Colon Cancer: Should Young People Worry?

0:00Hi, I'm Michelle Dang, and I'm filling in for Wendy Zukerman this week. And to start off today's episode, I want you to meet Becca Lynch. Becca lives in Colorado with her dog. She's 30 years old now, but throughout her 20s, she was leading a pretty hectic life. Kind of have always been pretty, like full steam ahead. I've never been like comfortable not being busy. She was getting her master's, growing her career, and being super active. I go climbing. I go to the gym. I was running a lot. I did a half marathon in 2024. Playing live music. Yeah, I have a little duo with a friend of mine that we play around town sometimes.

0:45But a couple of years ago, when Becca was 28, she noticed a change in her body, specifically in one area, the poo department. She noticed she was going number two more often, like five to six times a day. And it wasn't just that. There were a couple of weird things she saw in these frequent poos. And fair warning, we're about to get a bit detailed here. So for one thing, there was blood. It was like a dark, almost mucusy, kind of thicker, bloody substance that was everywhere, like when I was going to the bathroom. And it was every single time. And the other thing she noticed is that her poo started to take on a different shape than usual.

1:29Like thinner size-wise, like pencil thin. I did the thing that everybody does. Like I googled it. Obviously, I googled all my symptoms. The results spit out quite a list of things it could be. Ulcerative colitis, IBS, Crohn's disease. Becca thought she should get it checked out, but didn't go in right away. And then one day, she was scrolling on social media. Someone's video came across my feed. I think it was on Instagram of someone talking about the exact same symptoms. She had said, like, for years she thought she just had hemorrhoids, right? But this woman didn't have hemorrhoids. She had something a lot scarier, colon cancer.

2:06It was really advanced, stage four, and she was making these videos to tell people what to watch out for. And this was the push that Becca needed. I think it definitely solidified, like, okay, I should go to the doctor. Her doctor ordered a colonoscopy. So Becca eventually went through the prep where you have to drink this gross liquid and poo a whole lot. And then she went in. I went there first thing in the morning. They just took me back and I met the doctor who was going to be doing it. You know, he was very like chipper and just like, yeah, we're going to figure out what's going on. He's like, could be a bunch of things.

2:43Like, it might just be hemorrhoids. Like, don't worry about it. You're going to be in and out of here in half an hour. Like, I'll see you in there. and then they rolled me back and that was it. I took a lovely nap. When Becca woke up, there was a nurse there and immediately Becca could tell something wasn't good. The nurse told her she was going to go out to the waiting room to get Becca's friend who had come to pick her up. And she was just like, we're bringing your friend back because the doctor has to tell you something. And I was like, something bad? And she was like, yeah. And then she left.

3:18I waited there for 10 minutes. She left me with a bag of goldfish and a Sprite. I sat there and waited. And eventually my friend came back and I was trying to keep it light. But at that point, I think I kind of knew, like I knew it wasn't going to be good, obviously. The doctor came back in and I just remember like it was more so his body language and like facial expressions that were more upsetting than like what he was saying because he had been this very like chipper, bubbly person before, like the last time I'd see him. When he came back in, he was very sad. And he like sat at the foot of my bed and he just was like, we found a mass.

3:59It's five centimeters, about the size of a lemon. For Becca to officially get a diagnosis, the doctor told her she would need more scans and surgery. And he kind of ended it with being like, if it is cancer, which I'm certain that it is, you'll be the youngest person that I've ever seen with it. Becca was eventually diagnosed with stage 3 colon cancer at age 29. And this was really weird. She didn't have any of the usual risk factors. They ran genetic tests and didn't find any explanation. It all felt very strange. I knew that it was happening, but it really felt like I was watching it happen to someone else.

4:39But from that moment on, time kind of split, And I just went into this kind of numb headspace of, all right, well, we have to deal with this. So, you know, we're going to deal with it and we'll figure it out. And Becca isn't the only person having to deal with this and figure it out. Around the world, more and more young adults are getting diagnosed with colorectal cancer. In the U.S., one in five people diagnosed with it are now younger than 55. That's a big increase from just a few decades ago, when only 1 in 10 colorectal cancers were being diagnosed in younger people. And that's not the only concerning thing.

5:18We're hearing that young adults are more likely to get diagnosed with a cancer that has already progressed pretty far, despite being otherwise healthy. So today on the show, we're going to talk about what exactly is going on here. Why are so many young people suddenly turning up with this type of cancer? And we'll hear more about what this has looked like for Becca. All that is coming up.

