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.
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, 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.
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.”
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 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, 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.
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.
Women living in states with abortion bans obtained the procedure in the second half of 2023 at about the same rate as before the U.S. Supreme Court overturned Roe v. Wade, according to a report released Tuesday.
Women did so by traveling out of state or by having prescription abortion pills mailed to them, according to the #WeCount report from the Society of Family Planning, which advocates for abortion access. They increasingly used telehealth, the report found, as medical providers in states with laws intended to protection them from prosecution in other states used online appointments to prescribe abortion pills.
“The abortion bans are not eliminating the need for abortion,” said Ushma Upadhyay, a University of California, San Francisco public health social scientist and a co-chair of the #WeCount survey. “People are jumping over these hurdles because they have to.”
Abortion patterns have shifted
The #WeCount report began surveying abortion providers across the country monthly just before Roe was overturned, creating a snapshot of abortion trends. In some states, a portion of the data is estimated. The effort makes data public with less than a six-month lag, giving a picture of trends far faster than the U.S. Centers for Disease Control and Prevention, whose most recent annual report covers abortion in 2021.
The report has chronicled quick shifts since the Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling that ended the national right to abortion and opened the door to enforcement of state bans.
The number of abortions in states with bans at all stages of pregnancy fell to near zero. It also plummeted in states where bans kick in around six weeks of pregnancy, which is before many women know they’re pregnant.
But the nationwide total has been about the same or above the level from before the ruling. The study estimates 99,000 abortions occurred each month in the first half of 2024, up from the 81,000 monthly from April through December 2022 and 88,000 in 2023.
One reason is telehealth, which got a boost when some Democratic-controlled states last year began implementing laws to protect prescribers. In April 2022, about 1 in 25 abortions were from pills prescribed via telehealth, the report found. In June 2024, it was 1 in 5.
The newest report is the first time #WeCount has broken down state-by-state numbers for abortion pill prescriptions. About half the telehealth abortion pill prescriptions now go to patients in states with abortion bans or restrictions on telehealth abortion prescriptions.
In the second half of last year, the pills were sent to about 2,800 women each month in Texas, more than 1,500 in Mississippi and nearly 800 in Missouri, for instance.
Travel is still the main means of access for women in states with bans
Data from another group, the Guttmacher Institute, shows that women in states with bans still rely mostly on travel to get abortions.
By combining results of the two surveys and comparing them with Guttmacher’s counts of in-person abortions from 2020, #WeCount found women in states with bans throughout pregnancy were getting abortions in similar numbers as they were in 2020. The numbers do not account for pills obtained from outside the medical system in the earlier period, when those prescriptions most often came from abroad. They also do not tally people who received pills but did not use them.
West Virginia women, for example, obtained nearly 220 abortions monthly in the second half of 2023, mostly by traveling — more than in 2020, when they received about 140 a month. For Louisiana residents, the monthly abortion numbers were about the same, with just under 700 from July through December 2023, mostly through shield laws, and 635 in 2020. However, Oklahoma residents obtained fewer abortions in 2023, with the monthly number falling to under 470 from about 690 in 2020.
Telehealth providers emerged quickly
One of the major providers of the telehealth pills is the Massachusetts Abortion Access Project. Cofounder Angel Foster said the group prescribed to about 500 patients a month, mostly in states with bans, from its September 2023 launch through last month.
The group charged $250 per person while allowing people to pay less if they couldn’t afford that. Starting this month, with the help of grant funding that pays operating costs, it’s trying a different approach: Setting the price at $5 but letting patients know they’d appreciate more for those who can pay it. Foster said the group is on track to provide 1,500 to 2,000 abortions monthly with the new model.
Foster called the Supreme Court’s 2020 decision “a human rights and social justice catastrophe” while also saying that “there’s an irony in what’s happened in the post-Dobbs landscape.”
“In some places abortion care is more accessible and affordable than it was,” she said.
There have no major legal challenges of shield laws so far, but abortion opponents have tried to get one of the main pills removed from the market. Earlier this year, the U.S. Supreme Court unanimously preserved access to the drug, mifepristone, while finding that a group of anti-abortion doctors and organizations did not have the legal right to challenge the 2000 federal approval of the drug.
This month, three states asked a judge for permission to file a lawsuit aimed at rolling back federal decisions that allowed easier access to the pill — including through telehealth.
