Episode Transcript
Interviewer: You may have heard of the news stories about the dramatic rise in colorectal cancer in younger adults. Some perspective and what you need to know next on The Scope.
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Interviewer: Colon cancer used to be something that most people didn't really start worrying about until after they turned 50 or maybe 40 if they had a family history. But doctors are seeing more and more younger people developing the disease earlier in their lives. Dr. Andrew Gawron is a gastroenterologist at University of Utah Health and some perspective on this. First of all, the headlines that I'm seeing about "Dramatic Rise in Colorectal Cancer in Younger Adults," is that accurate?
Dr. Gawron: It is accurate. The data that was published recently this year does show that, especially in younger patients, there has been an increase in the incidence, which is the new cases, of colorectal cancer in young adults. I think it's important to remember that colon cancer is still very rare in this population, and so, therefore, it's hard to know how many new cases we're going to see in the future. But we did see an increase of about 1% to 3% in those younger patients with this new study.
Interviewer: I feel like maybe there are two things going on in this study, and help clarify this for me. I feel like one issue is that Gen-X and millennials are going to be more likely to develop colon cancer than other generations after they turn 50. And then I think the second part felt to me like there are more people under the age of 50 than normal developing signs of colorectal cancer as well.
Dr. Gawron: I think that's accurate, based on the reading of the study, that we are going to see more. I think that the important thing to take home from this study is that colorectal cancer is a preventable, but serious disease. Right now, even though there's this what we call "dramatic increase," even though that dramatic increase is basically an increase from, like 1% to 3%, which translates into about 10,000 cases per year.
So on a population level, meaning that if you look at the entire population of young people, it's not a very common cancer. Now, again, if you're that one person, though, that develops colon cancer, you don't care about statistics.
Interviewer: Right. The statistics don't do you much good. So for those that are going to be more likely to develop it after 50 or you expect to see more people after 50 develop it, they would have a colonoscopy probably, some sort of screening that would protect them. But what about these cases before the screening happens at 50, you know, people that are developing in their 20s or 30s? What can they do?
Dr. Gawron: So right now, I think there are a number of things that we can do as both patients and doctors. First is just to be more acutely aware of symptoms of colorectal cancer.
One, dramatic change in your bowel habits, bleeding from your bowels, unexplained weight loss, loss of appetite as well as any type of change in your bowel habits that is not related to bleeding, such as prolonged constipation or diarrhea. These are all symptoms that may kind of be brushed off as an infection or essentially food intolerance, but if they occur for a period of time, even, you know many, many weeks, it'd be good to see a doctor or get yourself checked out.
Interviewer: And even if you see a doctor, I've read a couple . . . there was a "Times" article, for example. They talked about a 24-year-old woman. She had blood in her stool, and she went in. And the doc couldn't see any hemorrhoids, but that's what he diagnosed her with. And is it true that doctors . . . it's unexpected, so they're not really looking for it, so you might have to get a second or third opinion if you're that concerned.
Dr. Gawron: I think it's very important to be your own advocate, and younger people with symptoms often have delays in diagnosis because cancer is rare and not usually the first thing we look for or treat for. But if you're concerned and worried, be your own advocate. Don't feel afraid to get a second opinion. Don't feel afraid to go to your primary care doctor and say, "I really want to get referred to a specialist to have this evaluated." As a patient, as a young adult, you want to make sure that the most serious diagnoses are not missed if you are really concerned about your symptoms.
Interviewer: Got it. And if you have a family history of it, you should probably be more acutely aware. Screening guidelines say you should start at 40 in that case. But I've read a statistic somewhere, and tell me if this is true, 70% of colorectal cancers aren't related to family history.
Dr. Gawron: That's true. So we don't quite know all of the genetic factors that are playing a role in these cancers that are developing in young people. In fact, it appears that most of the cancers may be what we call "sporadic," meaning that they just are onset. But I think that's because we don't yet understand the genetic risk factors, and that's something that, hopefully, in the future will allow us to personalize screening.
I do want to say one thing, that family history is important, and I think it's important to, along with those warning signs and symptoms, to understand your actual family history. Many patients that I see do not know if somebody had polyps or somebody had cancer in their family, so having an understanding of what people actually had. For example, your parents when they had a colonoscopy, just ask them what was found, and so that you know to tell your doctor. And that will then allow us to have a better risk assessment when you come to see us in the office.
Interviewer: Got it. So I feel like the two takeaways are, one, that you should be aware of the warning signs, and even if you're a younger adult, pay attention to those warning signs in a way that you might not have normally done so because the research is showing people are developing it younger and younger. And then lifestyle choices make a huge different.
Dr. Gawron: Right. Again, the main point is to remember is I don't think you need to be walking around being scared you're going to develop colorectal cancer. It's still very rare in patients that are young, and you should go about your life as you normally would.
But be aware of these very serious symptoms that might need to be evaluated, and healthy lifestyle choices are important, not smoking, avoiding processed meats, having a healthy diet, exercise, maintaining a healthy weight, and again, understanding your family history and asking your older relatives about their colonoscopies and what was found.
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