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7:25Welcome back. I'm producer Michelle Dang. Today on the show, we're looking at colorectal cancer. And with me is senior producer Rose Rimler. Hey, Rose. Hi, Michelle. You know, Rose, I wanted to make this episode because I kept seeing scary headlines about this, about colorectal cancer increasing in young people. Have you been seeing these headlines too? Yes, I have. I've been seeing headlines about people getting colorectal cancer really young. and there's been some really high-profile people that have gotten it and unfortunately actually died from it. So I'm thinking of the guy from Black Panther.

8:04That was a little while ago. Yeah, Chadwick Boseman. Yes. Yeah, he died from it in 2020 and he was only 43. That's awful. Yeah. And then just last month, the actor James Van Der Beek, he also died from colorectal cancer and he was 48. Right. Yeah. And by the way, this term called rectal cancer, it includes both colon cancer and rectal cancer, and sometimes also called bowel cancer. Okay, got it. And for years, doctors have thought of these cancers as cancers that older people get. In fact, Becca ran into this too. The hospital that I went to, they put me in this support group. It was like a Zoom support group for other people with GI cancers.

8:49And I joined it once. And it was like me and then four women all in their like 70s and 80s. And they were all so kind and so lovely. And they were very sweet to me. And like, I think one of them told me she was pissed off at God on my behalf, which I thought was very sweet. And the thing is, these cancers are still more common in older people. If you are under 50, the risk of getting this cancer is actually very low, way less than 1%. But this increase is real, and it's freaking doctors out. So it's not—because sometimes you hear about a disease going up, and it turns out what's really happening is that doctors are getting better at catching it or diagnosing it or something.

9:32But in this case, it sounds like what you're saying, Michelle, is that no, it's actually going up in young people. It's simply going up. There's more cases and there's more deaths. Okay. And doctors really caught onto this in the 90s. But the risk keeps increasing with each generation. Like take a 40-year-old who's part of the millennial generation. My generation. Oh, your generation. Yep. And compare it to a 40-year-old who's part of the boomer generation. My generation, spiritually. No, just kidding. Yeah, so the 40-year-old millennial compared to a 40-year-old boomer, the millennial has a two to three times greater risk of developing colorectal cancer.

10:14So if you're 40 now, basically, your risk of colon cancer or colorectal cancer is higher than someone who was 40, you know, in the 80s or 90s. Yes, exactly. Geez. Wow. That's real. Yeah. And in the U.S., colorectal cancer was just declared the leading cause of cancer death in people under 50. It's led to nearly 4 ,000 deaths a year. Wow. So the thing I want to talk about next is the fact that when young people are diagnosed with this cancer, a lot of the time it's really serious. You hear about people turning up with stage 3 or stage 4 cancer upon diagnosis. and studies have found that more than half of cases in early onset colorectal cancer are caught at these later stages.

11:00That sucks. Yeah, this makes this cancer sound really scary because stage 4, for example, is when the cancer has already started to spread to different organs and other parts of the body. And if this is the case, it can be incredibly hard to cure. Your chance of dying within five years with colorectal cancer at stage 4 is about 80%. Wow. Okay. So I wanted to find out, like, why is this? Yeah, what's going on here? So I called up Dr. Michael Foote. He's a gastrointestinal oncologist from Memorial Sloan Kettering Cancer Center. And he's been watching what's going on here. We've been worried about this for a while, you know, over 10, 15 years.

11:43But it has reached a critical point in the last few years. And I wanted to know, is there something weird or creepy about the colorectal cancer that young people are getting? Like, is it moving faster or is it more aggressive? And Michael told me, no. Based on the studies we have, it looks like... Once they're diagnosed, the tumor behaves pretty similarly to a dozen adults. It responds to treatments in the same way. It can be just as aggressive. So why are young people showing up sicker? Michael says that young people's symptoms tend to be worse and the cancer spread further, not because of this idea that cancer is more aggressive, but because it's often getting caught a lot later than it is in older people.

12:26Not their fault, but they've had a longer amount of time before they were diagnosed to catch this. Well, that makes sense to me, Michelle, because they're not routinely getting screened because they're too young to start getting screened with colonoscopies. So if there was a really young cancer, a really new cancer that wasn't causing any symptoms, there would be no way for them to know. But an older person who is getting screened, that would get picked up. Yeah, exactly. Like, the main reason that we find this cancer is with a colonoscopy. And we're just not usually giving those to young people unless something is wrong.

