Miami Herald: 20-somethings have twice the risk of getting colon cancer


You’re not too young to get colon cancer. While the rate of colorectal cancers is declining for adults 65 and older, the U.S. rates are sharply on the rise for young and middle-aged adults.

“Young people born in 1990 have double the risk of having colon cancer and quadruple the risk of rectal cancer compared to people born in 1950,” said Dr. Floriano Marchetti, a colon cancer expert with the Sylvester Comprehensive Cancer Center at the University of Miami.

Marchetti was referring to a study published in the Journal of the National Cancer Institute that reviewed more than 490,000 cases of colorectal cancer between 1974 and 2013.

Until now, Marchetti said, there was very little benefit to put people younger than 50 through the ordeal and cost of a colonoscopy. Now, he said, “The American Cancer Society is looking into whether we should lower the age of screening.”

Frank Izaguirre had just completed his master’s degree and was home visiting his parents in Coral Gables when he had symptoms and was diagnosed with colon cancer.

“I had just turned 26 the day before,” Izaguirre said. “I was astonished. I didn’t think it was in the realm of possibility,” Izaguirre added.

Izaguirre knew he was at risk at some point because his dad had had colon cancer, but his dad had it at an older age, not 26.

Because Izaguirre’s cancer was Stage 1, he didn’t have chemotherapy, but two years later, a tumor appeared on his liver, which, he said, is a common place for colon cancer to reappear. He had to undergo chemotherapy, then surgery and more chemo. Now at age 31, he is recovering from surgery from a second liver tumor.

Jorge Ghiglione didn’t seek treatment as quickly. He was running an electrical contracting business with 20 employees and was busy with his young family. He had pain in his abdomen and, he recalled, “When I go to the bathroom, I see blood.”

After about two months, he went to see Dr. James Leavitt, a gastroenterologist with Gastro Health, and had an endoscopy and a colonoscopy.

“I find out I have celiac disease and in the colonoscopy find two polyps. One wasn’t bad but one was really bad. I freaked out,” Ghiglione said.

He was 36 at the time. He had surgery to remove the tumor and then chemo. He couldn’t quit work but his wife helped him out. He’d have chemo on Fridays and by Tuesday would make himself go to work and by Wednesday would feel a little better and struggle through the week. Now 37, he remains under the doctor’s watch but is doing well.

While noting that the incidence of colon cancer in the younger age groups is still very small, Leavitt said, “Don’t discount symptoms when you hear them because the patient is young. If we can find cancer early, we can increase the rate of cure. I think that’s the point of the study.”

Leavitt emphasized the importance of screening and early detection.

“We know if we can screen people routinely, we can reduce the death rate of colon cancer by 60 or 70 percent. That’s huge,’’ he said. “Colon cancer is the second most common cause of cancer deaths in the United States. For every dollar spent on screening, we save $3 of cost in care.”

Dr. Steven Wexner, chairman of the colorectal surgery department at Cleveland Clinic Florida, said the current guidelines recommend a screening at 50. Those who have had a parent, sibling or child with colon cancer should have a colonoscopy at the age 10 years younger than the relative was when cancer was diagnosed.

“Colon cancer is perhaps the only cancer, if not, certainly one of the few cancers that can be prevented by removing the pre-cancerous legion [polyp],” Wexner said, noting that the polyps are routinely removed during a colonoscopy.

As a surgeon, Wexner has seen young people who say, “Yeah, I went to see one doctor, two doctors, three doctors, emergency room, walk-in clinics and it wasn’t until Dr. X said, ‘Gee, let’s do a colonoscopy,’” that the tumor was discovered.

“And that’s the sad part of it. That’s why I’m personally in favor of a young age at which screening should start and an increased awareness by physicians of the possibility that a young person with abdominal pain, changing bowel habits or bleeding could have colon cancer,” Wexner said.

Marchetti also mentioned fatigue, a sudden, unexplained weight loss or abdominal cramping, particularly on the left side, as possible symptoms. Even bright red blood shouldn’t automatically be discounted as being caused by hemorrhoids. “It’s a mistake that sometimes can be lethal.”

Said Ghiglione, who’ll turn 38 in October, “My recommendation is, as soon as you feel something, you have to check it out. Don’t think it’s not going to happen to me.”