Addressing Colorectal Cancer in Early Adulthood: A Sioux Falls Public Health Plan

Abstract

Colorectal cancer is characterized by abnormal cell growth that originates in the colon or rectum. Polyps, or growths, occur on the inner lining of the large intestine and are most common in older individuals. A public health lens can be used to further investigate the recent increases in prevalence of this cancer in individuals aged 20-45 years old [1]. Current lack of public awareness results in lower survival rates and more cases being discovered at late stages beyond repair. A 2023 report by the American Cancer Society states, “colorectal cancer cases among adults younger than 55 increased from 11% (1 in 10) in 1995 to 20% (1 in 5) in 2019” [21]. We aim to raise awareness of colorectal cancer to help individuals recognize the risks and signs, and to provide them with the resources to prevent further progression of this disease. To do this, we extracted data from several sources that reflected South Dakota’s Sioux Falls, the location of the target population, and identified risk factors for this population. We gathered information from various stakeholders who discussed how this disease affects the community. The Sioux Falls area is at high risk for colorectal cancer due to poor diet patterns and rising rates of obesity. We focused on social context as a social determinant of health, as it contributes to delayed detection of colorectal cancer in younger adults. 

Keywords: Colonoscopy; genetic mutations; immunochemical tests; oncologist; polyps; screening

Introduction

Colorectal cancer traditionally is a disease that predominantly strikes older adults, but a greater number of younger individuals aged 20-45 years old are being diagnosed each year [1]. It is now one of the most common and lethal cancers in the United States, as a developing health concern for young adults. Socially, individuals who lack consistent healthcare access, such as low-income families, rural residents, and American Indians are less likely to access early screening [14]. Economically, addressing the advanced stage of colorectal cancer can be costly; for instance, chemotherapy, operation, and follow-up can cost almost $300,000 [4]. The primary purpose of our intervention is to understand why colorectal cancer rates are rising among young adults in Sioux Falls, South Dakota. By identifying the public health determinants contributing to the number of cases among young adults and organizing these factors using the socio-ecological model, we can propose an intervention to enhance prevention and early detection. Readers will learn about colorectal cancer, compare national trends to the local data available in Sioux Falls, understand the current efforts of local programs, and discover our step-by-step health plan for the future.

The Importance of a Public Health Lens 

Addressing colorectal cancer through a Public Health Framework is important for several reasons. Catching the onset of colorectal cancer is beneficial, according to MD Anderson Cancer Center [29]. If the cancer is caught within the first 5 years, the survival rate is 94% for people under 50 years old [29]. With the framework, we can reduce health disparities by promoting equitable access to healthcare services such as screenings for low-income families, rural communities, and ethnic minorities. Additionally, preventing a disease is more cost-efficient than treating developed stages of cancer. We can create interventions and strategies to inform communities on proactive lifestyle choices to improve health and reduce the incidence of colorectal cancer. In summary, a public healthcare framework could prevent, detect, and lower the impact of colorectal cancer on communities. 

The socio-ecological model is a framework that illustrates how multiple factors can influence a behavior. The five levels–individual, interpersonal, organizational, community, and policy–are the core concepts that are necessary for long-lasting behavior. In the case of colorectal cancer, the individual level can reveal disparities due to a lack of awareness, as well as the potential costs associated with treatment. At the interpersonal level, individuals may lack encouragement towards screenings without the support of family and friends. Healthcare providers and schools can assist at the organizational level by addressing limited healthcare access for minorities and inadequate outreach programs. On a community level, the lack of normalization around prioritizing health care and timely screenings, or even the stigma surrounding them, needs to be addressed. Finally, on a policy level, insurance coverage could pose a problem for families without insurance. Expanding these policies to provide coverage for every family would ensure an equitable environment to encourage screenings.

Methods

We took data from government and state department websites as well as reliable healthcare organizations and databases, including peer-reviewed research and testing statistics. Specifically, we obtained information from the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the South Dakota Department of Health. We also extracted data from institutional websites such as Sanford Health, GetScreenedSD, Live Well Sioux Falls, and Avera Health. Additionally, PubMed and Google Scholar were consulted to identify national trends, research related to colorectal cancer risk factors, and the impact of social determinants of health. We also consulted data and updated screening recommendations from the American Cancer Society. 

We conducted a literature review to provide more recent context reflecting the most updated trends and risk factors for the Sioux Falls population. We also focused specifically on colorectal cancer screening access, social and biological aspects behind disparities in outcomes, and trends among younger populations ages 20-45 [18]. We also prioritized credible health organizations because of their reliability and current recommendations on screening guidelines. We did not include articles that were outdated or irrelevant to our specific area of study. Studies that only focused on advanced treatment technologies were used less often because our primary purpose was to understand prevention and community-level interventions. In total, we reviewed 25 articles for this paper. 

Our stakeholders came from a variety of different backgrounds and perspectives surrounding colorectal cancer. These stakeholders were important based on their personal history in Sioux Falls and their diagnosis with colorectal cancer at some point in their lives. We selected patients diagnosed at various stages of their lives to create a more diverse group of stakeholders. Our first stakeholder helped us specifically with the medical side of colorectal cancer. Our next stakeholder was an oncology nurse who had several years of experience caring for patients with colorectal cancer and chemotherapy in addition to her diagnosis with the cancer. Our final interview was conducted with a Sioux Falls resident who was recently diagnosed with colorectal cancer, from whom we gained insight into the diagnostic process. We compared our interviews with each of these stakeholders to determine the importance of our topic and how exactly to approach our final 12-month plan.