13:02And what is interesting is that in older people in the U.S., rates of this kind of cancer have actually been decreasing. Like fewer people are getting it, fewer people are dying from it. And we think that's partly because we've gotten like pretty good at getting older people to go get colonoscopies regularly. Where they can catch polyps in your gut that might turn into cancer. So the rates in older people are going down, but the rates in younger people are going up? Mm-hmm. Yeah, it's a dichotomy or discrepancy of like, why is it going down for most of the people who are getting this? Right. but going up particularly for young people.

13:39And because of that, several years ago, doctors did decide to lower the recommended age for your first colonoscopy, for most people, from 50 to 45. There's actually people who say it should be even lower. Another piece of all of this is that for a lot of these young people, the symptoms can be easily confused for other things. Here's Michael again. I have a young person right now who's in their 30s, in their mid-30s, who has an extremely aggressive cancer type that is very, very sick with metastases all over his bones. So this patient of Michael's has stage 4 colon cancer. And what's weird is that Michael told me that their main symptom was back pain.

14:26Wow. Okay. I mean, that could be anything. Like, who doesn't have back pain? And I could imagine you wouldn't go and get seen for that, you know, certainly not by an oncologist. Who would think you'd have cancer just because your back hurts? Yeah, exactly. Here's Michael. Why are you having so much back pain? Why is this going on? No one would ever think about colon cancer. And then we found it, you know, we found it on a colonoscopy and he's been ongoing with treatment. How did that patient react when they heard the news? They were absolutely terrified. Yeah. And the real reason this patient had the back pain was because the cancer had spread to his spine.

15:06Are they still with us? They are. Yeah. And it's not great. They're treating the cancer, but it's aggressive. So basically, Michael and his team are just trying to make him feel better and give him as much time as they can. Less pain, at least. Yeah. Now, Michael says that that back pain as the only symptom is extremely rare. Yeah, we're really freaking everyone out, Michelle, with that one, that story. I'm sorry. Yeah. But, you know, changes in your stool are much more common, like blood in your stool and even abdominal pain. But even those symptoms are something that you could mistake for something else.

15:46Okay. Actually, Michelle, I have a question for you. I have seen like a lot of chatter about this online and people talking about like symptoms to watch out for. But mostly they just say like, look for any change in your bowel movements. It's like, get that checked out. And I find that really broad, like not very helpful. I've seen those kinds of videos too. And I'm curious too, like what exactly should you look for in your poop? Yeah. And so I asked Michael for you. Thank you. He told us that you shouldn't panic over a few weird poo days. But it's more like if you see changes or feel pain that lasts for weeks, then get it checked out.

16:24This includes things like diarrhea, constipation, and dark, tarry stools or blood, like what Becca saw. And Michael has some more particular advice here too. What we typically say with the stool is the stools become thinner, meaning, you know, If there's a tumor there, it starts to press on the colon and like a little cylinder squeezes the stool into thinner shape, right? Because if there's less space in the tunnel, you have a smaller diameter there for the stool to go through. So it starts to get thinner. And while Becca, she had a lemon-sized tumor in her colon. Right, and she was talking about the skinny stools as well.

17:01Like the mass was putting a lot of pressure on my colon, which was obviously making me having to go to the bathroom a lot more often. and the mass was also what was bleeding. So that's where the blood was coming from. That makes sense. But Becca's experience with her cancer speaks to another huge problem that doctors are seeing. Because some of this stuff, like some of these poo symptoms, they often don't show up until the cancer is already pretty far along when the tumor is already there and has had a chance to grow and cause problems. Which is still so crazy to me because when I think about how long I was having symptoms, really, it was like noticeable symptoms were only a few months.

17:37and it was still stage three. Yikes. And that plus the fact that some of the symptoms can be vague means that sometimes young people get misdiagnosed by doctors or even told they're too young to have colorectal cancer. So, you know, they don't get the tests that they need. Like in a big survey, four in 10 young people with colorectal cancer were initially told that they were too young to have it. Oh, wow. Okay. Overall, it can take like a really long time for young people to get diagnosed. and one study found that compared to older people, young people waited 40 % longer to get a diagnosis from an oncologist.

18:15So by the time they get to us, it's further along in their disease course. So bottom line, it's not the disease itself that's doing something weird. It seems to be more like it's sneaking up on people and their doctors too and getting found after it's had a lot of time to get dangerous. So I guess that answers the question of why is it more likely to be caught at a later stage in younger people? But it doesn't answer the question of why are younger people getting it at all in such increasing numbers? Yes, that is the big question. And actually, we'll be looking at that next. Why is this all happening?

