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Colon Cancer in Young Patients

Panelists: John Marshall, MD, Georgetown University; Cathy Eng, MD, Vanderbilt University; Tanios Bekaii-Saab, MD, Mayo Clinic; Dustin Deming, MD, University of Wisconsin; Michael Morse, MD, Duke Cancer Institute
Published: Wednesday, Aug 07, 2019



Transcript: 

John Marshall, MD: Let’s talk about a couple of interesting scenarios. Dustin, I think you’re obviously the person to begin this discussion. Why are young people getting colon cancer?

Dustin Deming, MD: This is actually really concerning. Over the past 40 years, the rate of colon cancer in patients less than 50 has doubled, and rectal cancer has quadrupled. Obviously, I’m one of them. The honest answer is I don’t think anybody really knows why. It looks like it’s a worldwide phenomenon. There’s now been data presented across many countries that are seeing a very similar effect. There are people interested in microbiome and diet, childhood obesity, and gene-environment-type interaction. However, we really don’t have a good handle on why this is the case.

John Marshall, MD: I’d really like your comments on the shift. Recommendations were made to shift screening to 45. What does that do for this problem?

Dustin Deming, MD: I think it helps, to some degree, because a big proportion of the patients who are being diagnosed early are in that range. However, I think what’s more important is getting the idea out to primary care doctors that when they see a young person with rectal bleeding, it’s not always hemorrhoids. Being proactive and looking for rectal cancer, and understanding that people in their 20s and 30s are getting rectal cancer at a much more prevalent pace than before, is really important.

John Marshall, MD: God bless the primary care doctor or the emergency department doctor who’s got to make that decision 30 times a day of how much testing to recommend? Cathy, I know you care a lot about this space. What are your thoughts?

Cathy Eng, MD: Yesterday when they presented the TNT [total neoadjuvant therapy]-updated arm, one-third of those patients were less than 50 years old, which was so striking to me. It’s something that we all need to investigate further. Patients, family members, and PCPs [primary care physicians] need to pay attention, as well, to help get patients to us sooner and get them diagnosed.

Tanios Bekaii-Saab, MD: In addition to the PCP, I think there should be global awareness in the overall population that this is a problem. Oftentimes, it’s not just the primary care physician. It’s the patient who’s young and sees blood, googles it, and thinks, “Probably hemorrhoids, because it’s very unlikely at this age to get cancer.” There should be general awareness across the board about this. This is a rising problem, and probably going to continue to get worse.

Cathy Eng, MD: The issue is often that young patients, a large part of the time, are so healthy, they don’t think they need a PCP, right? Many of them don’t even have one.

John Marshall, MD: Particularly, men in this age group don’t go regularly. Women have gynecological visits, but men don’t generally go. More and more, doc-in-a-box or strip mall urgent care centers are replacing primary cares, too. This is a really important message. My hope is that, as we study this, we will actually gain some important, fundamental understanding of colon cancer and what’s going on, which might be applicable to all sort of patients, right? It would be a good thing.

Cathy Eng, MD: There are also lots of additional patient advocate groups, as well as other organizations and institutions that are supporting a young colorectal cancer program.

John Marshall, MD: As a guy who’s been sort of jealous of breast cancer all my life, to me, this wave of young people getting the cancer is a way for us to get some advocacy, and to get the kind of research support that we need urgently, quite honestly.

For all the audience out there listening, make sure your community knows about this. Make sure your emergency department people and your primary care referral network are aware of this. Dustin, thank you for sharing your thoughts on that.

Transcript Edited for Clarity

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Transcript: 

John Marshall, MD: Let’s talk about a couple of interesting scenarios. Dustin, I think you’re obviously the person to begin this discussion. Why are young people getting colon cancer?

Dustin Deming, MD: This is actually really concerning. Over the past 40 years, the rate of colon cancer in patients less than 50 has doubled, and rectal cancer has quadrupled. Obviously, I’m one of them. The honest answer is I don’t think anybody really knows why. It looks like it’s a worldwide phenomenon. There’s now been data presented across many countries that are seeing a very similar effect. There are people interested in microbiome and diet, childhood obesity, and gene-environment-type interaction. However, we really don’t have a good handle on why this is the case.

John Marshall, MD: I’d really like your comments on the shift. Recommendations were made to shift screening to 45. What does that do for this problem?

Dustin Deming, MD: I think it helps, to some degree, because a big proportion of the patients who are being diagnosed early are in that range. However, I think what’s more important is getting the idea out to primary care doctors that when they see a young person with rectal bleeding, it’s not always hemorrhoids. Being proactive and looking for rectal cancer, and understanding that people in their 20s and 30s are getting rectal cancer at a much more prevalent pace than before, is really important.

John Marshall, MD: God bless the primary care doctor or the emergency department doctor who’s got to make that decision 30 times a day of how much testing to recommend? Cathy, I know you care a lot about this space. What are your thoughts?

Cathy Eng, MD: Yesterday when they presented the TNT [total neoadjuvant therapy]-updated arm, one-third of those patients were less than 50 years old, which was so striking to me. It’s something that we all need to investigate further. Patients, family members, and PCPs [primary care physicians] need to pay attention, as well, to help get patients to us sooner and get them diagnosed.

Tanios Bekaii-Saab, MD: In addition to the PCP, I think there should be global awareness in the overall population that this is a problem. Oftentimes, it’s not just the primary care physician. It’s the patient who’s young and sees blood, googles it, and thinks, “Probably hemorrhoids, because it’s very unlikely at this age to get cancer.” There should be general awareness across the board about this. This is a rising problem, and probably going to continue to get worse.

Cathy Eng, MD: The issue is often that young patients, a large part of the time, are so healthy, they don’t think they need a PCP, right? Many of them don’t even have one.

John Marshall, MD: Particularly, men in this age group don’t go regularly. Women have gynecological visits, but men don’t generally go. More and more, doc-in-a-box or strip mall urgent care centers are replacing primary cares, too. This is a really important message. My hope is that, as we study this, we will actually gain some important, fundamental understanding of colon cancer and what’s going on, which might be applicable to all sort of patients, right? It would be a good thing.

Cathy Eng, MD: There are also lots of additional patient advocate groups, as well as other organizations and institutions that are supporting a young colorectal cancer program.

John Marshall, MD: As a guy who’s been sort of jealous of breast cancer all my life, to me, this wave of young people getting the cancer is a way for us to get some advocacy, and to get the kind of research support that we need urgently, quite honestly.

For all the audience out there listening, make sure your community knows about this. Make sure your emergency department people and your primary care referral network are aware of this. Dustin, thank you for sharing your thoughts on that.

Transcript Edited for Clarity
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