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.
Skinstitut Holiday Gift Kits take the stress out of gifting
Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.
In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.
“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.
There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.
Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.
Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.
In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.
Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?
It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.
Here’s how you can prepare your digital life for your survivors:
Apple
The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.
For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.
You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.
Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.
Google
Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.
When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.
You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.
There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.
Facebook and Instagram
Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.
When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.
The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.
You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.
TikTok
The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.
Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.
X
It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.
Passwords
Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?
Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.
But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.
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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.
The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.
New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.
The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.
Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.
Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.
“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.
“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”
McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.
But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.
The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.
He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.
“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.
“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.
McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”
McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.
He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.
“Early identification of reading difficulty can truly change the trajectory of a child’s life.”
This report by The Canadian Press was first published Oct. 23, 2024.
