By Felice Schnoll-Sussman│ Pocket│4 min

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A gastroenterology expert reveals what signs to look for.

Read when you’ve got time to spare.

Felice Schnoll-Sussman, M.D. is a member of the Men’s Health Advisory Board.

John, a 28-year old avid runner and biker, was seen by me because for months he felt he did not have enough energy for his early morning runs. He had been training for the NYC marathon and was hoping for a great personal record but he could just not keep up the pace or the weekly mileage suggested on the training app he was using.

For nearly a year, he had been suffering from crampy abdominal pain and difficulty going to the bathroom. His trainer at the gym thought that he was likely getting dehydrated. John pushed more fluids throughout the day and ate a really healthy diet with lots of fruits and vegetables, but the nagging belly discomfort would not go away completely.

He went to see his primary care doctor, who suggested increasing how much fiber he was eating. He was told he likely had irritable bowel syndrome. But when he started to see blood in his stool, he became alarmed went back to his PCP for further evaluation. He was sent to me for a colonoscopy (a examination which uses a long tube with a light source and a camera that’s guided up the colon to investigate the inside of the bowel) to evaluate his complaints. Shockingly, I diagnosed him with a colon cancer the size of a golf ball that was nearly blocking his rectum. John was sent for emergency surgery to remove the cancer and he’s undergoing chemotherapy treatments because some cancer has already spread to his liver.

When I first started practicing medicine, I would rarely ever think that a young healthy man with gastrointestinal complaints had colon cancer. No way…colon cancer was a disease of older people.

Well, that’s no longer the case. Although the risk is small, there is a real and worrisome trend you need to be aware of. Colon cancer, especially in the rectum, the lowest part of the colon, is actually on the rise in individuals younger than 50 years of age. A 2017 study showed the sharpest increase is being seen in those between ages 20 and 29.

Why is this happening? The drivers of young-onset colorectal cancer are not well understood. Some believe that the rise is due to risk factors such as obesity and diabetes. Others believe it may be related to a change in the microbiome (the unique bacterial mix that lives in our bodies), or to antibiotic exposure and dietary choices. We just do not really know the cause.

Rates of colorectal cancer diagnosis and death at all ages also vary by ethnic group. The most recent data from the American Cancer Society (at the time this article was written in August 2020) finds that incidence rates are nearly 20 percent higher for people who are Black than people who identify as non-Hispanic white. Death rates have even more disparity, with rates for Blacks at 40 percent higher than for non-Hispanic whites. The ACS suggests that there are complex reasons for the disparities, including a higher prevalence of risk factors including smoking and having obesity, and healthcare access (including screening).

But a great deal of research is now being focused on this issue. In fact, Dana-Farber Cancer Institute and Memorial Sloan Kettering Cancer Center both have dedicated centers to investigate young-onset colorectal cancer.

What is the key thing you can do to stay healthy? It is so important to listen to your body. If something is “off,” and if your symptoms are just not going away, you need to get checked out. Visit your primary care doctor with any concerns. Younger patients generally aren’t diagnosed in a timely manner, and subsequently run the risk of getting a diagnosis at a later, less treatable stage. It’s not good, but also not surprising. Why would a young guy believe he has something really serious like colon cancer going on? This often leads to a delay in going to the doctor in the first place. This bias has also been held by physicians, too. We all need to have the possibility of colorectal cancer in younger people on our radar screen.

Although colorectal cancer rates have declined overall in recent years thanks to widespread use of screening tests like colonoscopies, these screening tests have not been considered practical for a younger population.

I always say that no one should ever die of fear or embarrassment. Signs you should speak to your doctor include:

• Change in bowel habits – such as new onset constipation of diarrhea
• Blood in the stool
• Abdominal pain
• Unexplained weight loss

Although the likelihood is really good that these symptoms wouldn’t represent something serious in men who are young, we all need to be aware of the possibility it could be colon cancer.