What’s the first thing that comes to mind when you hear the words “colorectal cancer”? For some in their 20s, 30s, or early 40s, the response is: “that’s an old man’s disease.”
Over the past three decades, colorectal cancer has continually become a millennial disease too. Not because there aren’t any cases in older people but because each year the numbers of cases found in millennials climb.
Most recently, a study published in the February 2022 issue of the journal, Cancer Epidemiology, Biomarkers & Prevention, comparing colorectal cancer cases from 2000-2002 to 2014-2016 in people ages 20-54 found this:
Out of all the study participants, 30-39-year-olds showed the greatest increase in cases of late stage colon-only cancers, and 20-29-year-olds showed the greatest increase in the number of late stage rectal-only cancers.
In recognition of rising numbers of colorectal cancers cases in millennials and Colorectal Cancer Awareness Month, I spoke with Suneel Kamath, MD, a fellow millennial and medical oncologist at the Cleveland Clinic.
He describes for us the challenges of diagnosing colorectal cancer in millennials, symptoms we should be aware of when it comes to colorectal health, and when it’s time to press our healthcare providers for a colonoscopy, if they haven’t ordered one.
Plus, he tells us about the incredible new Young-Onset Colorectal Cancer Center at Cleveland Clinic—a site with care tailored toward millennial patients like us. “I was drawn to a career in gastrointestinal oncology because it’s an area of medicine where our treatments aren’t good enough yet and not improving as fast as many other areas in cancer research due to lack of funding,” Kamath told me. “I hope to change that.”
YMyHealth: Dr. Kamath, what makes young onset colorectal cancer so challenging both from the physician and patient perspective?
Dr. Kamath: It is hard to see more and more young people in the prime of their lives with young families and starting to build careers go through such a difficult diagnosis, often found at a late stage. It is challenging to get doctors to realize that even young people can get colorectal cancer, so we shouldn’t minimize symptoms as being hemorrhoids or just due to constipation.
We should refer for colonoscopies more often.
It is challenging for patients to be heard when they have these symptoms and also to realize themselves that they have something serious. Many patients have symptoms for months and don’t tell a doctor about it for a long time.
We need to raise awareness about this so that both physicians and patients are on high alert to the symptoms so they are addressed and diagnosed quickly.
YMyHealth: What are some symptoms we should be on the lookout for? And can some symptoms be masked by other symptoms or conditions?
Dr. Kamath: Blood in the stool, rectal bleeding, black or tarry stool (sign of blood that got processed in the intestines and turns black), changes in stool caliber or having a harder time evacuating your bowels. Another one that is concerning is having constipation that goes on for weeks.
It is easy to write off some of these symptoms as being constipation due to diet or hemorrhoids. People can have hemorrhoids and colorectal cancer at the same time.
YMyHealth: As a millennial and a patient, how can we determine when we have something more going on or that we should push the physician who is caring for us to look for more, if they have not recommended sending us for a screening yet?
Dr. Kamath: The key to me is a new symptom that doesn’t go away after 3-4 weeks. Benign things self-resolve, bad things won’t. Blood in your stool is never normal, nor is black stool.
YMyHealth: Tell us about the Cleveland Clinic’s new Young-Onset Colorectal Cancer Center.
Why do you believe having a center dedicated to millennials and younger aged patients with cancer diagnoses is so important?
Dr. Kamath: The key benefit to an actual center for young-onset colorectal cancer is having specific coordinators and patient navigators/nurses to help patients through their journey. Because we have liver surgeons who can offer ablations, complex liver metastases surgeries, liver transplant, radiation oncologists, colorectal surgeons, medical oncologists and clinical trials all in one center, we can be more aggressive in a coordinated fashion with the care we provide, which can lead to better outcomes where other centers wouldn’t be as aggressive.
Many places can give chemo, but comprehensive centers like ours are multidisciplinary, and we have the resources to make sure patients know about and can access those resources easily. Things like nutrition, integrative medicine, psychological support, fertility counseling and preservation tools, genetic counselors and palliative medicine are all so important, but it is easy for doctors and patients to forget to arrange for many of these services even though we know they are important.
With so much going on, it is easy to get overwhelmed and not follow up. We are one of 5-10 such centers in the U.S.
We are also trying to raise awareness about the lack of funding for CRC, which I think directly relates to why after 30 years of increasing cases of young-onset CRC, we still know so little about what is causing it.
We even have a dedicated research team working to understand why young-onset CRC continues to rise and how to best catch it early and develop newer, more effective treatments.