The kale-based concoction sped enough food through her system to make a partial blockage painful. A colonoscopy found a tumor, which surgeons removed the next day, along with a foot of her colon.
She was 34 years old.
She ate well. She exercised. She had no known hereditary risk. She appeared perfectly healthy, yet she harbored stage 4, or metastatic, disease.
Such a finding in such a patient would have made news at one time, but it has become disturbingly common of late, and no one knows why.
AN ALARMING TREND
The incidence of colorectal cancer has been steadily rising by about 1.5 percent per year for people under 50. Researchers who recently studied the trend expect it to continue until, in another 15 years, people under 50 will account for 1 in 4 cases of rectal cancer and 1 in 9 cases of colon cancer.
To make matters worse, younger adults are being diagnosed later in the course of the disease than their older counterparts. Routine screening catches many early-stage cases in older adults, but, except when family history justifies early checks, that screening begins at 50 years old. People who fall below that age cutoff often learn of their condition after the symptoms of advanced disease send them to the hospital.
As a result, more than 63 percent of younger colon cancer patients and 57 percent of younger rectal cancer patients are diagnosed with stage 3 or stage 4 disease. The comparable figures for older patients are 49 percent and 46 percent.
Later diagnosis naturally leads to inferior outcomes. The five-year survival rate is 90 percent for patients diagnosed with localized colorectal cancer, 71 percent for patients diagnosed with regional disease and 13 percent for those with distant tumors. Experts researching the trend say it’s too soon to consider lowering the recommended age for routine colon cancer screening, but Dawn Eicher is pushing for just that. Diagnosed with stage 4 colorectal cancer in 2013 at age 36, Eicher says the warning signs she’d experienced for years were ignored—in part because she had no family history of the disease.
As of early March, the wife and mother of two young children was seeking 75,000 signatures on an online petition to drop America’s initial age for colorectal cancer screening drastically, from 50 to 20. She planned to present the petition during a mid-March Call on Congress sponsored by patient advocacy group Fight Colorectal Cancer, during which members of the colorectal cancer community expected to have opportunities to meet with their federal representatives.
“We want to convince our lawmakers, the insurance companies and lobbyists how important these tests are and the critical nature of lowering the testing age,” she wrote in an explanation of the petition on the website Change.org. “There are new, simple blood tests (Cologuard), fecal occult tests, colonoscopies and sigmoidoscopies. Had I been offered any of these when I had initial symptoms, maybe I wouldn’t have been diagnosed at an advanced stage.”
Short of such a guideline change, one option for younger adults is to buy over-thecounter fecal occult blood tests and screen their own stool at home, proceeding to their doctors’ offices if the tests turn up positive.
A DIFFERENT SET OF CHALLENGES
Younger patients can typically weather treatments better than older ones and recover more fully, but they also face challenges that are unusual for the typical colorectal cancer patient, whose average age of diagnosis is 69.
Petzold, for example, worried about letting down the many people who depended on her: her three young children, her aging parents, her class of special-needs students, her coworkers and her friends. She was particularly worried about her husband, who would have to care for her, care more for the children and still earn a living.
“During my first course of chemo, when I had just lost the ability to do anything productive, I felt so guilty just lying there, watching the people I should be caring for taking care of me,” she says.
Still, even at her lowest moment, Petzold thanked God that she had gotten sick after she had children.
Josh Wimberly had no such luck. He was just 30 when a colonoscopy found his stage 3b cancer and his doctor urged him to begin immediately on a treatment plan that would likely render him sterile.
Wimberly and his wife wanted kids enough to risk a slight delay, so he spent a few weeks building a deposit at a sperm bank before beginning chemotherapy. Subsequent in vitro fertilization procedures consumed Wimberly’s samples and the couple’s savings without producing a child.
Wimberly and his wife then turned to an adoption agency, but believe that Wimberly’s illness kept them at the bottom of the list. Only then, when things looked hopeless, did Wimberly’s reproductive system recover enough to allow him and his wife to conceive.
Research has yet to explain why colorectal cancer is on the rise among younger people like Petzold and Wimberly. Many assume that the blame lies mostly with people eating less healthy diets and not exercising enough, but others think the full explanation may prove considerably more complicated.
For younger people who have the disease, however, asking “why” may actually be counterproductive. “Any moment I spend asking what I did to bring this upon myself is a wasted moment,” Wimberly says. “It’s a moment that I’m not doing something fun that makes a memory for my son.”