Why are more young people dying from colorectal cancer?

Sam Hawley: ABC journalist Jessica Kidd couldn't believe it when she was diagnosed with bowel cancer in her early 30s. It's been a long, tough road since then. And she's far from alone. Statistics show a sharp rise in the number of people under 50 being diagnosed with cancer. So what's going on? Today we speak to an oncologist about Jessica's experience and why cancer is on the rise in young adults. Sam Hawley here from Gadigal Land in Sydney. This is ABC News Daily. Jessica, we're about to talk to you about a very worrying rise in the number of young people developing cancer. And, really sadly, of course you're one of them. Tell us what happened to you?

Jessica Kidd: Well, Sam, I was 33 and I had just had my first baby. And when my baby was about 9 or 10 months old, I noticed blood in my stool. When I first saw blood, I went straight to my doctor, and he said, “You haven't had your baby that long. It's probably hemorrhoids. It's very normal, nothing to worry about.” And he told me to come back if it didn't go away.

Sam Hawley: So what happened? Did you just erase it from your mind?

Jessica Kidd: Well, I pushed it out of my mind. I went on with life. But over the course of a few months it started happening more and more frequently, and I couldn't ignore it anymore. So I went back to my GP. She acted on it, but still wasn't too concerned. I think she was just trying to make me feel better by saying, let's refer you to a colorectal surgeon. And I think she was more surprised than anyone when she was told after the colonoscopy that they had found a tumour in my intestine. It just shattered my world.

Sam Hawley: I can imagine. It's a real shock. Do you think that if you were older, the doctor might have tested you sooner the first time you went?

Jessica Kidd: Yes, our symptoms are dismissed as being due to busy lifestyles, lack of proper diet, pregnancy, and the danger of that attitude, especially for young women and especially for young people, is that for many young people, the cancer is not diagnosed until it is at a fairly advanced stage. Delayed diagnosis can be truly devastating.

Sam Hawley: So what stage was your cancer at? What did you have to do after that? What was the treatment?

Jessica Kidd: Well, to be honest, I was one of the lucky ones. I had to wait for surgery to remove the tumor and part of my intestine, then have the tumor tested to see if it was stage 1, 2, or 3. Thankfully, 5 days after the bowel removal surgery (which is a major operation in itself), I was informed that the tumor was stage 2A. So, not the earliest stage, but relatively speaking very early, and that was the only treatment I needed. I was able to avoid chemotherapy and radiation. So for me, it was just a matter of recovering from the surgery and learning to live with a shortened intestine, which will have ongoing effects.

Sam Hawley: Well, I wanted to say that even though I didn't have chemotherapy, I still had to have surgery. What has your life been like since then?

Jessica Kidd: It's actually had a big impact. I don't think people realize the ongoing impact of surgery like bowel surgery, because I look fine, I look healthy, I can do everything like I did before. Unfortunately, I have lost core strength as a result of the surgery, because they cut seven places in my abdomen and removed a pretty large portion of my bowel. But the surgery is affecting my bowel function every day, and some days I'm better than others. Some days I'm weak. Some days I'm like I have a gastroenteritis. So I'm constantly fighting with exercise, thinking, okay, do I have an important meeting this week, do I have a big event to go to? Okay, I'll avoid certain foods before that event and do my best to feel good on that day.

Sam Hawley: Yeah. It's had a huge impact on your life. How does that make you feel when you see the statistics that show more and more young people are getting colon cancer and other cancers? And you're… obviously, you want to talk about this because you want to warn others.

Jessica Kidd: Yes, I am. I am very involved with Bowel Cancer Australia. One of the reasons is that I felt very stigmatized. I always thought of bowel cancer as something that older people or people with a family history got. I never thought that it could happen to anyone. So I felt that there was space in Australia to talk about what we can do as a society to prevent bowel cancer in the first place. Bowel cancer is the second deadliest cancer for Australians and the deadliest cancer for young Australians. And we're not talking about it. To be honest, I remember lying in that hospital bed, unable to move because of the pain, I was angry. I was so angry that I didn't understand the risk factors and didn't know there were things I could do to protect myself.

Jeanne Tie: Hello, I am Dr Jeanne Thi. I am a medical oncologist and cancer specialist at the Peter MacCallum Cancer Centre. I specialise in the treatment of colon cancer. I am also a research fellow at the Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia.

