Several years ago, Boston oncologist Dr. Kimmy Ng began noticing an alarming trend in her research. At Dana-Farber Cancer Institute, men in their 20s, 30s and 40s – runners, CrossFitters, lifelong non-smokers – walked through her door. They all looked healthy and strong, but were battling colorectal cancer. Colorectal cancer is a group of diseases that can begin in the colon or rectum and are usually associated with older adults and people with risk factors such as family history or obesity.
Most troubling of all, many of them were presenting with advanced metastatic disease. One patient, Dan Luers, a 46-year-old Ironman finisher who worked out for nearly two hours every day, was diagnosed with Stage IV disease. Dr. Ng’s concerns grew over the years. But the problem didn’t become fully serious until a healthy-looking Marine showed up at the office in 2017. At just 29 years old, he said: “He is the youngest person I have ever treated with this type of cancer with no family history and is in perfect health – very healthy, active and eats a healthy diet.” But he had stage IV colorectal cancer. For people whose cancer has spread to distant parts of the body, as in his case, the five-year survival rate hovers around 14 percent.
For Luer and many of Dr. Ng’s other young patients, the haunting question has been, “How could I have prevented this?” She and her dozens of researchers across the country are working diligently to find the answer. Seeing so many young people suddenly being beaten “made me determined to do something about this,” Dr. Ng said.
Why is early colon cancer so concerning?
Colorectal cancer is the third most common new cancer in men (after prostate and lung cancer). And while the proportion of older men is decreasing, the proportion of young Americans is increasing. What doctors have been discovering in their daily work is finally being fully covered in medical research and news. In 2017, a large study on invasive colorectal cancer funded by the American Cancer Society found that people born around 1990 had twice the risk of developing colon cancer compared to people born around 1950, and rectal cancer. The risk of developing the disease was found to be four times greater. The ACS plans to lower the recommended screening age for people at average risk for colorectal cancer from age 50 to age 45. If this trend continues, JAMA surgery By 2030, the incidence of colon cancer and rectal cancer for people ages 20 to 34 is expected to increase by a staggering 90 percent and 124 percent, respectively. Survey results published in January 2024 Colorectal cancer has been found to be the leading cause of cancer death in men under 50 years of age. This is up from his fourth place in the late 1990s.
The situation gets even worse. New research suggests that early-onset colorectal cancer has distinctly different characteristics than what doctors are used to seeing. These cancers tend to arise elsewhere and have different mutations, “which means that even in the early stages of their formation, something about the cancer may be different.” “It gives us a hint,” says Scott Kopets, MD. Oncologist at MD Anderson Cancer Center. Some of these may be new versions of the disease, he added. For those doing follow-up research, that means there may be new reasons why these cancers form. A new reason why young men are more susceptible. and emerging needs for alternative treatments.
Along with Dr. Kopetz, research teams at Memorial Sloan Kettering Cancer Center and the new Juvenile Colorectal Cancer Center at Dana-Farber are working hard to understand what causes these changes. . One of the most interesting clues is the microbiome, the diverse and rich community of microorganisms that live inside our bodies. One of the few things we know is that it is constantly evolving. Some changes “may benefit surrounding cells, while others may harm them,” says Dana-Farber physician and scientist Marios Giannakis, MD. This means that the microbiome can influence the cells it comes into contact with and play a role in the development of disease.
Researchers are investigating what changes the microbiome and may affect these cancers. Now they know what you eat and what medications you take are at least part of it. Killing bacteria with antibiotics can disrupt the balance of your microbiome. It is also possible to consume too many foods with added sugar. (Aim for up to 36 grams a day for general health.) “There are open questions about what modulates the microbiome, whether it’s good or bad,” Dr. Giannakis says. say. I just don’t know yet. A new five-year, $25 million study led by Dana-Farber researchers aims to provide some answers.
Until research results are available, doctors say being generally healthy will probably help. That means maintaining a healthy weight. Eat plenty of gut-friendly, fiber-rich vegetables and whole grains. Avoid tobacco and processed meats. Limit carbohydrates. Stay active. But the important thing that men often don’t do is to be aware of symptoms, especially persistent changes in bowel habits, and get tested right away.
What symptoms of colon cancer should you watch out for?
The majority of early-onset colorectal cancers occur in the lowermost part of the colon, the rectum, and can be associated with symptoms such as rectal bleeding and constipation, says MSK’s Juvenile Colorectal Center. says Dr. Robin Mendelsohn, a gastroenterologist and researcher. cancer. If there is blood in your stool or toilet paper. If you notice your stools becoming thinner or changing in consistency. Or if you have new or strange symptoms that last “for more than a few weeks,” such as nausea, abdominal pain, or bloating, don’t ignore them. According to a recent Colorectal Cancer Alliance (CCA) study, up to 17 percent of patients with early-onset colorectal cancer may be initially misdiagnosed, so if your doctor objects to testing, immediately Please push back. “The earlier we can catch these cancers, the more effectively we can treat them,” says Dr. Mendelsohn.
Certainly, there are many ways to test for colon cancer other than going to the doctor and getting the most standard colonoscopy. However, screenings such as the fecal immunochemical test and his FIT-DNA test are for routine screening at home. If you think you have a problem, seek medical attention immediately. And don’t be afraid to keep pushing even if you don’t feel like your voice is being heard. Felice Schnoll-Sussman, M.D., director of the Jay Monaghan Gastrointestinal Health Center in New York City and consultant to MH, says that doctors and patients alike should “put the possibility of colorectal cancer in a young person on their radar screen. There is a need,” he says. And men need to speak up. “I always say no one should die of fear or shame,” she added.
It is important to get tested at all ages. The American Cancer Society says colorectal cancer death rates for black people are 40 percent higher than for non-Hispanic whites. ACS also found in a national study that “more than half of the survival disparity between blacks and whites is explained by differences in insurance status, and one-quarter is due to differences in tumor characteristics (e.g., grade, location).” He quotes and says: Black patients are less likely to receive prompt follow-up after an abnormal screening test result.
The CCA study found that 71 percent of patients with early-onset colorectal cancer had a stage III or stage IV diagnosis. Only about 19 percent of early-onset Stage IV patients survive five years, according to the most recent federal data available. However, some treatments appear to be effective. After surgery, chemotherapy and radiation therapy, she was cured of Luers disease and received her medical certificate earlier this year. Another of Dr. Ng’s patients, Greg Mancini, 42, learned he had colorectal cancer when he was 38 years old. When Greg Mancini, a father of two from Scarborough, Maine, started a trial of two-checkpoint immunotherapy, his cancer had spread to his spine and was in bad shape. Mancini said the cancer was gone within a few weeks. He said: “I had a bulging tumor in my neck and it melted like ice. It was unbelievable.”
But until it becomes a standard response to that stage of treatment, or until these cancers begin to reveal some of their secrets to Dr. Ng and his colleagues, pay attention to your body and be vocal about it. Raising it may help change the trend.
Kristen Mascia is a journalist and editor who writes about health, politics, people and zeitgeist trends. She is stationed in Brooklyn and currently lives in the San Francisco Bay Area with her husband and her son. For more information about her work, visit kristenmascia.com.