Why more young people are dying of bowel cancer

Sam Hawley: When ABC journalist Jessica Kidd was diagnosed with bowel cancer in her early 30s, she couldn’t believe it. And it’s been a long hard road since then. And she’s by no means alone. The stats show the number of people under 50 being diagnosed with cancer is rapidly increasing. So what’s going on? Today we speak with Jess about her experience and an oncologist about why cancer in young adults is on the rise. I’m Sam Hawley on Gadigal Land in Sydney. This is ABC News Daily. Jess, we’re going to be discussing, I suppose, a really concerning increase in the amount of young people who are developing cancer. And really, unfortunately, of course, you’re one of those people. Just tell me what happened to you.

Jessica Kidd: Yeah, well, Sam, I was 33 years old and I just had my first baby. And when he was about nine or 10 months old, I started noticing some blood in my poo. And I went to my GP pretty quickly after seeing blood for the first time. And she said, look, you’ve had a baby not that long ago. It’s probably haemorrhoids. It’s pretty normal and it’s nothing to worry about. She did say to come back if it didn’t resolve.

Sam Hawley: So what did you do? Just put it out of your mind?

Jessica Kidd: Yeah, put it out of my mind. I got on with life. But it gradually over a period of months just got more and more frequent until I couldn’t really ignore it any longer. And I went back to the GP and to her credit, she did act on it, but she still wasn’t very concerned. I think she was actually just trying to make me feel better by saying, oh, well, I’ll refer you to a colorectal surgeon. And I think she was as surprised as anyone when she had to tell me after that colonoscopy that she’d found a tumour in my bowel. It just shattered my world.

Sam Hawley: I can imagine. What an absolute shock. Do you think that if you had been older, that the doctors may have had you tested a bit earlier when you first went?

Jessica Kidd: Yeah, our symptoms are dismissed as a product of a busy lifestyle and not eating properly or pregnancy. And the danger with that kind of attitude for young women especially, but for young people, is that our cancers aren’t diagnosed until they’re at a much later stage for a lot of young people. And it can be really devastating to have delayed diagnoses.

Sam Hawley: And so what stage was your cancer at and then what did you have to do? What was the treatment?

Jessica Kidd: Yeah, well, I was one of the lucky ones, honestly. I had to wait for my surgery to remove the tumour and part of my bowel and then for testing to happen on that tumour to find out whether I was stage one, two or three. Thankfully, five days after that bowel resection, which in itself is a huge operation to go through, I got the news that my tumour was stage 2A. So not the earliest stage, but a very early stage, relatively speaking, and that was all the treatment I needed. I avoided chemotherapy or radiotherapy. So for me, the process was just recovering from that surgery and then learning to live life with a surgically shortened bowel, which has its own ongoing impacts.

Sam Hawley: Yeah, I was going to say, even though you didn’t have to have chemotherapy, you still had to have the surgery. So what’s your life been like since then?

Jessica Kidd: It’s actually had a huge impact and I don’t think people appreciate the ongoing impact of something like bowel surgery because I look well, I look healthy, I can do everything I did before. Unfortunately, my core strength suffered as a result of that surgery because I had seven incisions across my abdomen and I had a really big chunk of bowel removed. But it has an impact on my bowel function every day and some days are better than others. Some days can be debilitating. Some days it’s like having gastro. So it’s just a constant battle of working out, you know, do I have an important meeting this week or am I going to a big event? OK, well, I’ll avoid certain foods leading up to that event so that I give myself the best chance of feeling well that day.

Sam Hawley: Yeah, so it’s had a huge, huge impact on your life. When you look at these stats that are coming out showing that there are more and more young people actually developing bowel cancer and other sorts of cancers, what do you think? And what’s your… Obviously, you want to talk about this because you want to presumably warn others.

Jessica Kidd: Yeah, I do. So I do a lot of work with Bowel Cancer Australia as an advocate. And part of that was that I felt very short changed. I had always thought that bowel cancer was something that affected older people or people who had a family history of the disease. And I never appreciated that it could impact anyone. So I really felt like there was room in Australia for a conversation about what we can do as a society to prevent bowel cancer in the first place. It is the second deadliest cancer for Australians and it’s the deadliest cancer for young Australians. And we’re not talking about it. Honestly, when I was lying in my hospital bed and I couldn’t move from pain, I remember I was angry. I was just so angry that I didn’t understand the risk factors and I didn’t know that there were things I could do to protect myself.

Jeanne Tie: Hi, I’m Dr. Jeanne Tie. I’m a medical oncologist, cancer specialist at the Peter MacCallum Cancer Centre. I specialise in bowel cancer treatment. Also a research fellow at the Walter and Eliza Hall Institute of Medical Research from Melbourne, Australia.

