For people in their 30s and 40s, the signs and symptoms of colorectal cancer can be easy to dismiss. After all, colorectal cancer is only a risk for people over the age of 50, right?
Wrong, said Dr. David Hiller, a colorectal surgeon at Novant Health Colon & Rectal Clinic – Clemmons. A recent report indicates that the rate of new colorectal cases among Americans younger than 55 years of age have nearly doubled from 11% in 1995 to 20% in 2019. While colorectal cancer is highly treatable when it’s caught early, 60% of all new cases were advanced in 2019, that’s up from 52% in the mid-2000s. The takeaway: Don’t ignore symptoms or your family history.
In this episode of Meaningful Medicine, Hiller will answer questions about the rise of colorectal cancer in younger patients. He’ll also share what symptoms to look out for and how screenings and treatments have advanced over the years.
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Michael Smith (Host): Meaningful Medicine is a Novant Health podcast bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.
Today, I'm sitting down with Dr. David Hiller, and we're going to be talking about the rise of colorectal cancer cases in younger adults. But before we get started, Dr. Hiller, I always like to know from my guests, how did you go down the colorectal surgeon pathway? What was your passion? What motivated you?
Hiller: Yeah, I knew when I was in medical school that I wanted to be involved in cancer care and helping take care of patients who are dealing with cancer in some capacity. And once I knew that surgery was my calling and where my skills are going to be best used, then it was kind of figuring out what kind of surgeon involved in cancer do I want to be? You know, there's breast surgery, there's surgical oncology, there's all these different ways to go.
And in medical school, I had two fantastic mentors who were colorectal surgeons, and just to see the things that they could do in the operating room, the relationships they had in the office. I guess it's one of the few surgical fields where you still follow your patients long term, as opposed to just doing a procedure and then getting them to the next step. So, I really liked that component of still being able to take care of cancer through some complex surgeries in a field that was growing in terms of research and techniques, but to really help people and to have that relationship with them long-term. So, that's what dragged me into it, I would say.
Host: Fantastic. Love it. Listen, let's get right into this because it's concerning. Why are we seeing a rise and colorectal cancer cases among younger adults. What's going on?
Hiller: It's a great question. I don't think anyone has the best answer yet, it's probably something we're not going to be able to know for a long time until we can look back and see, you know, more retrospective data on why this is. But it is true, it's increasing. It's becoming, at this point, probably the second-most-common cancer in America if you combine men and women. And a lot of that increase is seen in a younger age than we've traditionally seen. Some people speculate, is this related to what we eat, our environment? Well, you know, what's going on? And there's a lot of theories there. I would say none that are definitely proven, but it is increasing. And while that is scary in the sense that we're seeing more of this at a younger age, I think the encouraging thing is that we have methods to detect it early and to get it before it grows or spreads. And so, getting people screened sooner and talking about it more like we're doing today is going to help, because we can do something about this. We can get this better.
Host: Yeah. You know, you wonder because the standard American diet has been pretty poor, nutritionally speaking, for decades. The environment's been pretty bad for decades. It just makes you wonder, is there something else underlying this that we're missing? So, I'm glad to hear that you guys are looking into this, and I'm sure we'll figure it out someday. If you're listening to this and you're a younger person, can you share with them what would be some of the symptoms that they might want to just keep in the back of their head in case they start developing?
Hiller: The biggest symptom, the most common way that someone's going to present or notice something's wrong is seeing blood in stool when you go to the bathroom, maybe on toilet tissue. And traditionally, people say, "Oh, it must be a hemorrhoid." That's the common story. "Oh, I've had this hemorrhoid that's been bothering me for six to eight months." Hemorrhoids don't last for six to eight months. They last for three to six weeks, right? So, stories like that are the common ones. So bleeding, bleeding is abnormal. And to that, I would say, just get checked out. Let one of us say, which is a very quick check, to be like, "Yep, that's a hemorrhoid. And here's what you can do," and then carry on. It's a very easy thing to rule out. But a lot of people just assume that's the case and that it'll go away. And then just, as life goes, we all push things off. It's easy to do, because a lot of people aren't experiencing pain if they're having early signs of colon cancer. They're not experiencing a lot of major changes. That happens way later in the disease process. Sometimes, not at all.
So, it's going to be subtle signs. Bleeding most commonly, maybe a change in how you go to the bathroom, maybe some bloating or some unexplained weight loss. But it's usually on the more subtle front outside of bleeding. That's the big red flag of, "Hey, just have someone take a quick look, make sure if nothing else is going on."
Host: Yeah. I'm glad you brought up the pain as something that is often early on, not part of the symptomatology of colorectal cancer, right? Because, you know, a lot of people out there, if you ask them, you know, "How's your gut and how do you feel?" And they're like, "Oh, everything feels fine," and they touch themselves as if they're going to feel pain, right? So, it's good that you mentioned that that's actually a later thing that somebody might experience. Now, when it comes to recommending screening age, didn't this change already a few years ago?
Hiller: Yes. The major task force for cancer in America several years ago recommend knocking it down to 45 from 50 for everyone, 45 across the board, which I think is a great recommendation. I would not be surprised in the future if that gets pushed down to 40. But for right now, 45, I think that's the way to go outside of having symptoms or significant family history or something else medically that would make you go sooner than 45, but 45 is now the age to start.
Host: So, family history, you might start at 40 or something. You might have a more aggressive approach to this, right?
Hiller: Right. If you have a significant family history that can bump the age down, it can be 40, sometimes sooner. If you had a mother, father, or a sibling who had colorectal cancer before the age of 60, sometimes we say 10 years before their diagnosis. So if they were diagnosed at 42, then we would tell you 32. So, there's some other instances. And that's why it's good to know your family history as best you can. And to be able to present that to your doctors as part of an individualized plan, because this isn't one-size-fits-all, and that's why it's important to have that conversation. Know as much about your family as you can and talk to your family about what's going on, so everyone knows what's happening in their lives. So, you can share that and we can screen you correctly.
Host: Since we're talking about the rise of colorectal cancer in younger adults, and we're talking about family history a little bit here, when to get screened, have you noticed that, or some of these younger adults, do they have a strong family history colorectal cancer,
Hiller: Usually not.
Host: Or is that just part of the theory? We don't really know yet what's going on.
Hiller: It can seem that way, because the number of cases is increasing so much. You're going to see people within a family both have it. But we would say now maybe 5-10% of colon cancers are inherited, so a majority or not, or if they are and it's some inheritance that we aren't aware of, some gene or some defect genetically that we don't know we haven't diagnosed or worked that one out that we'll be working on finding. But conventionally, we would say right now 5-10% are inherited. This is something that's coming because of your genetics. The other, you know, 90% of these are just from life, the environment, biology, not necessarily your family or in a way that we can say for certain.