with colorectal cancer, if we diagnose them quickly, we do diagnose them at lower stages, where outcomes are much better.

References

1. Agyekum A, Wagner S, Pineda KMD, et al. Cost-Effectiveness of Colorectal Cancer Screening in the Dominican Republic. Preprint. Res Sq. 2025;rs.3.rs-7829020. Published 2025 Nov 19. doi:10.21203/rs.3.rs-7829020/v1
2. Tan SX, Pumpalova Y, Rogers AM, et al. Cost-effectiveness of adjuvant chemotherapy for high-risk stage II and stage III colon cancer in South Africa. Cancer Med. 2023;12(14):15515-15529. doi:10.1002/cam4.6199