S1: Welcome in San Diego , it's Jade Hindman. On today's show , we are raising awareness about colorectal cancer. The risk factors and the symptoms. This is KPBS Midday Edition. Connecting our communities through conversation. March is colorectal cancer awareness month. The American Cancer Society estimates that more than 150,000 Americans will be diagnosed with colon and rectal cancer this year. And doctors are seeing the disease rise among middle aged adults and even young adults , leading to a push for earlier screening guidelines and research into why. Doctor Samir Gupta is a gastroenterologist and professor of medicine with UC San Diego Health. Doctor Gupta , welcome.
S2: Thank you.
S1: So to hear that this disease is rising among adults under 50 is concerning. And I want to explore some of the reasons behind that. But first , let's lay the groundwork.
S2: It's the second leading cause of cancer death in the United States. We expect about 150,000 new cases this year and about 50,000 deaths. Uh , one of the concerning things about colorectal cancer is that the incidence or the occurrence of the disease appears to be increasing in certain groups. You mentioned the increase in early onset , but we're also now seeing increases in people who are middle aged like 50 to 60.
S1: So what about prognosis ? For those who are diagnosed.
S2: The prognosis is highly dependent on when a person is diagnosed in terms of the stage. So people who have early stage colon cancer , the prognosis is excellent with over 90% survival. We can just do a surgery and cut the cancer out and they don't require additional treatment. But as the stage increases , and definitely if it , uh , spreads beyond the colon , uh , the mortality risk is much , much higher. And it's a much more difficult to treat disease.
S1: So this is spreading among adults in younger age groups.
S2: The occurrence increases with age. We currently recommend that everyone who is age 45 and older get screened for colon cancer. Okay.
S1: Okay.
S2:
S1: All right.
S2:
S1:
S2: One is that it's possible to detect colon cancer early and even prevent colon cancer by keeping up to date with screening. So if you're age 45 and older , get screened for colon cancer. The second thing is that people should know their family history , because if they have a first degree relative like a mother or father , brother or sister who had colon cancer , it's important for them to start their screen screening earlier as much as ten years earlier , before their relative was diagnosed with colon cancer. And the third thing is , I want everyone to know what the potential signs and symptoms of colon cancer can be , which can include rectal bleeding , new and persistent abdominal pain , or change in bowel habits , or an unexplained low blood count or anemia. Now , not everyone who has these symptoms has colon cancer , but if you have these symptoms , it's important to get checked by your doctor and bring up the possibility of colon cancer , so that this is one of the things that is considered as a possible diagnosis. Mhm.
S1: Mhm. Well , and talk a bit more about how much we know about what causes colorectal cancer.
S2: Across the whole lifespan. We know a lot. We know that in general colorectal cancer is a disease of Western lifestyle. So things like less physical activity , less healthy diet. So less fruits and vegetables , higher processed meats or higher red meats. All these things are known to contribute to risk for colon cancer. We know that increasing obesity tobacco exposure Alcohol. These also contribute to risk. Mhm.
S1: Mhm. And so here's a question. So there's this the growing number of people being diagnosed with colorectal cancer. And it's the growing number is in younger people. Is that correct.
S2: The increases that we're seeing are in people under 50 but also know middle aged people as well in 50 to 60. Whereas before for about 30 years we had been seeing decreases in colon cancer incidence in people who are age 50 and older.
S1: Are you seeing increases in adults as young as 20 ? Yes.
S2:
S1: We are now to the growing number of middle aged adults and even young adults being diagnosed with colon cancer.
S2: So under age 45 , We're seeing people present with those signs and symptoms that I mentioned , like having rectal bleeding. Um , for a primary care doctor who's evaluating one of these patients , it can be really hard because colon cancer , even though the incidence is increasing in young people , it's still uncommon. And so for many people who present with rectal bleeding , they don't always get a expedited workup to rule out colon cancer. And what we see often is for the patients who end up being diagnosed with colon cancer , that they often go a long time , 4 or 5 months before they finally get a colonoscopy to have their diagnosis made. We're also seeing young people with the precursors for colon cancer. So , for example , presenting with large polyps within their colon that are causing rectal bleeding , uh , and we end up doing colonoscopies for these patients and seeing these large polyps and those end up being an opportunity for prevention. We find and take those out. But I think as a whole , gastroenterologists are seeing more people who are young with colon cancer and young with large polyps.
S1:
S2: We think some of this is explained by the increased prevalence of obesity in the population. That contributes to some extent. There have been some studies linking changes in diet. So for example , exposure to sugar sweetened beverages and adolescent. That's also been seen as a link. It looks like there's consistent data that increased alcohol use appears to be linked with early onset colon cancer. But I would say that a lot of the risk is unexplained. We see plenty of people who've had early onset colon cancer who don't have any of these risk factors. And for those people , we think that there's probably something going on in terms of an environmental exposure , and this has been understudied. There's a lot of hypotheses out there , but there's not been anything proven.
S1: Well , I know UC San Diego is doing more research on the rise. Correct ? Yes.
S2: We want to do more on this.
S1: And you guys are looking at environmental PFAS.
S2: This is one of the studies we'd like to have funded , is to do a large study in which we examine and the potential environmental links. And the PFAS that you mentioned would be one of the potential environmental risk factors that we want to investigate , to see if the levels tend to be higher in people with versus without colon cancer. Hmm.
