NEW YORK — Although colorectal cancer is most frequently diagnosed among Americans 65 to 74 years old, about 10.5% of new colorectal cancer cases occur in those younger than 50 years.
In fact, according to a recent article in JAMA, incidence of colorectal cancer — specifically adenocarcinoma — in adults aged 40 to 49 years has increased by almost 15% from 2000-2002 to 2014-2016.1 That was part of the impetus for the U.S. Preventive Services Task Force to recommend that colorectal cancer screening begin at age 45, according to a study at the 2021 American Society of Clinical Oncology (ASCO) annual meeting.2
“This demographic shift has important implications for survivorship care, in particular regarding issues of future fertility especially in light of USPSTF’s recommendation for colorectal cancer screening to begin at 45,” emphasized researchers from the New York Harbor Veterans Healthcare System and the New York University School of Medicine. “ Although ASCO has longstanding recommendations for fertility counseling in patients with cancer, the rates of fertility counseling in younger patients with colorectal cancer are unknown.”
To find out, researchers reviewed records for new patient visits for colorectal cancer in patients younger than age 55 in a large academic cancer center between 2012 and 2019, focusing on demographics, disease characteristics, and documentation of fertility counseling.
The study determined that, among 194 patients who met inclusion criteria, 39.2% of patients were female, 10.4% were African American, 31.4% had rectal cancer, and 69.6% were treated with curative intent. About 14.5% of patients, who age ranged from 22 to 55, had Medicaid insurance.
The authors documented that the overall rate of fertility counseling among all patients was 15.5%, with 43.3% of them men.
Associated with greater likelihood of fertility counseling were:
- age less than or equal to 40 (p < 0.01),
- female gender (p = 0.03) and
- curative intent therapy (p = 0.03).
On the other hand, researchers noted, race, stage of cancer, insurance status, prior exposure to chemotherapy, year of diagnosis and colon vs. rectal cancer were not associated with counseling.
“The rate of fertility counseling was very low among patients with colorectal cancer, and exceptionally low among men,” the authors concluded. “Despite changes in the demographics of colorectal cancer, it does not appear that appropriate changes have been made infertility counseling. Increases in fertility counseling were not seen in more recent years despite recognition of increasing incidence in younger patients. Additional studies to identify barriers to counseling and strategies to improve survivorship care are urgently needed.”
Help might be on the way for veterans facing the issue. This spring, Rep. Julia Brownley (D-CA) reintroduced the Veteran Infertility Treatment Act, which would make infertility care, including in-vitro fertilization, a part of VA healthcare for enrolled veterans struggling with infertility, regardless of marital status, service-connection, or need for donated genetic material.
“For too long VA has overlooked the healthcare needs of veterans who struggle with infertility. This bill is simple, it states that we have an obligation to provide those who have served our nation with the healthcare they need to start a family of their own,” Brownley stated. “Parenthood is one of the most rewarding chapters in life, and veterans experiencing the challenges of infertility should have access to quality care, treatment, and resources.
- Knudsen AB, Rutter CM, Peterse EFP, Lietz AP, et. Al. Colorectal Cancer Screening: An Updated Modeling Study for the US Preventive Services Task Force. JAMA. 2021 May 18;325(19):1998-2011. doi: 10.1001/jama.2021.5746. PMID: 34003219.
- Peng C, Masri L, Roman S, Sherman S, Becker DJ. (June 4-8, 2021) Clinical and demographical factors associated with fertility counseling in colorectal cancer.. ASCO 2021 annual meeting. Virtual. https://meetinglibrary.asco.org/record/200516/abstract