MARK LEWIS: Hello, my name is Dr. Mark Lewis. I’m a gastrointestinal oncologist. I’m the type of doctor that you never want to meet because if you’re in my office that means that you have cancer and in my office specifically it means you have cancer of the gut. Why is this relevant? It’s relevant because colon and rectal cancer are affecting people at younger and younger ages. Now, if you’re watching this that doesn’t mean it’s destined to happen to you, but there are a few things you should know.
Number one, age is not as protective as we once thought or hoped. It is absolutely possible to get colorectal cancer under the age of 45, which is when we now screen. So how do you know when to be worried? Well, you know your own body better than anybody, you inhabit it 24/7. So if you’re having new abdominal pain and cramping, especially when you’re going to the bathroom, that can be worrisome.
The presence of blood in the stool is usually hemorrhoids, however, it’s hard to presume that and so have a very low threshold– I know it’s uncomfortable– to talk to your primary care provider and ask even for a rectal exam. There are also at-home stool tests you can do, not just for blood, but for precancerous DNA in the stool that can really tell you, hey, do I need a colonoscopy right now or is this something that I can watch?
And then finally, your family history does matter. This is about you, it’s also about the genes you inherited. So if you know the people in your family have been getting colorectal cancer around age 50, we would normally subtract about 10 years from that and start screening you even earlier than your peers. So all told, putting this together, screening is about ideally protecting you, but diagnosis is about investigating the problems that you uncover in your own body so both can come together to give you the best possible outcome. I wish you the best of health.
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MARK LEWIS: Hi. My name is Dr. Mark Lewis. I’m a gastrointestinal oncologist. And I’m here to talk about some changing trends in colorectal cancer, and what they mean for patients, and how patients can advocate for themselves. So we are here at the largest cancer conference of the year, and there are four abstracts or presentations that specifically address the changing tides of colorectal cancer.
So one thing to address right off the bat is a lot of people conceive of cancer in general as a disease of aging. The cells replicate and go through cycle after cycle. They are more likely, then, to accumulate flaws over time. This is generally true. Perhaps the most worrying thing is that we can no longer make that assumption when it comes to age and the likelihood of getting colorectal cancer, because all four of these studies in their own way showed us that we’re seeing things go in the right direction for patients who are older than 50 but very much in the wrong direction for people that are younger than 50. And I know that’s scary, and I’m not here to fearmonger. I’m here to tell you what can you do about it.
So one of the things that came across these studies was trying to look for demographic clues. OK. So it’s one thing to say that you’re young. You’re under 50, which is traditionally when we screen for colorectal cancer. What can you do beyond that? The group I think is most at risk are women. So in my practice, if you take the average age of all of my patients, the average age of all of my patients with a GI cancer is 68. And yet, 1 in 7 of my patients is a young adult with colorectal cancer, and I do see more women than men.
And what I see happening again and again– and this is hindsight bias by me– is they have been having problems. They’ve been having abdominal or pelvic pain. Sometimes they’ve even been having bleeding with the passage of a stool. And yet, they’re told, you’re having a gynecologic problem.
I’m here to tell young women in particular to please, please advocate for yourselves. If you’re talking to your doctor, say, your primary care physician or your gynecologist, and you’re having a problem that seems out of proportion, doesn’t seem to fit what you understand about your body and your cycle, that merits investigation. I can’t tell you how many times I’ve seen a young adult– and again, this is what I do– but with a colorectal cancer who have been told, rather dismissively, this is just hemorrhoids. You are too young to have cancer. Unfortunately, that phrase no longer carries any weight.
So what can you do? Well, A, as I said, you’re the expert, the content expert, on your own body. You know what patterns are abnormal for you, and you should raise those to medical attention. B, you should know your family history. There is absolutely a component here of heredity.
And as a general rule, we take the youngest person in your family affected by colon cancer or rectal cancer. We subtract at least 10 years from their age. And we ask that you start getting screened then. This is different than the recommendation for the general population. You may know, in the last several years, we have lowered the age of average risk screening from 50 to 45.
So now at age 45, with absolutely no other medical information or risk, you can go to your doctor and you can get a colonoscopy. Why is that so powerful? Colonoscopy might be the one screening tool that we have for cancer that is also prevention. If a young woman, for instance, starts getting mammograms at age 40, a mammogram can tell her that there’s a problem, like a breast mass. It doesn’t actually remove that problem. It just identifies it. The colonoscopy can do both.
A colonoscopist, which is generally a gastroenterologist, sometimes a surgeon, very rarely a family medicine doctor, can both see a polyp and remove it. And in doing so, you’ve interrupted that polyp’s disease trajectory. It can’t become a cancer if it’s removed from your body. So to sum up, know yourself, know your family, and know the age when you should start screening.
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MARK LEWIS: Hello. My name is Dr. Mark Lewis. I am a gastrointestinal oncologist. And I’m here to tell you about some shifting trends in colorectal cancer. Colorectal cancer is not fun to talk about, and it’s happening in younger and younger people. So the traditional age of screening for this disease recently dropped from 50 to 45. But what do you do as a young person, especially if you are not yet 45?
You need to know your family history. You need to know if you have relatives who have had colorectal cancer and at what age. That can inform when your doctor will start screening you. You also need to know your own body. Again, I know this is not pleasant. But blood in the stool is not always hemorrhoids. And many, many people, even their physicians, presume hemorrhoids when, in fact, you need to look further.
And then finally, I’ll just say that, unfortunately, there is no such thing as “too young for cancer”. This is no longer and, in fact, probably never has been a disease of aging. And we’ve never seen more colorectal cancer happening in such young people. It’s the only demographic, people under age 50, where this disease is rising and becoming more deadly not less common and less deadly. So please watch out for yourself and advocate.