Sam Hawley: Jeanne, more people are getting cancer at a young age. That’s what the data is showing us. Under the age of 50, more than ever before. Have you actually noticed that in the work that you do?

Jeanne Tie: Yes, yes, absolutely. Day to day, I do see many young patients come in. You know, often in a clinic list, I would see the majority of patients will be under the age of 50. A proportion of them are under the age of 40 that attend our bowel cancer clinic. So, you know, the incidence has really increased, particularly between the age group of 20 to 39 since the mid 1990s. And is now the leading cause of cancer death in this young age group. And what is concerning, I think, is a lot of these patients present with very advanced disease, stage four disease, compared to earlier stage where they’re more curable. And we think it’s probably because of delayed presentation as a potential contributing factor.

Sam Hawley: So there was a conference in the US that just really looked at this increase in the number of young people getting cancer, not just bowel cancer. What do the figures actually show us in terms of that?

Jeanne Tie: What is very interesting is that the particular group of type of bowel cancer that’s increasing the most is the left side of the rectal cancer. It’s gone up by 75% since 1973. So it is estimated by 2030, which is not far away, one in 10 colon cancer, one in four rectal cancer will be diagnosed in individuals aged less than 50. And recently from our registry data of all stage four bowel cancer, 14% of patients currently are under 50.

Sam Hawley: Wow. Okay. So it’s really the bowel cancer that’s of greatest concern at the moment in terms of young people.

Jeanne Tie: Yes.

Sam Hawley: And the increase there.

Jeanne Tie: Yes. It is the leading cause of death, cancer related death in this young age group of between 20 to 39.

Sam Hawley: Okay. So obviously, I’m assuming researchers are really trying to figure out what’s happening and why there’s been this massive increase over the years. So what do we know so far? What do they think might be going on?

Jeanne Tie: Yeah. So there’ve been a lot of research obviously going on in this area. It’s complicated. What we think might be happening is potentially the global westernisation of diet might have contributed to this rising incidence of early onset bowel cancer because the rising incidence tend to be uniquely in these high income countries with Australia being one of them. And we have the highest, one of the highest incidence of bowel cancer in the world. You know, from childhood, early exposure, maternal infection, stress, nutrition, prolonged use of antibiotics has been cited as a potential factors. You know, on average, those children under by age of two years old have had 2.7 courses antibiotics and they have 10.9 courses of antibiotic by age 10. Sedentary lifestyle, more processed sugar, more refined grains, you know, all the westernised diet is thought to impact on the bacterial composition of the gut that may have contributed to the early development of young onset bowel cancer. But it’s very difficult to tease out which of these individual components. There’s a lot of research at this stage looking at them. It will take some time for us to get an answer.

Sam Hawley: So we don’t know for sure, but given it’s to do really with our digestive system.They are looking at things like processed foods and we do eat a lot of processed foods, don’t we, in Western countries like Australia?

Jeanne Tie: Absolutely. And also, we are increasingly stressed.Fast moving Western lifestyle, stress may have something to do with it as well. I do think that this entire lifestyle change over the past few decades has impacted on this increasing incidence.

Sam Hawley: Sounds like, Jeanne, we need to change our own perceptions too so we’re more alert or young people are more alert that this could happen to them. Because I guess you sometimes think of bowel cancer as something that happens to older people.

Jeanne Tie: That’s right. So, you know, on average, the age of diagnosis is close to 70. So I think being vigilant and being more aware is definitely going to help hopefully patient presenting to their doctors earlier. And also, you know, from a medical point of view, general practitioner who the patient often present initially to for them to be aware of cancer as a potential cause of these gut symptoms is I think vitally important.

Sam Hawley: Well, Jeanne, is there anything else I suppose that young people should be doing? I know we don’t know exactly why this is happening, but should we be changing things like our diet? Should we be avoiding things like processed foods?

Jeanne Tie: I think in general, you know, from not only just from the cancer outcome, but from health perspective, having exercise, having a healthier diet would improve health outcome in general. So I think just adopting a healthier lifestyle is I think is very, very important. I think we should start doing this now instead of waiting for research to come through. That may be too late.

Sam Hawley: Professor Jeanne Tie is a cancer specialist at the Peter MacCallum Cancer Centre in Melbourne. Jessica Kidd is a journalist at the ABC. This episode was produced by Jess O’Callaghan, Bridget Fitzgerald, audio production by Anna John. Our supervising producer is David Coady. I’m Sam Hawley. Just to let you know, I’ll be taking a break for a couple of weeks and my colleague Mel Clarke will be with you until July 15. Thanks for listening.