Colon cancer patients getting younger, no one knows why

WASHINGTON — Austin Thomas is a 28-year-old dietitian and athlete. She is also a colon cancer survivor.

The diagnosis came just five days after her 27th birthday.

“Everything was kind of a blur then,” she says, remembering how she went in for a colonoscopy after complaining of abdominal pain and bloating. She woke up with the doctor sitting on the edge of her bed explaining that they found a large mass and couldn’t even complete the screening procedure.

Colorectal cancer is usually thought of as a disease for older adults, with screening recommended only for people older than 50. But gradually the demographics of the disease have been changing. Colon cancer patients are getting younger, and no one is quite sure why.

“I am the first person on either side of my family to have any type of cancer. How did this happen to me?”  Thomas asks. She acknowledges there is no clear answer, but adds, “Cancer doesn’t discriminate.”

In a way, this young woman from Reston, Virginia, is representative of the new breed of colon cancer patients. She was initially misdiagnosed, and by the time that telling colonoscopy was performed, the cancer — which had spread to her liver — was stage four.

“It tends to be a more aggressive behavior in the younger patient,” says her oncologist, Dr. John Marshall, chief of hematology and oncology at MedStar Georgetown University Hospital.

A study that appeared recently in the journal Cancer found that many adults younger than 50 with colorectal cancer — like Thomas  — are diagnosed at an advanced stage and are more likely to receive surgery and radiation therapy than older patients.

And while the overall rate of colon cancer has declined in recent decades, a review of National Cancer Institute data last year revealed that it continues to rise among the younger-than-50 set.

According to the Colon Cancer Alliance, 11 percent of colon cancer diagnoses and 18 percent of rectal cancer diagnoses occur in those who are younger than 50, but Marshall indicates the actual number may be higher.

“Maybe half of my clinic on any given day is full of patients who are under the age of 50 diagnosed with colon cancer,” he says, adding many have no family history at all.

There are a few theories as to why, but at this point there is nothing conclusive.

“This is really the anxious part because we don’t understand why we are seeing it younger. Is it something in the environment?  It is something we are eating?” Marshall asks.

Whatever the cause, oncologists and young colon patients alike say it may be time to rethink the current recommendation to begin colonoscopies — except for those with significant risk factors — at the age of 50.

Thomas, who beat the disease, reflects on the rise in colon cancer among younger adults. “I wonder if it is because we just are not screening,” she says.

Marshall acknowledges it would be tough to get 20- and 30-somethings to line up for routine colonoscopies, which are proving a tough sell even for many of their parents. He says part of the solution is the development of alternative kinds of screening. But he stresses it is also important to increase awareness in the medical community of this demographic trend.

“In the old days, not too long ago, if a young person came to a doctor complaining of bleeding, the doctor would  often say, ‘Oh, this can’t be colon cancer, it has got to be something else like a hemorrhoid,’” Marshall says.

Now, they are beginning to consider other options and are ordering more tests on young adults with worrisome symptoms. They include:

  1. A change in bowel habits
  2. Rectal bleeding
  3. Cramping or abdominal pain
  4. Unexplained weight loss

These symptoms can sometimes mirror other conditions, as was the case with Thomas. The good news is, roughly a year and a half after her diagnosis, she is well and back to her energetic self.

On Sunday, Thomas plans to participate in the annual Chris4Life Scope It Out 5k for Colon Cancer Awareness. And like the runner she was before getting cancer and remains today, she speaks of her fight against the disease as a marathon with highs and lows on the way to victory at the finish line.

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