18:54Because I'm very impatient. I want to know now. Yes. So after the break, we'll take a look and talk to the scientist he's trying to find out. Okay, I can wait until after the break.

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21:15Welcome back. I'm Michelle Dang. We just learned that colorectal cancer is on the rise in young people. And the question now is why? So we're on the trail trying to figure it out. Like what the hell is going on here? And I'm here with senior producer Rose Wormler. Hello. Hey, Rose. So yeah, one thing that comes up a lot is diet. People are eating a lot more ultra processed food than they were before. And a big study just came out on this. It looked at this big data set of almost 30 ,000 nurses and their health. I don't know if you're familiar, like the nurses. The nurses health study. Yeah. Yeah.

21:53It's a group of nurses that have been followed for a long time and used in a bunch of studies. And what they found in this study is that people who ate the most ultra-processed food had a 45 % higher chance of having polyps in their gut, which polyps can be harmless, but sometimes they do lead to cancer. Okay, so people who ate more ultra-processed food had more polyps. Very suspicious. It's not super surprising because, as we know from the ultra-processed foods episode, they tend to be associated with a lot of bad health outcomes. as we know from the fiber episode if you're not eating a lot of vegetables you need the fiber and vegetables so that all makes sense that that would be bad for your gut and probably create an environment that could be helpful for growing cancer yeah it's like we always come to that conclusion in science versus episodes we do it's like eat vegetables okay over and over and over and over yeah and that is because we do think Like there's some stuff that could be causing problems in ultra-processed foods, like preservatives.

23:02And then we also know that eating a lot of red meat, especially charred meat and processed meats, are linked to some cancers too. Yeah, actually working on the ultra-processed food episode, I stopped buying like lunch meat. Oh, really? Like sometimes I'd have like turkey, sliced turkey meat. Yeah, I don't eat that anymore. Sliced turkey meat? Yes, because it has nitrates and nitrites in it. And that has been associated with cancer. What about cheese boards? Cheese boards, does that count? Oh, sorry, I meant like prosciutto and salami. Oh, like charcuterie boards. Yeah, yeah, yeah, charcuterie boards.

23:36Once in a blue moon. I don't set out my spread of, you know, peeled grapes and charcuterie boards every night anymore. Yeah. Overall, it's probably a good idea to eat less of this stuff. And there are a few other risk factors that might be at play here too. Things like obesity, lack of exercise, smoking, and alcohol. But I kept thinking there's got to be something else going on here because I keep seeing and hearing stories of people with very healthy lives that eat great, exercise a bunch, yet still getting colorectal cancer at a very young age. Here's Dr. Michael Foote, who we heard from earlier.

24:18Most of the people that we see are actually pretty healthy. I have a patient who was a vegan, you know, who came in and she was like astounded. She had an early stage colon cancer. So we were able to remove it with surgery and then treat her and she's doing well. But, you know, she didn't really drink very much. She didn't smoke at all. So, you know, that's kind of the scary thing, I think, for all of us. Yeah. I'm thinking about Becca, who we met earlier. She seemed very healthy. I don't know what she was eating, but it didn't sound like she was sitting down at McDonald's for every meal. Yeah, similarly, Becca told me she wasn't big on processed foods or alcohol.

24:57I don't know. Like I said, I was 28. I was healthy. Like, I had just run a half marathon. I really wasn't thinking I might have cancer. My energy levels were fine. I was still go, go, go. So what could be going on here? Lots of scientists are wondering if there's something else weird in the environment that people were exposed to that's maybe contributing to this or perhaps changed up the gut microbiome. They're on the hunt for explanations. And so I want to talk about one of these ideas. Okay, great. One scientist we talked to is looking for clues inside the cancers themselves, like the actual DNA of these tumors.

25:33And his name is Professor Ludmil Alexandrov. And he's a cancer biologist at the University of California, San Diego. I actually specialize in cancer genetics and cancer genomics, and my focus is on understanding the processes that cause cancer. Several years ago, Ludmil and several colleagues started this big study looking at the genetics of colorectal cancer tumors. So what they did is they collected a bunch of tumors from people who had this kind of cancer. And they ended up with almost a thousand tumors from across 11 different countries. Then they brought these samples back to the lab to test their genetic profiles.