Colorectal Cancer on the Rise in Younger Adults

While March may be Colorectal Cancer Awareness Month, this potentially deadly condition has been making recent news headlines for a different reason. Once thought to be primarily a disease affecting senior citizens, cases of colorectal cancer among younger adults are increasing at an alarming rate.

A study published last year by the Journal of the American Medical Association reported that, as of 2023, colorectal cancer was the leading cause of cancer deaths in adults under 50, topping lung and breast cancer. According to Colorectal Cancer Canada, “Despite overall declines in incidence and death rates for colorectal cancer in Canada, cases have been increasing among the country’s younger population.”

“With routine circadian rhythm disruptions, extended sedentary duty periods, irregular eating habits, and chronic low-grade inflammation, airline pilots need to educate themselves about this trend to ensure they adequately protect themselves against this disease,” remarked F/O Richard Mahoney (Delta), ALPA Pilot Assistance Aeromedical Committee chair.

Symptoms, Causes, Treatment

Colon and rectal cancers are clusters of cells that form in the large intestine due to changes in one’s DNA and are often classified together (i.e., as colorectal) because of their proximity and the many common features they share. According to the World Health Organization, “Common symptoms include diarrhea or constipation, blood in the stool, abdominal pain, unexplained weight loss, [and)] fatigue and low iron levels....”

While researchers haven’t specifically determined the cause for the increase in occurrences in younger adults, rates of obesity and cases of diabetes, which are both risk factors for cancer, have also been rising. A tendency to routinely consume prepackaged meals and sugar-laden beverages, which contain preservatives and additives, and the ongoing exposure to materials like microplastics and triclosan—an antimicrobial compound found in soaps and other household goods—may be contributing factors.

While highly treatable in most cases if detected in its early stages, colorectal cancer is disqualifying for pilots flying for U.S. airlines under FAR 61.53. To fly again, you must demonstrate that your cancer is nonmetastatic and that any applicable radiation or chemotherapy treatments have been completed. In addition, the doctors responsible for your cancer therapy and your primary-care physician must also submit current status reports that verify your overall health and cancer remission.

What Pilots Should Know

United States

Many colon cancers, if detected and treated early, are eligible for a CACI—Conditions AMEs (aviation medical examiners) Can Issue. More complicated cases require FAA review after a one- to three-year cancer-free observation period. If you’ve been cancer free for five years or more without metastases, your AME can issue a standard medical certificate. For detailed information, see the FAA Guide to AME section on colon cancer.

Canada

In Canada, health issues are managed on a case-by-case basis, but it’s the use of high-risk drugs, including cancer medications, that are disqualifying and determine the conditions that must be met for civil aviation medical examiners to clear recovered pilots for aviation medical certification.

Cancer Screening Recommendations

The American Cancer Society recommends that average-risk individuals undergo colorectal cancer screenings by age 45. Those with a family history of this ailment, inflammatory bowel disease, continued gastrointestinal problems, unaccounted-for anemia or weight loss, and rectal bleeding may want to initiate screenings by age 35. As always, talk to your physician about what you’re experiencing and your best course of action.

Screening options include colonoscopies at least every 10 years, yearly fecal immunochemical tests, or Cologuard tests. While screening doesn’t affect medical certification, anesthetic drugs used for colonoscopies typically require a 72-hour no-fly period after the procedure.

To improve your chances of avoiding or, at the very least, beating colorectal cancer (if you contract it), health professionals recommend that you eat “real” food, maintain a healthy weight, exercise regularly, get sufficient sleep, limit your alcohol intake, and get screened—when age appropriate or if you exhibit symptoms.