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Colorectal cancer keeps rising among younger adults. No one's sure why – CBC News

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After giving birth to her third child at 35-years old, Alexis Juliao began noticing blood in her stool.

“Everyone said to me, it’s hemorrhoids, you just had a baby,” the London, Ont., mother recalled. “Everyone explained it, or dismissed it, as being normal.”

But Juliao knew it wasn’t normal. And she knew she didn’t have any hemorrhoids.

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What followed was a lengthy, frustrating process to figure out what was actually going on. For more than six months, Juliao kept experiencing the same bleeding, but most people simply brushed it off because of her age. She eventually took photos of the blood in her stool, prompting her physician to refer her for a colonoscopy.

Once Juliao finally had her scope — after nearly nine months of experiencing symptoms — she learned what was causing her bizarre bleeding while breastfeeding her youngest daughter in her hospital bed: a tumour. 

She had Stage 1 colon cancer, despite only being in her mid-30s.

“I was actually relieved they had found what was wrong,” she said, “which very quickly turned into realizing the gravity of the whole situation.”

Juliao required major surgery to remove a roughly 30-centimetre stretch of her lower colon, had to take more than half a year off her work as a midwife to recover, and is now learning to live with life-altering changes to her digestive system.

Alexis Juliao took this photo of her abdomen in hospital after having major surgery to remove a roughly 30-centimetre stretch of her lower colon. (Submitted by Alexis Juliao)

While her situation remains rare, it’s increasingly clear to gastrointestinal specialists that colorectal cancer is on the rise among younger adults. The trend has been observed for years, in multiple countries including Canada, with no clear cause — though there are plenty of swirling theories that it could be linked to dietary or lifestyle changes in recent decades. 

Whatever the reason, doctors are worried that younger patients may be slipping through the cracks of a medical system that screens older adults — and asking whether that needs to change.

“One of the challenges for young people is that, when presenting with symptoms, [they] are often told that they have hemorrhoids or some benign condition that’s causing bleeding,” said Vancouver-based colorectal surgical oncologist Dr. Carl Brown.

“But we feel strongly that all those patients, all of those people, should have [an] endoscopic evaluation to rule out cancer.”

WATCH | Colorectal cancer cases are rising in young people, but no one knows why: 

Colorectal cancer cases are rising in young people, but no one knows why

2 days ago

Duration 2:58

A new health study out of the United States is revealing a worrying trend – colon and rectal cancer are on the rise in younger adults. Doctors say it’s happening in Canada too. No one is quite sure why, but some doctors are now asking if screenings should be made available to younger patients.

Colorectal cancer rising in people under 50 in U.S., Canada 

New data from the American Cancer Society paints a stark picture: The incidence of colorectal cancer went up two per cent each year in people under 50 between 2011 and 2019, even though U.S. incidence rates have either dropped or stabilized for older adults who are eligible for screening programs.

Deaths have also gone up by one per cent each year since 2005 for people younger than 50, according to a report released this month, while advanced disease now appears to be increasingly common across the board. 

“We know rates are increasing in young people, but it’s alarming to see how rapidly the whole patient population is shifting younger, despite shrinking numbers in the overall population,” said lead author Rebecca Siegel, the American Cancer Society’s senior scientific director for surveillance research, in a statement.

“The trend toward more advanced disease in people of all ages is also surprising.”

Top Canadian clinicians weren’t shocked by the data, with similar trends north of the border as well.

“As physicians, we need to be aware of these trends — and these alarming numbers — and have a lower threshold to refer [patients] on for investigation,” said Dr. Ian Bookman, medical director of the Toronto-based Kensington Screening Clinic, who said he’s been seeing more younger people with colorectal cancer, often at later stages, in recent years.

