We have seen a dramatic change in who is getting colon cancer. We started off with thinking that most people who get colon cancer are over the age of 50, that’s who gets screened, that’s who goes to get checked up. But what we are seeing is that all of a sudden in the last ten years or so that 20 year olds, 30 year olds, 40 year olds are getting colon cancer and the scary part is we don’t really know why. The first thought was this is genetic, it’s because they inherited the gene, but we test for that and none of these people has the gene so it is not that. The second thought was we are getting fat, we’re not exercising, we’re playing on our video games too much and that’s the reason but, no, most of these people are very fit, they’re healthy, they’re trim, they’re exercising and they’re doing all the right things. So right now we do not understand what’s going on in our environment that might be changing this phenomenon but we’ve been tracking it now for 5-10 years and it’s a clear phenomenon.
How can we address this ‘phenomenon’
The first part that we have to figure out is why. What some in America have done is say, ‘Oh, we should just screen earlier. We should put people through colonoscopies or stool tests earlier.’ But that’s not the answer, that’s not an appropriate use of those resources. What we’re hoping is that we’ll understand something about the biology.
Now, the leading thought on this right now is that it has to do with what we call our microbiome, the bacteria that live in our mouths and our GI tracts. We’ve evolved, if you believe in evolution like we do in science, we’ve evolved over millions of years to keep the bacteria in our GI tracts. Why would we do that if it wasn’t important for our health? So now that we’ve started to study this we recognise that the bacteria in your GI tract is different than the bacteria in my GI tract and may relate to our health. So we are thinking that maybe these young people are, in fact, doing something that’s altering the bacteria in their GI tracts. Counter to what you might think, we wash our hands a lot, we don’t go outside and play with each other, we play like this with each other. So it may be that we’re not training our bacteria, we’re not colonising our coral reef, if I could use that analogy, so that it’s nice and balanced. So we and many others are beginning to study the microbiome, the bacteria in our GI tracts and hope that that gives us some early answers.
Are there any studies looking into this?
We have a big study going on now where we are looking at microbiome and genetics in young and old. There are studies looking at left-sided colon cancer versus right-sided colon cancer which, believe it or not are two different cancers, to try and understand their relationship with the bacteria. There are some fascinating studies looking at microbiome and the immune response, our immune systems’ response, and then in colorectal cancer we now have some evidence that the bacteria actually are helping the tumours metastasise. We’re finding bacterial DNA in our liver metastases so there’s a clear relationship between these bacteria that we carry around with us and cancer and the process of our trying to fight the cancer. We’ve got to figure it out and we’ve got to figure it out fast.
In the future what do you hope will be achieved in this field?
We have first, right away, have to recognise as a healthcare community that young people can get colon cancer. What I presented today was some data that basically says these people are delayed a long time because, one, they don’t go to doctors; second, when they go to a doctor the doctor doesn’t think they could possibly have colon cancer so they don’t check. By delaying these people present with a much more advanced cancer. So, first, the medical community and the community at large needs to recognise that, yes, a 20 year old could get colon cancer.
Secondly, more importantly in the long run, is we need to figure out why. If we can figure out why then we can prevent not only this problem but maybe affect colon cancer in general.
