Never Too Young: The Impact of Early-Onset Colorectal Cancer

Shawn Farrah understands the words “never too young” all too well. In May 2017, at age 44, he underwent an appendectomy but around the same time, he also noticed blood in his stool.

He discussed the concern with his surgeon who was adamant it was related to the surgery and pain medication.

“I kind of put it off and I felt that I wasn’t paying as much attention, and eventually it got worse,” Farrah said in an interview with CURE®.

A few months later, Farrah decided to see his family doctor who recommended a colonoscopy, which is a procedure often conducted to check for colon cancer. Symptoms of this disease include a change in bowel habits, rectal bleeding, blood in the stool, pain or cramping in the belly and unintended weight loss.

Most guidelines recommend screening people for colon cancer at age 50. Farrah felt lucky because his doctor didn’t question his age or symptoms.

“He didn’t try and put it off,” he explained. “I have a lot of friends that did have issues with them saying that even though there is bleeding there is no way this could be cancer because you’re under a certain age or you’re in good shape. Other than the symptoms, I was very healthy and even training for a marathon at the time the symptoms started.”

Although colon cancer typically develops in people 50 and older, the rate is on the rise in individuals younger than 50 accounting for 11% of diagnoses, according to the Colorectal Cancer Alliance, the country’s leading nonprofit organization dedicated to colorectal cancer. In addition, experts also are seeing a rise in rectal cancer diagnoses — 18% of people 50 and younger.

During the colonoscopy, Farrah’s doctor said that there was something there too big to remove. The week before Christmas Farrah learned he had colon cancer. “I was home that day, so I was by myself and I get a call from my nurse and she told me what it was and she used the medical term. I remember saying, ‘What does that mean, does that mean it's cancer?’ and she said ‘Yes, that’s cancer,’” Farrah recalled. “I felt myself turn white. I don’t think you're ever ready to hear that and I think one of the hardest things, even going through chemo and everything, I had to go through was that I had to call my wife at work right after that and let her know that it was cancer.”

Farrah isn’t alone in facing a colon cancer diagnosis. In fact, social media platforms are filled with stories similar to his that are shared through several hashtags and one in particular, #NeverTooYoung or #Never2Young, which was created by the Colorectal Cancer Alliance to help raise awareness for younger people.

A Growing Trend

Many experts are still trying to determine the reasons behind the rise in young-onset colorectal cancer cases. And although this is concerning, Dr. Peter Stanich, an associate professor in the division of gastroenterology, hepatology and nutrition at The Ohio State University Wexner Medical Center, explained that there are a few things to consider.

“The most important thing to keep in mind is that the absolute risk is still very low,” he said. “So, when you look at new information that was released, less than eight people per 100,000 will be affected. When you compare that to people who are 50 to 64 years old, that's more around 80 people per 100,000.”

In addition, the cancer is being found earlier as screening and detection in this patient population improves, Stanich noted.

In finding the disease earlier, patients can be treated in a timely manner before the cancer spreads.

For Farrah, everything was up in the air after getting the phone call. “(My wife and I) spent the next night or two talking about it. There were tears and at that point when you find out you have cancer and there’s no plan yet, you don't have a plan to concentrate on or anything, you're just waiting to hear what the plan is going to be,” he said. “It felt like a punch in the gut, we weren't prepared for that.”

A surgeon at The Ohio State University Wexner Medical Center recommended surgery followed by radiation and chemotherapy. For five weeks, Farrah received radiation five days a week and oral chemotherapy twice a day. Currently, Farrah has no evidence of disease after receiving his original colon resection in May 2018 followed by eight months of additional chemotherapy and a liver resection after doctors found lesions around the organ.

Engage Your Health Care Provider

Stories like Farrah’s prove that physicians need to be careful not to dismiss warning symptoms in anyone.

“That means if a 30-year-old comes into your office with rectal bleeding, that patient needs a colonoscopy,” Stanich said. “Most times it will probably be hemorrhoids or a benign cause, but that's the alarm system we're looking for to hopefully pick up a colon cancer early and let that person have life-saving intervention.”

Stanich also noted that when considering screening and surveillance it’s hard to think of something as “beneficial” when trying to decrease the ramifications of colorectal cancer because the entire population needs to be considered.

“Even though colonoscopy or other colon cancer screening such as fecal immunochemical tests are low risk, when you think about all the people who may be undergoing screening, it's harder to balance some of those risks with the potential benefits and that's why it is still debated when the best age to start is,” he said. “I do think that the wave of evidence is showing that earlier colon cancer screenings will be here sooner rather than later, but I'm not sure when the nation as a whole will undertake that.”

Every decision is not a onetime thing and that’s the end of it, Stanich explained. Patients should continue to engage their doctor and discuss ongoing symptoms or concerns.

“With the known alarm symptoms for colon cancer like rectal bleeding or iron deficiency anemia or new onset of significant bowel changes then that health care provider should continue to work with you and set you up for a colonoscopy,” he said.

Advocating for Yourself

The best thing a person can do is advocate for themselves and stay informed. Farrah is now on the Never Too Young board at the Colorectal Cancer Alliance and works on getting information out there to help make people aware of their symptoms.

“There are (symptoms) that I didn't notice before I noticed the blood in my stool. I had narrowing stool and things like that, but it didn’t really click as to what it was,” he said. “I have heard story after story of people going with all the symptoms of colorectal cancer, but I think in some of those doctors' minds just because of a patient’s age (they think) there’s no way it is cancer. They'll send them home with every other reason except for colorectal cancer and so they don’t get screened. By the time they do get screened, they’re at a later stage.”

Farrah stressed the importance of patients pushing for what they want. If a doctor is hesitant and doesn’t want to screen for colon cancer, then go to another doctor.

“You really have to advocate for yourself when you’re in a situation where you’re dealing with all these symptoms and you can't get screened,” he said.