Dr. Carl Brown, shown here in an operating room is the lead for surgical oncology at the B.C. Cancer Center.
Dr. Carl Brown, the lead for surgical oncology at B.C. Cancer, said many of the younger patients he sees have tried to get medical care for months, but were turned away because most physicians and caregivers didn’t realize they could be at risk. (Submitted by Carl Brown)

The typical age for patients, according to oncologist Dr. Christine Brezden-Masley, used to be around 65 years old and predominantly male. But in just the last few months, she recalled seeing three patients under 45 who progressed into advanced disease.

“We are all bewildered as to why younger patients are being diagnosed with [colorectal cancer], and some with advanced and more aggressive disease,” said Brezden-Masley, the medical director of the cancer program at Sinai Health System in Toronto, in an email exchange with CBC News.

One Canadian study, published in 2019 in the peer-reviewed Journal of the American Medical Association, found the incidence of colorectal cancer among younger Canadian adults has recently been rising by more than three per cent each year “and possibly accelerating.”

Brown, who’s also the lead for surgical oncology at B.C. Cancer, said many of the younger patients he sees have tried to get medical care for months, but were turned away because most physicians and caregivers didn’t realize they could be at risk. 

“In some cases we’re seeing 30-year-old people with young families, and the emotional aspects, the challenges there, are intense,” Brown said.

Even if medical teams can cure these cancers — which they often can, Brown quickly added — the surgical treatments involved can dramatically alter someone’s life, since removing tumours often means removing portions of the colon, impacting bowel function and, in some cases, fertility or sexual function. 

Bookman, in Toronto, said incontinence and lifelong reliance on ostomy bags — pouches used when stool is surgically redirected out through someone’s abdomen — are other potential impacts that can be particularly hard on young, working adults.

A woman with long brown hair smiles in a portrait.
Dr. Sharlene Gill is a professor of medicine at the University of British Columbia and a gastrointestinal medical oncologist with B.C. Cancer. (Submitted by Sharlene Gill)

‘This is still a mystery’

Some scientists believe the rise in cases among younger adults may be linked to more consumption of processed meats and sugars and more liberal use of antibiotics in recent decades. Parsing a precise cause, though, is a difficult task.

“The leading hypothesis is that these kinds of factors influence the bacterial diversity within our gut, what we call the gut microbiome,” said Dr. Sharlene Gill, a professor of medicine at the University of British Columbia and a gastrointestinal medical oncologist with B.C. Cancer. That, in turn, may lead to chronic inflammation, which can hike the risk of cancerous cells developing.

Other researchers speculate that an increasingly sedentary lifestyle could be playing a role, or people eating less fruits and vegetables. Diet, alcohol use, and possibly other unknown, external factors may all be contributing, Brezden-Masley suggested. 

“But this is still a mystery,” she added, “and shifting perhaps to earlier screening may be needed.”

Two years ago, the American Cancer Society — which put out the startling new U.S. statistics this month — dropped the recommended age cut-off for colorectal cancer screening to 45, down from 50.

Here in Canada, the conversation around the right age to get screened is ramping up as well. 

Dr. Ian Bookman, medical director of the Toronto-based Kensington Screening Clinic, holds up the long, black scope used during a colonoscopy.
Dr. Ian Bookman, medical director of the Toronto-based Kensington Screening Clinic, holds up the scope used during a colonoscopy. (Lauren Pelley/CBC)

What age should people be screened?

Multiple clinicians CBC News spoke to suggested Canada should be considering a lower cut-off, while also weighing the risks and benefits — alongside the need for more awareness of screening programs for all eligible adults.

“We’re investigating that in Canada, but we have not gone down that road at this point,” said Brown, in B.C. “One of the challenges is it takes a lot of resources to do screening programs, but we think the value of that is immense.”

So far, the provinces offering screening programs have stuck to a cut-off of 50 and up for average risk individuals, and typically only offer screening to those younger than 50 if they’re at a higher risk due to family history of the disease. (Northwest Territories, Nunavut and Quebec are still in the process of organizing screening programs, though screening tests are offered on a patient-by-patient basis.)