We designed our plan of action by primarily determining the concerns and conditions surrounding colorectal cancer. With the information provided by our stakeholders in Sioux Falls, we identified a knowledge gap regarding the personal risks associated with their lifestyle habits and genetics. Of the several patients we interviewed, a major concern was the 10-year interval between each screening. The stakeholders discussed how the cancer could spread rapidly within a short time and thus the importance of early action. With this insight, we focused our plan of action on early detection, educating the community, and providing equitable care for isolated populations.

National Literature Review 

According to The Colorectal Cancer Alliance, “[i]n 2025, colorectal cancer is the fourth most commonly diagnosed cancer and the second leading cause of cancer deaths in the United States,” with an estimated 154,270 new cases and 52,900 deaths expected in 2025 [10]. Since the early 2000s, the prevalence of colorectal cancer in people under the age of 50 has continued to rise about 2.4% each year [23]. Some groups are at a higher risk for developing colorectal cancer. For instance, men are more often diagnosed than women are, and African Americans are around 20% more likely to be diagnosed and 40% more likely to die from the disease in comparison to White Americans [2]. Alaska Natives and American Indians also have high rates of incidence and mortality [19]. These discrepancies result from factors such as socioeconomic challenges, access to healthcare, and environmental influences. Obesity, alcohol and tobacco use, poor diet and malnutrition, and physical inactivity also contribute to the rise of colorectal cancer [17].

People of lower socioeconomic status can face financial difficulties that prevent them from accessing regular screenings or treatment. Without a stable job or insurance, colonoscopies are expensive, even when medically necessary. Individuals with low health literacy may be unaware of the warning signs and therefore may not get screened. Limited access to healthcare may also prevent screenings and colonoscopies, which are essential for detecting colorectal cancer before it spreads. Neighborhood and environmental factors can also affect individuals’ health choices, including food availability, opportunities for exercise, and safety. Underserved or low-income communities are at increased risks for colorectal cancer as a result of unhealthy diet, physical inactivity, or lack of medical appointment availability. Lastly, mistrust in the healthcare system, stigma, and lack of culturally sensitive care can all influence an individual’s use of preventive services.

Justification for Target Population

Our research team, composed of members from Illinois, South Dakota, and Texas, has reported the most disproportionate findings from Sioux Falls, South Dakota. With 9.64% of the population considered low-income and living in poverty, this community is at high risk of being diagnosed with colorectal cancer [16]. Colorectal cancer is one of the leading causes of cancer-related deaths in Sioux Falls. From 2016 to 2020, South Dakota saw an average of 398 newly invasive colorectal cancer cases per year, making up about 9.0% of all cancer deaths [14]. The rise of colorectal cancer is meaningful because many individuals under 45 are not routinely screened for it [26]. Raising awareness among young adults and healthcare providers is crucial for detecting early symptoms and preventing delays in diagnosis.

Individual: Lifestyle choices can make a significant impact on physical and individual health. Diets high in fiber, fruits, vegetables, and whole grains can reduce the risk for colorectal cancer. Conversely, consuming red or processed meat and high alcohol intake are dietary habits that increase the risk for colorectal cancer [28]. Besides diet, genetics can play a role in the development of colorectal cancer. Inherited gene mutations, such as Lynch Syndrome and Familial Adenomatous Polyposis, can increase an individual’s chances of being diagnosed with colorectal cancer. With these factors in mind, we must promote a healthy and active lifestyle for the community of Sioux Falls.

Interpersonal: Family support, peer relationships, and social networks play a crucial role in determining how individuals manage their health. Patients with a sound support system are more likely to attend screenings, follow treatment guidelines, and experience better mental or physical outcomes as a result. On the other hand, those facing social isolation have higher risks of delayed care and, in turn, poorer quality of health. With the increase in cases of colorectal cancer among younger individuals, building a strong network as a foundation and having familial support in Sioux Falls is essential to improving the proper management of this disease.

Organizational: The steps we can take on an organizational level include community-based initiatives that focus on patient accessibility and enhance treatment opportunities. Sanford Health from 2015-2019 increased the number of screenings through colonoscopies or standardized screenings by 78.1% according to the American Cancer Society National Colorectal Cancer Roundtable [22]. Encouraged screenings in workplace and community settings can make prevention and early detection of colorectal cancer more accessible to a larger group of people. These organizational measures in Sioux Falls can ensure a patient’s best chance at recovery.

Community: Major hospitals in this area, such as Sanford Health or Avera Health Center, provide local care and education regarding this cancer. They provide articles on how to prevent colorectal cancer, what colorectal cancer is, and what treatments might look like [5]. At the Avera Cancer Institute, several clinical trials are in place to improve the quality and options of treatments for these patients [6]. In addition, South Dakota State University and the University of South Dakota have published research exploring the role of age and gender in colorectal cancer [13]. Overall, Sioux Falls offers resources to improve the lives of those diagnosed with colorectal cancer.

Policy: The South Dakota Department of Health provides general information about colorectal cancer, various screening options, and risk factors for developing the disease. According to GetScreenedSD, 75.3% of people from South Dakota were screened for colorectal cancer in 2020 [14]. The state-level programs encourage safety and ultimately decrease the incidence of colorectal cancer in the state. Furthermore, 72% of people in South Dakota are classified as overweight [25]. Because obesity is a leading risk factor for colorectal cancer, the state may need to implement interventions to lower the impact of this high prevalence. Other risk factors, including smoking and alcohol use, are also linked to colorectal cancer.