With recent reports that early-onset bowel cancer in England has more than doubled since 2001, and USA figures following a similar pattern, we look at what’s behind the rise and how you can best protect yourself.
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Why is bowel cancer rising in young adults?
The bottom line seems to be whilst doctors know it’s happening, they still don’t know exactly what is causing the rise of bowel cancer in younger people.
According to colorectal surgeon Dr Alex Crean, who works at MASJAX, there are some possible factors that’s causing it.
“We know bowel cancer is rising amongst younger people but we are not entirely sure why,” he said. “In the United States, the incidence of colorectal cancer in people between the ages of 20 and 49 has been increasing by roughly 3% each year. On the other hand, colorectal cancer rates in older adults have actually fallen. Current research points to diet, lack of physical activity, obesity, and gut microbiome dysfunction as possible contributors.”
Another colorectal surgeon Dr Carmen Fong, Chief Medical Officer of BUMMED, agrees that scientists are yet to properly understand why cases of bowel cancer amongst younger people is on the rise.
“The short answer is that we don’t know what’s causing the rise in early onset colorectal cancer. “There are a lot of theories as to what’s causing it, or perhaps somehow with the increased celebrity deaths, the awareness is also out there so that people are being diagnosed sooner. However, the science that contradicts this is that young people who have colon cancer are being diagnosed at later stages.
Possible factors that could be contributing to the rise of bowel cancer
“A few things that have been implicated include food dyes, microplastics, vitamin D, calcium, red meat, constipation and radiation,” explained Dr Fong.
“However I think the strongest evidence right now is for changes in the gut microbiome and some research talking about early antibiotic use in childhood shaping that microbiome. I’m on an early onset colorectal cancer task force along with experts like Dr. Shruti Patel and we’re all cautious to point fingers at what exactly it could be before all the evidence is out.”
What causes bowel cancer?
Dr Crean explains that bowel cancer, also known as colorectal cancer, occurs when the cells lining the colon or rectum change genetically, letting them grow uncontrollably.
“This often begins as a pre-cancerous polyp, which can gradually develop into cancer over time. The main risk factors are age, family history, inherited diseases, inflammatory bowel disease, excessive alcohol consumption, obesity, and diets high in processed and red meats.
“Interestingly, many younger patients we diagnose lack any family genetic history that would predispose them to colon cancer at a young age.”
What symptoms should women look out for?
“Younger women need to take the possible symptoms of colon cancer as seriously as their more mature counterparts,” added Dr Crean. “Rectal bleeding, changes in bowel habits, unexplained abdominal pain, sudden weight loss and more are all potential symptoms, though they are not necessarily specific to cancer.
“The bottom line is that any unusual abdominal or intestinal symptoms should be checked out by a qualified medical professional.”
Dr Fong adds: The symptoms are the same as anybody with colorectal cancer, which starts with vague abdominal pain or discomfort, abdominal bloating, unable to have bowel movements, changes in bowel habits or changes in stool caliber, and of course, rectal bleeding, which tends to be a late symptom.
“You can also have dark tarry stools and unintentional weight loss. I always say that colorectal cancer will usually have a constellation of these symptoms but one of these symptoms, if persistent, should prompt you to get an urgent evaluation with a medical professional and a colonoscopy, which is both diagnostic and therapeutic.”
Is bowel cancer different in younger adults?
“We are still trying to understand if bowel cancer acts differently in younger adults. We do know that bowel cancers in younger adults are typically diagnosed at a later stage,” explained Dr Crean. “However, we know, in part, this is because symptoms are often attributed to other concerns, with cancer not even entering the conversation. Whether colorectal cancers are more aggressive in younger patients remains to be seen through various ongoing studies.”
How is bowel cancer treated?
“Treatment for bowel cancer largely depends on the malignancy’s location and whether it has spread (metastasis). For localized disease that has not spread to distant organs, surgery is often a frontline treatment,” explained Dr Crean.
“The medical team, usually made up of colorectal surgeons, radiation oncologists, and medical oncologists, works together to develop a treatment plan that may include one or more modalities, depending on the extent of the disease.
“Modern medicine is now, more than ever, using personalized genetic and molecular markers to guide the treatment plan.”
How can women reduce their risk of getting bowel cancer?
“Women can reduce their risk of colorectal cancer by maintaining a healthy weight, staying physically active, quitting smoking, limiting alcohol intake, and changing their diet to include more lean meats, legumes, vegetables, fruit, and fiber while avoiding processed and red meats,” advised Dr Crean.
“That said, lifestyle alone cannot completely eliminate risk, so knowing family history, screening when appropriate, and getting any concerning symptoms checked is an excellent way to stay ahead.”
As someone who follows Dr Fong on social media – Dr Fong’s instagram – I can attest to the fact her posts are super informative and interesting.
“Part of my work on social media is to destigmatize butt gut health so that people will seek help sooner,” she explained. “Unfortunately there is no way of saying that anything can prevent women from getting colorectal cancer because I’ve seen even those with the healthiest lifestyle may have had certain exposures or just bad genes or bad luck.
“However, in my family, I will tell you that the evidence is there for having a high fiber diet, full of both soluble and insoluble fiber to keep your gut microbiome healthy, plenty of water, avoiding a sedentary lifestyle and staying active, and we do avoid red meat- as in, we don’t eat it every single day of the week, and avoid carcinogens and microplastics as much as possible.
“In a family with young children, avoiding all of these things 100% of the time is virtually impossible, for example, we had steak ‘n Shake for lunch this weekend, but if we can avoid it 80 to 90% of the time, I will say that we are succeeding, and I will be comfortable knowing that I did what I could with what I knew for my family.”