Sam Hawley: Jeanne, people are getting cancer at younger ages. The data shows that. More people under 50 than ever before. Have you actually noticed that in your work?

Jeanne Tie: Yes, yes, that's true. We have a lot of young patients coming in every day. If you look at the patient list in the clinic, the majority of our patients are under 50 years old. We have some under 40 years old who attend the colon cancer clinic. So, since the mid-1990s, we've really seen an increase in incidence, especially in the 20-39 age group. And it's becoming the leading cause of cancer deaths in this younger age group. And the concern is that a lot of these patients are coming in with very advanced disease, stage 4, compared to the earlier stages, which are more curable. So maybe delayed presentation is an underlying contributing factor.

Sam Hawley: There was a conference that really looked at the increase in young people getting cancer in the U.S., not just colon cancer, but what do the numbers actually show in that regard?

Jeanne Tie: What's really interesting is that the group of colon cancer types that is growing the most is left-sided rectal cancer, which has increased by 75% since 1973. So by the not-too-distant 2030, it's estimated that one in ten colon cancers and one in four rectal cancers will be diagnosed in people under the age of 50. And recent registry data for stage 4 colon cancer shows that 14% of patients are currently under the age of 50.

Sam Hawley: Wow. I see. So when it comes to young people, colon cancer is the biggest concern right now.

Jeanne Tie: yes.

Sam Hawley: And the increase there.

Jeanne Tie: Yes, cancer is the leading cause of death in the younger age group between 20 and 39 years old.

Sam Hawley: Okay. So I think it's clear that researchers are trying to figure out what's going on and why we've seen such a huge spike in the last few years. So what do we know so far? What do they think is going on?

Jeanne Tie: Yeah. There's obviously a lot of research going on in this area. It's complicated. What we think is that the global westernization of diet may be contributing to the rising incidence of early-onset colon cancer because the rising incidence tends to be particularly pronounced in high-income countries, including Australia, which has one of the highest incidence rates in the world. Potential contributing factors include early childhood exposure, maternal infection, stress, nutrition, and long-term antibiotic use. On average, children under the age of two receive 2.7 antibiotic doses, and by age 10, they receive 10.9 antibiotic doses. Sedentary lifestyles, more processed sugars, more refined grains, and a westernized diet are all thought to affect the bacterial composition in the gut and contribute to the early onset of early-onset colon cancer. But it's very difficult to figure out which of these individual factors is responsible. There's a lot of research going on with them at this stage. It's going to take a while to get the answers.

Sam Hawley: So we don't know for sure, but we think it has to do with our digestive system. They look at things like processed foods, but in Western countries like Australia, we eat a lot of processed foods, right?

Jeanne Tie: Absolutely. And we are also more and more stressed. The fast-changing Western lifestyle, the stress, may also play a role. I think the whole lifestyle change over the last few decades has influenced this increased incidence.

Sam Hawley: Jeanne, I think we need to change our own perception and pay more attention, or maybe younger people need to be more aware that this could happen to them, because sometimes colon cancer is thought of as something that happens to older people.

Jeanne Tie: Right. So, you know, the average age of diagnosis is closer to 70. So I think being vigilant and being more aware definitely helps patients to consult their doctor sooner. And from a medical perspective, I think it's extremely important that general practitioners, who are often the first point of contact for patients, are aware of cancer as a potential cause of bowel symptoms.

Sam Hawley: So Jeanne, is there anything else you think young people should be doing? I don't know exactly why this is happening, but should we change our diet or whatever? Should we avoid processed foods or whatever?

Jeanne Tie: In general, I think that not only from a cancer prevention standpoint, but from a health standpoint, exercising and eating a healthy diet will improve your overall health. So I think it's very, very important to adopt a healthier lifestyle. I think we should start doing that now, rather than waiting for the research to come out. It may be too late.

Sam Hawley: Professor Jean Tai is an oncologist at the Peter MacCallum Cancer Centre in Melbourne. Jessica Kidd is a journalist for the ABC. This episode is produced by Jess O'Callaghan and Bridget Fitzgerald, with audio production by Anna John. The supervising producer is David Cody. I'm Sam Hawley. Just to let you know, I'll be taking a two-week break. My colleague Mel Clark will be joining me until the 15th of July. Thank you for watching.