Nancy Reye M.D.

Colon Cancer at Age 30, Not as Uncommon as You Think

I was in my medical residency, my second year of a three year journey to become a Family Medicine doctor. That evening I was taking over the floor call from the residents that were at the hospital. The other residents signed out a case for me to follow up on. A young woman, 30 years old with a 9 year old daughter, engaged to be married that summer. She had come into our clinic with a complaint of constipation. Properly, she was sent for a colonoscopy-a procedure to look inside the intestine in order to find what might be causing the blockage. The gastroenterologist performing the procedure couldn’t get much past the mass in her rectum. He ordered a CT scan-a detailed type of x-ray of the abdomen to take a better look. It was my job that night to keep an eye out for the results and inform her of them. I logged onto the computer and my heart sank. A large colon mass-spread to the liver as evidenced by masses seen on the CT scan.

I knew I had to tell her. I had never even met her and this was a horrible introduction. I got my courage together and went into the room. There she was, a young, beautiful woman with her handsome fiance and 9 year old daughter looking at me cautiously. Giving her the results was the worst moment of my career. Telling this otherwise healthy appearing woman that she had stage 4 colon cancer was unbelievably difficult. She sobbed and her daughter started to scream. I let her know the surgeon would see her the next day. I felt useless and couldn’t imagine what it would be like to receive that news.

With the recent news release I am reminded of that patient 16 years ago. The news this week from the American Cancer Society, “COLORECTAL CANCER RATES JUMP AMOUNG YOUNGER ADULTS”. Something that seemed like a rarity, may now become a common conversation. In this recent study results show that people born in 1990 and later have 2 times the rates of colon cancer and 4 times the rate of rectal cancer than what Americans have previously been experiencing.

We have been seeing great strides in colon cancer rates over the years due to more effective screening in what was thought to be the higher risk age group in people 50 years old and older. Colonoscopy with polyp removal has greatly decreased the rates of invasive colorectal cancer in the screening population. This news is a game changer. What we are being told is the colorectal cancer rates for millennial is taking us back to cancer rates equal to the rates of cancer from before we started screening, but occurring at much younger ages. Colon and rectal cancer rates in adults ages 20–54 have increased dramatically from the mid 1980’s until the end of the study period in 2013. This affects an age group that currently fall outside the screening guidelines, so when these cancers are found it is generally because people are symptomatic. We know that when people have symptoms from colorectal cancer it is generally more advanced and that is bad news for the patient.

This increase in colorectal cancers is unlikely from inherited causes. Most cases of colon cancer are not genetic, so then the question must be asked. Why is this occurring and what can we do? We know that colon cancer is one cancer that is very strongly associated with lifestyle. People who eat diets rich in saturated fat (think cheese, meat, processed foods in bags and boxes) and trans fats (artificially made fats) and alcohol and who are not physically active are most likely to get colorectal cancers. People who eat enough fiber by consuming a largely plant based diet have the lowest rates of colorectal cancer. Additionally, we know that people who regularly exercise are also at lower risk. We could wait for the studies to be completed, but who has time to waste here? We need to look at how are children are eating from the moment they are born and the food habits they develop as teenagers and young adults. We need to educate parents and the schools to feed children real food everyday so that children have healthy bodies. Young people need an understanding of what food they should eat so as they grow up to be adults they will make better food decisions for themselves. The cancer that is diagnosed today is not a development of the eating habits of the last week or even the last month. It is a culmination of the lifestyle and environmental habits in the person over the years and the damage that occurs from consuming “fake” food that damages your body’s DNA, eventually leading to massive cellular damage that can’t be stopped.

We will be provided with more information on this surge in colorectal cancer in people in their 20’s, 30’s and 40’s, but the best idea is to arm yourself with knowledge. We know that what you eat and your activity levels will have a significant influence on this cancer. Eating plants, fruits, vegetables and whole grains is your best defense. Don’t eat on the run and don’t go through drive throughs or fast food. The time saved will cost you in the long run. Stay tuned, I am sure the screening guidelines will be changing, but realize you have more control over your health than you know!