Climate change may be contributing to thousands more wildfire smoke-related deaths every year than in previous decades, a new study suggests — results a Canadian co-author says underline the urgency of reducing planet-warming emissions.
The international study published Monday is one of the most rigorous yet in determining just how much climate change can be linked to wildfire smoke deaths around the world, said Sian Kou-Giesbrecht, an assistant professor at Dalhousie University.
“What stands out to me is that this proportion is increasing just so much. I think that it really kind of attests to just how much we need to take targeted action to reducing greenhouse-gas emissions,” she said in an interview.
The study estimates, using mathematical modeling, that about 12,566 annual wildfire smoke-related deaths in the 2010s were linked to climate change, up from about 669 in the 1960s, when far less carbon dioxide was concentrated in the atmosphere.
Translated to a proportion of wildfire smoke mortality overall, the study estimates about 13 per cent of estimated excessdeaths in the 2010s were linked to climate change, compared to about 1.2 per cent in the 1960s.
“Adapting to the critical health impacts of fires is required,” read the study, published in the peer-reviewed journal Nature Climate Change.
While wildfires are a natural part of the boreal forest ecosystem, a growing number of studies have documented how climate change, driven by the burning of fossil fuels, is making them larger and more intense — and contributing more to air pollution.
The same research group is behind another study published in the same journal Monday that suggests climate change increased the global area burned by wildfire by about 16 per cent from 2003 to 2019.
Those climate-fuelled fires then churn out more fine particle pollution, known as PM2.5, that’s tiny enough to get deep into the lungs — and in the long run can have serious health effects.
The study that estimated the scale of those effects is based on modeling, not historical data about reported deaths from air pollution.
Researchers used established public-health metrics for when pollution is thought to contribute to mortality, then figured out the extent to which wildfire smoke may have played a role in that overall exposure to arrive at the estimates.
Meanwhile, Health Canada estimates that between 2013 and 2018, up to 240 Canadians died every year due to short-term exposure to wildfire air pollution.
Kou-Giesbrecht said Monday’s study did not find that climate change had a major influence on the number of smoke-related deaths from Canada’s boreal wildfires.
She suggested that’s likely due to the country’s relatively small population size, and how tricky it is to model forest fires in the region, given its unique mix of shrubs and peat.
But she also noted that a stretch of devastating Canadian wildfire seasons over the past several years was not captured in the study, and she expects future research could find a bigger increase in deaths and public-health problems linked to climate change.
The most affected regions in the study were South America, Australia and Europe.
Kou-Giesbrecht said the more studies that uncover the link between climate change and disasters as “tangible” as wildfires, the more the case for “drastic climate action” will be bolstered.
“I think that the more and more evidence that we have to support the role of climate change in shaping the past 100 years, and knowing that it will continue to shape the next 100 years, is really important,” she said.
“And I find that personally interesting, albeit scary.”
The study used three highly complex models to estimate the relationship between climate change, land use and fire.
The models, which each contain thousands upon thousands of equations, compare what wildfires look like in the current climate to what they may have looked like in pre-industrial times, before humans started to burn vast amounts of fossil fuels.
The researchers used the models to calculate gas and aerosol emissions from wildfires between 1960 and 2019, and then make estimates about annual smoke-related deaths.
The type of methodology used by Monday’s studies, known as attribution science, is considered one of the fastest-growing fields of climate science. It is bolstered in part by major strides in computing power.
This report by The Canadian Press was first published Oct. 21, 2024.
Some Ontario doctors have started offering a free shot that can protect babies from respiratory syncytial virus while Quebec will begin its immunization program next month.
The new shot called Nirsevimab gives babies antibodies that provide passive immunity to RSV, a major cause of serious lower respiratory tract infections for infants and seniors, which can cause bronchiolitis or pneumonia.
Ontario’s ministry of health says the shot is already available at some doctor’s offices in Ontario with the province’s remaining supply set to arrive by the end of the month.
Quebec will begin administering the shots on Nov. 4 to babies born in hospitals and delivery centers.
Parents in Quebec with babies under six months or those who are older but more vulnerable to infection can also book immunization appointments online.
The injection will be available in Nunavut and Yukon this fall and winter, though administration start dates have not yet been announced.
This report by The Canadian Press was first published Oct. 21, 2024.
-With files from Nicole Ireland
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