Colorectal cancer screenings usually involve one of two options: An at-home fecal immunochemical test, or FIT, is a screening tool that looks for hidden blood in fecal matter, which is typically offered when people don’t have major risk factors. When people are at a high risk, or actually displaying symptoms, a colonoscopy is typically offered.

Dr. Jill Tinmouth, the lead scientist for Ontario's colon cancer screening program, in her office.
Dr. Jill Tinmouth, the lead scientist for Ontario’s colon cancer screening program, stressed that there’s not yet sufficient evidence that the benefits of screening people under 50 would outweigh the potential harms that follow colonoscopies. (Turgut Yeter/CBC)

Dr. Jill Tinmouth, the lead scientist for Ontario’s colon cancer screening program, stressed that there’s not yet sufficient evidence that the benefits of screening people under 50 would outweigh the potential harms that follow colonoscopies. 

It’s an invasive test, involving a flexible scope inserted in the rectum, typically while a patient is under anesthesia. While the test is generally safe, and capable of spotting issues inside the colon that could be cancerous, Tinmouth said it comes with slight risks when physicians remove polyps — things like bleeding or puncturing the walls of the colon.

“We just want to reserve it for the cases where we really think the chances of finding something important are there,” she said.

Offering screenings to millions more Canadians could also be a “huge challenge” given the current backlog, Brown said. 

Waiting lists, and wait times, for a colonoscopy ballooned in many regions in recent years as provinces struggled to catch up with the number of procedures cancelled or delayed during the COVID-19 pandemic. One federal estimate suggests 540,000 Canadians might have missed their colorectal cancer screening between April and the end of June in 2020.

As the country plays catch-up, Brown worries primary care providers are struggling to even get those already eligible through the screening system.

“When they know that the wait list for a colonoscopy may be a year, they look for other ways of investigating and managing people rather than sending them for what they think maybe a few really long wait,” he said.


Need for ‘increased awareness’

Whether or not Canada follows the U.S. on lowering screening cut-offs in the future, several physicians said both Canadians and their family doctors or other primary care providers need to be more aware that, while still rare, colorectal cancer is a rising threat to the health of younger adults. 

Elizabeth Holmes, senior manager of health policy at the Canadian Cancer Society, said it’s important to be upfront about changes in your bowel habits, and push to have medical assessment to rule out serious illness. 

“Trust yourself that you know what is right for your body,” she said. “If there’s something wrong, it might not be something serious, like colorectal cancer, but it’s still something that is bothering you.”

Juliao, the Ontario mother of three, wonders what could have happened if she’d given up on getting a colonoscopy. 

“It could’ve been much more devastating,” she said.

WATCH | Later cancer diagnoses a looming disaster, experts warn: 

Late cancer diagnoses an impending disaster, experts say

2 years ago

Duration 2:54

Cancer specialists are bracing for a wave of patients suffering from more advanced disease due to delays in both screening and diagnostic testing during the pandemic.

But even her Stage 1 diagnosis was life-altering. The first year of her recovery after surgery was challenging, since the loss of a portion of her colon led to major changes in how her digestive system works.

Juliao began suffering from pain and bloating, and realized her body simply can’t handle certain foods anymore, from garlic to certain types of beans. 

“I have to go to the bathroom much more frequently,” she added. “It’s not something we really talk about in our society but initially after the surgery, I had to poop 10 to 12 times a day. That’s not something you can manage with work, with having kids. I couldn’t really go anywhere.”

Like many Canadian clinicians, she’s now calling for more awareness of the risks facing younger adults. Otherwise, she warned, more people like her could have their lives upended by a cancer no one wants to talk about.

“It’s about trusting ourselves, and listening to ourselves,” Juliao said. “And for care providers, it’s about trusting their patients.”


Colorectal cancer symptoms to watch for

  • Diarrhea, constipation, or other persistent changes in bowel habits or stool consistency. 
  • Blood in your stool or bleeding from the rectum.
  • Unexplained weight loss.
  • Ongoing abdominal pain, gas, or cramping.
  • Feeling like your bowels don’t fully empty out.
  • Weakness or fatigue.

