roomaroger: Colorectal cancer on the rise for those under 50

Body and Mind staff

The Patriot-News

on December 02, 2012 at 12:58 AM, updated December 02, 2012 at 12:59 AM

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Sue Webb, surrounded by her family starting with her husband Matt Webb, top left, Adam Webb, 19, top right, Cassandra Webb, 13, right, Connor Webb, 7, left, and Ava Webb, 5, bottom, at their home in Mechanicsburg.
CHRIS KNIGHT, The Patriot-News

Three years ago, Sue Webb was a typical busy wife and mom, juggling her work schedule with the needs of her family, often grabbing fast food when time was short.

When she noticed some blood in her stool, the Hampden Twp. woman told herself it was likely another bout of hemorrhoids ? after all she?d had four kids ? and she let it go for more than six months. Cancer wasn?t even a blip on her radar screen.

Today, Webb, 43, has stage 4 colorectal cancer that has metastasized to her lung.

?When I started researching metastasized rectal cancer, I was like, ?wow, it?s not good.? I just have to put myself into my faith and know that whatever God?s plan is, I?ll be OK with it,? she said, then paused. ?But I refuse to leave my kids. They have to have their mommy.?

Sometimes it?s easy to turn a deaf ear to another statistic ? like the one that says colorectal cancer is on the rise in those under age 50 ? until there?s a face behind the statistic. Sue Webb is that face.

?When I started practicing, seeing someone under age 50 with colorectal cancer was the exception and it was someone with a strong family history. Right now, I have up to half a dozen younger patients with it,? said Dr. Roy Williams of PinnacleHealth Medical Oncology Associates in Harrisburg. ?It?s definitely been increasing over the past 15 years. Still, we don?t see many patients with colorectal cancer who are this young, but unfortunately when they present, it?s usually at a later stage.?

Webb, who was diagnosed at stage 2 of the four stages, had no family history of colorectal cancer. After chemotherapy and radiation to shrink the 7-centimeter mass, Webb had surgery to remove it and then more chemo. She remained optimistic, but then a CT scan in 2011 showed something on her lung, which, upon another look earlier this year, turned out to be cancer. She underwent a lung resection in May and is finishing up six months of chemotherapy.

?The second time around was a big slap in the face,? Webb said, but she still clings to optimism. ?I?m atypical that it spread to just one spot in my lung. Usually it spreads like wildfire. There?s a 25 percent chance that I had a single metastasis.?

Although it is still the second-leading cause of cancer deaths in men and women, colorectal cancer rates have been steadily dropping over the past 20 years. Recent studies, however, suggest the decline is only among those over age 50 and rates are actually increasing in every 10-year age category from age 20 to age 50.

A team of researchers led by the American Cancer Society tracked some 20,000 people from 13 U.S. cancer registries over 13 years ? from 1992 through 2005 ? and found that colorectal cancer rates increased 1.5 percent annually in men under age 50 and 1.6 percent annually in women. The increase among non-Hispanic whites was mainly driven by rectal cancer, for which there was an average increase of 3.5 percent per year in men and 2.9 percent per year in women, researchers found.

?It?s still a small number of patients, but the growth rate is surprising,? said Dr. Stephen Milito, medical director at Oakwood Cancer Center in Lower Allen Twp., a Holy Spirit Health System affiliate. ?It won?t drastically change how we screen for colorectal cancer because the amount of cases is still so low that screening 30-year-olds wouldn?t be cost-effective, but it is a trend to watch.?

Currently, the American Cancer Society recommends screening with colonoscopy at age 50 and then every 10 years after that for people at average risk for colorectal cancer.

Why the rise in cases among younger people? Researchers and doctors point to diet as a possible reason: a high-fat, low-fiber, processed food diet has become the norm over the past several decades.

?We already know that a high-fat, low-fiber diet is a risk factor for this cancer,? Milito said. ?The best thing to do is to eat a good diet ? high fiber, not a lot of red meat or processed foods.?

It?s no secret that obesity rates in America are rising and with 17 percent of children and adolescents ages 2 to 19 already overweight, some doctors say the trend toward increasing colorectal cancer rates will likely continue.

?Obesity rates in this country are shocking. In Africa, colon cancer is practically unheard of,? said Williams, who advises a ?Garden of Eden? diet full of fresh fruits and vegetables. ?When I was in medical school, type 2 diabetes was called ?adult type? diabetes because children never got it. Now, children are getting type 2 diabetes at alarming rates and it?s because of obesity and lack of exercise.?

Webb, who put on weight after having kids, said she thinks her diet could be the cause of her cancer. She said she often ate fast food and she spent a lot of time on the high-fat Atkins diet in hopes of losing weight.

Since her diagnosis, she?s lost 45 pounds and is consciously trying to eat more fresh fruits and vegetables, juices and foods high in antioxidants. She?s spending more on food, though, and she wishes insurance companies would see diet as a medical factor in treatment and begin to cover nutritional costs.

Webb and her husband, Matt, have made other lifestyle changes since her diagnosis, such as downsizing their house so that Sue won?t have to work and they can spend more time together as a family.

?I?m going to live better than I was without the diagnosis,? Webb said. ?I?ve been blessed with a wonderful life so far, but I?ve realized we need to give up some things and slow down.?

Most importantly, doctors say the study is a wakeup call for younger Americans ? and their primary care doctors ? to think about colorectal cancer as a possible cause of symptoms such as rectal bleeding, bloating, change in bowel habits and weight loss.

?If you see a 27-year-old with abdominal pain and bloating, you know colon cancer doesn?t jump to the top of your mind,? Williams said. ?However, the patient should have a colonoscopy. Evaluation with CAT scan doesn?t visualize the insides of the bowel very well at all.?

? Written by CAROLYN KIMMEL For The Patriot-News

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