“I think if it was one answer, we would have figured it out,” says Dr. Mendelsohn. “If it were something obvious, or one major thing, we would have found it.”
She thinks it is more likely some combination of behavioral and/or environmental changes.
Among the things researchers are looking at: the age of parents at time of the patient’s birth, whether they were born via Caesarean section, whether they were breast fed, antibiotic use – and even wifi exposure.
Younger patients tend to get diagnosed at later, more advanced stages of the disease because they’re not being screened and they may have to go through several doctors before they figure out what’s wrong.
April’s story
April Witzel, a nurse practitioner and midwife, was diagnosed with colorectal cancer at age 45.
She didn’t have any obvious risk factors: “I’m female, I’m Caucasian, I didn’t eat a high-meat diet, I didn’t have colon cancer in my family,” she says.
Her first symptoms were intense stomach pain and nausea. Then there was blood in her stool – so much blood, she took a picture of the toilet contents and went to the ER.
And even though she’s a health professional who spends her days inside the hospital, Witzel didn’t receive the care she expected.
“I was having severe pain, and I’m crying, and I had blood in my stool. And he [the doctor] said ‘Are you sure you aren’t on your period?’”
A shocked Witzel responded: “I am a woman’s health practitioner. I see more vaginas in a day than you see in a year… I know whether I’m bleeding from vagina or my rectum.”
The ER doctor then took another look at her pictures and asked if her she’d “eaten beets recently.”
Advocating for yourself
“When I think about how much I had to advocate for myself… I had the medical knowledge. I didn’t have the cancer knowledge, but I knew how to navigate the system. So many people don’t. And they just expect that their caregiver is going to do to the right thing,” Witzel says.
By the time Witzel got her diagnosis, her disease had spread. “It’s so treatable if it’s caught early. I currently have stage four with metastases to my liver and lungs.”
Witzel’s story is an example of what can happen when younger people go in for an appointment and doctors don’t think to test for something usually associated with an older population.
Her story may be a worst-case scenario, but she hopes others will learn from her experience and push to receive the care they need.
Key differences between young and old patients
The majority of younger colorectal cancer patients don’t have family history of the disease, and most of them don’t have a genetic disposition toward it. And while obesity does seem to play a small part in some of these cancers, many of these younger patients are vegetarians; some even marathon runners – lifestyles usually associated with being more protective against developing colorectal cancer.
“Our hope in our research is to try to find a high-risk group to do early screening,” says Dr. Mendelsohn.
She urges everyone over 45 to get a colonscopy or other screening test.
Those mail-away tests are generally reliable and helpful, she says, but there is a reason why colonoscopies remain the gold-standard: “In general, stool-based tests are as good as colonoscopies for early detection of cancer. But they’re not as good at finding polyps. [With a colonoscopy] you can get them [the polyps] removed at the time,” says Mendelsohn.
Ultimately, says Dr. Mendelsohn: “Colorectal screening saves lives. If you’re younger than screening age, know your family history. We are working hard to figure this out, and there’s hope on the horizon that we will figure it out.”
Timothy Mitchell was 43 years old when he was diagnosed.
“The older generation didn’t talk about what was going on, which was a disservice to us,” Mitchell says. “It was almost a hush-hush thing.”
Knowing your family history is important and can save your life. In Mitchell’s case, his relatives didn’t always talk about why family members were in the hospital, what illnesses they had, and what their symptoms were.
“What goes on in the house, stays in the house. We don’t tell people our business,” Mitchell says. For him, that could have been fatal.
“Because we don’t know what to look for, because I had Lynch syndrome, and until I talked to my auntie, I didn’t know that so many people in my father’s family had so much cancer.”
That Lynch syndrome put Mitchell at an increased risk for colorectal cancer, something he didn’t realize. Now he plans to encourage his sons get their first colonoscopies in their early 30’s. (Doctors generally recommend children of colon cancer patients receive their first colonoscopies about 10 years before their parent’s age of diagnosis.)
Mitchell, an avid motorcycle rider, regularly approaches other bikers and strikes up conversations about colonoscopies. Not your usual biker talk, perhaps, but potentially life-saving.
“People hear they have cancer and they think they’re gonna die. You should not feel like it’s a death sentence,” he says.
“Cancer is detectable, treatable and beatable,” says Mitchell.
What you need to do
Knowing your family history and talking about it is important. A family history of Lynch syndrome or colon cancer is something you should be aware of, so you can be screened early.
Anyone experiencing a significant change in bowel habits, or anyone who sees blood in their stool, should consult a doctor.
“Most people don’t talk about their poop; it’s not good dinner conversation,” admits Dr. Mendelsohn. Most rectal bleeding does not turn out be cancer, stresses Dr. Mendelsohn, but you should always be checked.
Find a doctor you feel comfortable with, who’s taking your concerns seriously.
“You don’t want to talk about bodily functions,” admits Witzel, the nurse who wasn’t taken seriously. “It tends to be an embarrassing thing. But I will share my story every day if it saves one person.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