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Measles case reported locally turns out to be negative: health unit

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NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
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On March 26, the Simcoe Muskoka District Health Unit (SMDHU) was notified by Public Health Ontario’s (PHO) laboratory that due to laboratory error, the case of measles that had been lab-confirmed positive on March 12, based on symptoms and a positive urine measles laboratory result by PHO’s laboratory, is in fact negative for the measles virus.

“With this new information of the negative lab result, we believe that that individual was not infected with measles and that there has not been any public exposure to measles resulting from this individual’s illness,” said Dr. Charles Gardner, medical officer of health. “We recognize that notifying the public of what we believed to be a positive measles case in our area created worry, anxiety and disruption for some, and we regret this.

“We do know that, despite best efforts, on rare occasions laboratory errors can occur. We are working closely with the PHO’s laboratory to do all that we can to ensure that such an incident does not occur again.”

Measles is a highly contagious viral infection that spreads very easily through airborne transmission. The measles virus can live in the air or on surfaces for up to two hours.

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Symptoms of measles begin seven to 21 days after exposure and include fever, runny nose, cough, drowsiness, and red eyes. Small white spots appear on the inside of the mouth and throat but are not always present. Three to seven days after symptoms begin, a red, blotchy rash appears on the face and then progresses down the body.

The risk of transmission to those vaccinated with two doses is low, and when it does occur tends to show a reduction in the severity of these symptoms.

“Although we are relieved for the individual involved, and for all Simcoe-Muskoka residents, that this case has now been confirmed as negative, we know that measles is still active in Ontario at this time and the potential remains for new cases to arise, especially given the increase in Ontarians travelling to areas in the world that have higher numbers of measles cases,” said Dr. Gardner. “This is why we continue to advise individuals to keep up to date with their routine immunizations, including measles, mumps and rubella (MMR) vaccination.”

The risk of measles is low for people who have been fully immunized with two doses of measles vaccine or those born before 1970; however, many children have been delayed in receiving their routine childhood immunizations and people who have not had two doses of measles vaccine are at higher risk of contracting the disease.

People who do get sick usually recover without treatment, but measles can be more severe for infants, pregnant women, and those with compromised immune systems. Possible complications include middle-ear infections, pneumonia, diarrhea, or encephalitis (swelling of the brain) and occasionally death in the very young. Even individuals who are up to date with the measles vaccine should watch for symptoms of measles for 21 days after exposure.

For more information about measles, please visit smdhu.org or call Health Connection at 705-721-7520 or 1-877-721-7520, Monday to Friday between 8:30 a.m. and 4:30 p.m. to speak with a public health professional.

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Kate Middleton Not Alone. Cancer On Rise For People Under 50, Say Experts

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Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery

London:

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When Catherine, Princess of Wales, revealed she was being treated for cancer last week, part of the shock was that an otherwise healthy 42-year-old has a disease that mostly plagues older people.

However, researchers have been increasingly sounding the alarm that more and more people under 50 are getting cancer — and no one knows why.

Across the world, the rate of under-50s diagnosed with 29 common cancers surged by nearly 80 percent between 1990 and 2019, a large study in BMJ Oncology found last year.

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The researchers predicted the number of new cancer cases among younger adults will rise another 30 percent by the end of this decade, with wealthy countries particularly affected.

The increase in cases — and soaring global population — means that the number of deaths among under 50s from cancer has risen by nearly 28 percent over the last 30 years.

This occurred even as the odds of people of all ages surviving cancer have roughly doubled over the last half century.

Shivan Sivakumar, a cancer researcher at the UK’s University of Birmingham, called it an “epidemic” of young adult cancer.

Since Kate Middleton revealed on Friday that her cancer was discovered after she received abdominal surgery earlier this year, Sivakumar and other doctors have spoken out about the uptick in younger cancer patients they have been seeing at their clinics.