S1: Hmm.
S2: We've seen a lot of advances in treatment over the last ten years , new treatments like the availability of immune therapy. We've have new options for treating rectal cancer , where some people can get immune therapy and radiation as a first go to help treat their cancers. In terms of putting it in context of younger people , I think that the biggest impact is , is a lot of the people who are being impacted are in their 40s. They're kind of sandwiched between taking care of kids and taking care of their parents , uh , trying to do what they're doing at work , and the burden of having to engage in a treatment for a cancer that's more advanced , that that's really hard on them and their families.
S1: Earlier you mentioned potential connections between sugary drinks. But talk to me a bit about how alcohol can raise the risk.
S2: So what's been observed as far as alcohol is that among people with early onset colon cancer , the tendency is for there to be higher rates of alcohol consumption than among people who've not had early onset colon cancer , and this has been shown in a number of studies. What we don't know yet is what is it about the alcohol ? Is it just the sheer volume ? Does it have to do with the pattern of drinking , for example , binge drinking ? Does it have to do with when people started getting exposure to alcohol ? This still needs to be explored further for us to understand the relationship better. Hmm.
S1: Hmm.
S2: What's hard about these symptoms is that they're in general very common in the population. Otherwise , for example , lots of people have hemorrhoids that can cause rectal bleeding. Abdominal pain has lots of different causes , and a lot of people might notice a little change in their bowel habit. I think there's a couple of things that separate out the people who might have colon cancer from those where they just have a benign explanation. One is the persistence of the symptoms , and the second is that almost all benign causes of these symptoms , uh , there's a diagnosis that can be made. For example , the hemorrhoids can be seen and confirmed , or they go away with the initial treatment. Uh , so in people with colon cancer , if you do an initial treatment , like just increase the fiber in the diet , if you're trying to address rectal bleeding from hemorrhoids or a change in bowel habit , uh , the symptoms are not going to go away just by increasing fiber in the diet if someone has a colon cancer. So one of the messages we've been trying to deliver to primary care clinicians is to keep colon cancer on their differential diagnosis when people have these symptoms , and to close the clinical loop. And what we mean by that is if you have someone who has these symptoms , you think you think it's a benign cause , make sure you see that patient back in 30 to 60 days to confirm that they've gotten better , that you've established the diagnosis. And if they haven't , that you should consider referring that person for a colonoscopy. Mhm.
S1: Mhm. Uh you know , so we've we've mentioned the sugary drinks and the alcohol. Are there any foods we should be avoiding to lower our risk of colon cancer.
S2: Prescribe avoiding any specific food entirely ? I think what we want to look at are the patterns of diet that tend to be associated with higher versus lower risk , and the patterns of diet that tend to be associated with higher risk would be Eating fewer fruits and vegetables , getting less fiber , uh , eating more red meat. Uh , that doesn't mean that you , for example , can't eat red meat. It just means to do it in moderation.
S1: And so there are a number of events. Well , let me ask you this.
S2: Number one , if you're 45 or older , you need to get screened for colon cancer and stay up to date. The second is know your family history. If you've had a close relative with colon cancer , you may need to start colon cancer screening earlier than other people. And the third is to be aware of what some of the signs and symptoms are. Colon cancer can be so that if you develop them , you're able to work with your doctor to identify the diagnosis or to request a colonoscopy to rule out colon cancer if it's appropriate.
S1: And there are a number of events this month to raise awareness of colorectal cancer , including one called Screen Your Gut , Save Your Butt. Tell us about that.
S2: This is a really fun event that's going to happen on Saturday , March 29th. And it's A5K run walk. You can do what you please. And the whole idea is to raise awareness about colon cancer screening and colon cancer survivorship. We always have a great crew come out. We have an inflatable colon so that you can get a sense of what the inside of the colon looks like , what a polyp or a small growth looks like inside the colon. We have survivors come and tell some of their stories of what they experienced in terms of their diagnosis and their treatment. Um , and it's a it's a really fun event. All the proceeds go to the California Colorectal Cancer Coalition , which is a non-profit organization. They distribute the funds to community clinics throughout California to help develop programs for increasing colon cancer screening. Participation. Hmm.
S1: Hmm.
S2: I like to communicate to people that they have options for screening. So the most commonly done test is called an AP. But if someone's not ready to have a colonoscopy , either because they can't take a day off work or they're of the invasive nature of the procedure , we let them know that they have non-invasive options that they can choose. For example , there are a couple stool tests that are available which can look for early signs of colon cancer. That can be done in the convenience of your home. The FDA recently approved a new blood test , which may be becoming more available depending on how the Preventive Services Task Force reviews the evidence around that test. But the key thing for patients to know is that colon cancer is is preventable , and it can be detected early by participating in screening , and that they have a number of options they can consider for screening.
S1: I've been speaking with Doctor Samir Gupta. He's a gastroenterologist. He's a gastroenterologist and professor with UC San Diego Health. Doctor Gupta , thank you so much.
S2: Thank you so much. I really appreciate your attention to this issue.
S1: And for information on colon cancer and events this month , you can visit see a Colon Cancer org or our website , pbs.org. That's our show for today. I'm your host , Jade Hindman. Thanks for tuning in to Midday Edition. Be sure to have a great day on purpose , everyone.
