The increasing incidence of young-onset colorectal cancer: a call to action.

In the United States, colorectal cancer (CRC) is the third most common and second most lethal cancer. More than one-tenth of CRC cases (11% of colon cancers and 18% of rectal cancers) have a young onset (ie, occurring in individuals younger than 50 years). The CRC incidence and mortality rates are decreasing among all age groups older than 50 years, yet increasing in younger individuals for whom screening use is limited and key symptoms may go unrecognized. Familial syndromes account for approximately 20% of young-onset CRCs, and the remainder are typically microsatellite stable cancers, which are more commonly diploid than similar tumors in older individuals. Young-onset CRCs are more likely to occur in the distal colon or rectum, be poorly differentiated, have mucinous and signet ring features, and present at advanced stages. Yet, stage-specific survival in patients with young-onset CRC is comparable to that of patients with later-onset cancer. Primary care physicians have an important opportunity to identify high-risk young individuals for screening and to promptly evaluate CRC symptoms. Risk modification, targeted screening, and prophylactic surgery may benefit individuals with a predisposing hereditary syndrome or condition (eg, inflammatory bowel disease) or a family history of CRC or advanced adenomatous polyps. When apparently average-risk young adults present with CRC-like symptoms (eg, unexplained persistent rectal bleeding, anemia, and abdominal pain), endoscopic work-ups can expedite diagnosis. Early screening in high-risk individuals and thorough diagnostic work-ups in symptomatic young adults may improve young-onset CRC trends.

Evaluation results of a 21st birthday card program targeting high-risk drinking.

UNLABELLED: The B.R.A.D. Birthday Card initiative was started on the campus of Michigan State University (MSU) in April 1999. MSU administrators send the safe-drinking 21st birthday card (B.R.A.D.) and laminated wallet card to students shortly before their 21st birthday. OBJECTIVE: To evaluate the effectiveness of the 21st birthday card, MSU and B.R.A.D., Inc, applied for and were awarded a 2-year US Department of Education grant in 2001. PARTICIPANTS: The authors surveyed 1,731 students within 2 weeks of their 21st birthday. METHODS: Of all students turning 21 years old during the study, the authors randomly selected students for each group. A control group received no card. All others received the standard B.R.A.D. card or a gender-tailored message card. RESULTS: Key findings include: 74% of students saved part of the card, 65% shared the card with family or friends, 22% reported thinking about the card during their celebration, 12% reported drinking less because of the card, 15% reported learning something new about alcohol poisoning, and 98% believed that MSU and B.R.A.D. should continue sending cards to students. CONCLUSIONS: Receiving, reading, and recalling the content of the B.R.A.D. card appears to reduce the total number of drinks a celebrant consumes.