While breast cancer remains the most common for people under 50, the researchers expressed particular concern about the rise of gastrointestinal cancers — such as of the colon, pancreas, liver and oesophagus — in younger adults.

Colon cancer is now the leading cause of cancer deaths in men under 50 in the United States, according to the American Cancer Society. For women, it is number two — behind only breast cancer.

One high profile case of colorectal cancer was “Black Panther” actor Chadwick Boseman, who died at the age of 43 in 2020.

Why is this happening?

“We just don’t have the evidence yet” to say exactly what is causing this rise, Sivakumar told AFP, adding it was likely a combination of factors.

Helen Coleman, a cancer epidemiology professor at Queen’s University Belfast who has studied early onset cancer in Northern Ireland, told AFP there were two potential explanations.

One is that people in their 40s were exposed to factors known to cause cancer — such tobacco smoke, alcohol or being obese — at an earlier age than previous generations.

She pointed out that the “obesity epidemic” did not start until the 1980s.

Sivakumar felt that at least part of the puzzle could be explained by obesity.

However, there is “another wave” of under-50 patients who are neither obese nor genetically predisposed still getting cancer, he emphasised, adding that this could not be put down to “statistical chance”.

The other theory, Coleman said, is that “something different” has been going on with her generation.

Fingers have been pointed out a range of possible culprits — including chemicals, new drugs and microplastics — but none have been proven.

Some have suggested that so-called ultra-processed foods could be to blame. “But there’s very little data to back any of that up,” Coleman said.

Another theory is that the food we eat could be changing our gut microbiome.

While there is nothing conclusive yet, Coleman said her own research suggested that cancer causes changes to the microbiome, not the other way around.

Anti-vaxx conspiracy theorists have even tried to blame Covid-19 vaccines.

This is easily disproven, because the rise in young adult cancer has taken place over decades, but the vaccines have only been around for a few years.

What can be done?

To address the rise in younger colorectal cancer, in 2021 the US lowered the recommended age for screening to 45. Other countries have yet to follow suit.

But the researchers hoped that Catherine’s experience would remind people at home that they should consult their doctor if they sense anything is wrong.

“People know their bodies really well,” Sivakumar said.

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“If you really feel that something isn’t right, don’t delay — just get yourself checked out.”

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Almost 3,000 students suspended in Waterloo Region over immunization issues

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Close to 3,000 children attending elementary school across Waterloo Region were suspended from school on Wednesday morning for not having up-to-date immunization records.

The region says Waterloo Public Health suspended 2,969 students under the Immunization of School Pupils Act (ISPA).

For several months, the region has been campaigning for people to get their children’s vaccinations up to date, including sending letters home to parents on a couple of occasions, warning that students’ records needed to be up to date or they would be suspended.

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It announced in January that 32,000 students did not have up-to-date records: 22,000 elementary students and 10,000 high school students.


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“We have made remarkable progress from the original 27,567 immunization notices we sent to parents in November and December 2023,” Dr. Hsiu-Li Wang, medical officer of health, stated.

“Since that time, we have resolved more than 24,500 outdated vaccination records, providing students with valuable protection against these serious and preventable diseases.”

The high school students still have a few weeks to get their records up to date or else face suspension.

The ISPA requires students to have proof-of-vaccination records for diphtheria, polio, tetanus, pertussis, measles, mumps, rubella, varicella (chickenpox) and meningitis, which must be on file with public health.

Public health says caregivers whose children are suspended will need to book an appointment at regionofwaterloo.ca/vaccines for clinics, which will be held in Cambridge and Waterloo on weekdays.

“Given the high number of suspensions, it may take several days before you can be seen at an appointment and return your child to school,” a release from the region warns.

“Record submission and questions must be done in person to ensure immediate resolution.”

The last time suspensions over immunizations were issued was in 2019, when 1,032 students were suspended.

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