Colon cancer risk for the young
Sarah DeBord was 24 when she first noticed blood in her stool. She saw a gastroenterologist who did a procedure called a flexible sigmoidoscopy to examine her lower colon and rectum, then gave her a diagnosis of hemorrhoids.
“I don’t see any hemorrhoids, but that’s probably what it is,” DeBord recalled the doctor saying.
For the next 10 years, whenever DeBord saw blood in her stool, she told herself it was probably hemorrhoids. At 34, she began losing a lot of weight, which she at first chalked up to her training for a half marathon. But she was also so constipated she was making endless trips to the bathroom. She had a colonoscopy and learned she had advanced colorectal cancer that was inoperable and had spread to her lung.
“It was staring me in the face the whole time,” said DeBord, who lives in Minneapolis and has such advanced disease that she can never stop chemotherapy treatment. “I’d Google ‘blood in stool,’ and 10 different things would come up,” including colon cancer, “but I thought colon cancer was only in older people.”
Most cases of colon and rectal cancer are indeed found in people 50 and older. But there has been a sharp increase of colorectal cancer in adults as young as their 20s and 30s. A recent study from the American Cancer Society that analysed colon and rectal cancer incidence by birth year found that rates dropped steadily for people born before 1950, but have been increasing for every generation born since then.
The cause, or causes, of the increase have eluded scientists. While rates of cancers tied to human papillomavirus, or HPV, have been rising in recent years, that virus causes cancers mainly of the cervix, back of the throat and anus (anal and rectal cancers are distinct), and scientists do not believe sexual behaviors or HPV are driving the increase in colon or rectal cancer.
DeBord, who has two young children and works for the Colon Cancer Coalition, is encouraging young adults to be aware of the warning signs of colorectal cancer, and urges them to get a second opinion, or a third, if they think their doctor might be missing something. Younger people are much more likely to be diagnosed after the disease has spread, when it is much harder to treat, as in DeBord’s case.
Warning signs include blood in the stool, rectal bleeding or stools that are dark or black in color. The blood, released from the tumor, may be bright red or “tarry” in appearance, which can result when blood has broken down in the intestine. Unexplained or unintentional weight loss or fatigue can also be symptoms. General digestive complaints can also occur, including persistent abdominal cramps, gas pain or low back pain, feeling bloated, or experiencing a change in bathroom habits that lasts more than a few days, such as diarrhea, constipation, narrower than usual stools or a feeling that your bowel is not emptying completely.
“I kept making excuses for my symptoms,” said DeBord, until “it got so bad I knew something was wrong.”
Many symptoms that could indicate colorectal cancer may be benign, or related to other medical conditions, which is why the diagnosis is often missed in young adults, experts say. Iron-deficiency anemia, for example, is common in women with heavy periods, but it can also be a sign of colorectal cancer.
“We don’t want to create a panic, and the frequency in younger adults is still relatively low, but we are seeing an increase,” said Dr. Mark Pochapin, director of gastroenterology at New York University Langone Medical Center. The new data “raise the flag to be vigilant,” he said. “We need doctors to realise colorectal cancer is possible in younger patients, and if they are having something like rectal bleeding, this could be something more serious. Young people’s symptoms should not be dismissed.”
Physicians are trained to think of the most common conditions first, that “When you hear hoofbeats, think horses, not zebras,” Pochapin said. “But this isn’t as much a zebra as people think.”
Routine screening tests for colorectal cancer are not recommended in people younger than 50 who are considered to be at average risk because the number of cases is so low that universal screening tests would most likely do more harm than good, experts say. Colonoscopies, for example, require sedation and can result in serious complications, such as perforation of the intestine, in a small percentage of cases. But noninvasive laboratory tests can also be done to detect blood or DNA markers in the stool.
So what’s the average millennial or Gen-Xer to do?
- Find a primary care physician whom you like and trust, and establish a relationship with him or her “when you’re well,” said Pochapin. That way, if you ever develop worrisome symptoms, “you can get care from someone who knows you already. A lot of young people are embarrassed to talk about these things.”
- Know your family history and share it with your physician. Has anyone in your family had colorectal cancer, or had precancerous polyps removed? “If you have a first-degree relative – a parent or sibling – who had colon cancer at 50,” for example, “you should be screened at 40,” or 10 years earlier, said Williams. Certain medical conditions, like inflammatory bowel disease and certain other cancers, may also increase the risk.
- Know what’s normal for you, said Anne Carlson, executive director of the Colon Cancer Coalition. “Know your body,” including your stool, and “be aware of changes,” she said. If your doctor isn’t taking a concern seriously, be persistent.
- Eat a diet high in fruits, vegetables and fibre, and avoid eating lots of red or grilled meats and processed meats, which are associated with an increased risk of colorectal cancer. Obesity, smoking, heavy use of alcohol and sedentary lifestyles are also associated with an increased risk.
The New York Times
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