Joey Wahler (Host): It is on the rise, so we're discussing colon and rectal cancer in young adults. Our guest is Dr. Debora Fox-McClary. She's a dual board-certified surgeon specializing in general surgery and colon and rectal surgery. This is WIC Care Talks, the podcast from Wickenburg Community Hospital and Clinics, dedicated to helping our community lead healthier, more active lives.

In each episode, we connect you with trusted health experts to share valuable insights on a wide range of topics from managing chronic conditions to simple tips for everyday wellness. Thanks so much for joining us. I am Joey Wahler. Hi there, Doctor. Welcome.

Debora J. Fox-McClary, MD: Thank you, Julia. I'm happy to be here.

Host: Great to have you aboard. So first, how exactly do colon and rectal cancer rates among young adults these days compare with those in the older populations?

Debora J. Fox-McClary, MD: That's a great question. So, everyone has seen the headlines now that it's on the rise. When we compare the incidence of colorectal cancer in the 1990s to now, we've seen across all ages below 50, about a 50% rise in the incidence of colon cancer. And experts are projecting that, by 2030, we will see about 150% rise in the 20 to 30 age group. So, it's a big topic right now with a lot of effort at research to clarify why and how we fix the problem.

Host: So indeed, Doc, those are some eye-opening numbers for sure. And it's not really known exactly why it's on the rise that way, right?

Debora J. Fox-McClary, MD: That's correct. For my entire career, we have talked about people over the age of 50 having the higher risks of colon cancer. Recently, we lowered the screening age to 45. But now, the topic in the industry is how do we screen all of these younger people, when do we screen them-- and maybe even more importantly-- is what can we do to protect ourselves.

Host: Absolutely. And since we are trying to raise awareness with this conversation, before we get into some further specifics, what misconceptions do you find about colorectal cancer in young adults that need to be addressed right here, if you could?

Debora J. Fox-McClary, MD: This is another very good question. The number one problem I've encountered and what we see discussed in the literature is that young people aren't given the time of day in response to their concerns. In other words, a young person might come in with some bleeding when they use the toilet. And they talked to their primary care doctor who says, "Oh, don't worry, it's probably hemorrhoids." And so, they're not triaged into the next level of evaluation to look for cancer as a cause. And a lot of that is because people of our generation, those of us who are over 50 don't think of young people as getting colorectal cancer. So, we need to have all of our primary care doctors and our specialists change their thinking now and always entertain that thought that, if this person has hemorrhoids or I think they have hemorrhoids, could they have this other disease process going on?

Host: And indeed you mentioned bloody stool there. What are some of the early symptoms of colon and rectal cancer that young adults should be aware of? Because sometimes there are no symptoms, right?

Debora J. Fox-McClary, MD: Well, historically, we've described colon cancer as the silent cancer. Again saying, "Okay, you're 45, you need to come in for screening." These younger people, however, are not at the age where we would even consider them for screening based on our current federal guidelines. And so, the symptoms can be subtle. But the classic ones that we discuss would be new bleeding.

A second one would be change in bowel habits. So in other words, you were going easily every day and now you're going in the irregular fashion, or we talk about the caliber of the stool. One of my colleagues talks about it being the size of a banana. And if it suddenly was less than a banana, then you should be thinking about going and talking to the doctor about that.

Host: Interesting. I've never heard it put that way. It's a good thing for people to keep in mind. How about risk factors or lifestyle habits that may contribute to this growing incidence in younger populations?

Debora J. Fox-McClary, MD: That's also interesting. And I'll bring up actually that we're seeing these changes not just in the United States, but we're seeing them globally. And it tends to be a higher issue where they're often described as well off countries. So, we're talking Australia, England, United States. We think that a large part of this is related to the type of modern diet, that we're eating diets that are high in fat and red meats. That's point one.

Point two is we think it's a lack of exercise and activity. One of the concerning studies out there has shown that the exercise factor may actually be what we call a cohort trend, meaning that each generation who's had less exercise is seeing an increase in this. And so, some scientists believe that it's early exercise that becomes really important for this.

A third concern is changes in the microbiome. So, we've known for years that our colon contains a community of bacteria that may actually drive how we think and how we feel about things. And modern stress, exposure to antibiotics and dietary changes, we think are affecting that microbiome. And finally, we think it's just related to overall changes in the environment and all the other factors. So, we really are focusing now on better dietary choices, even dating back into the teenage years. More physical activity, going to the gym three or four times a week is an option for many of us. And possibly, there may be a role for the probiotics we see at the store and helping with the type of colonic bacteria community that we have.

Host: So, picking up on that, Doctor, when we talk about diet, what are some of the foods to increase in our diet to help prevent this? And what are some of those to stay away from?

Debora J. Fox-McClary, MD: So, we think that a diet that's high in fiber and grains is really important. We speak commonly about the use of fiber. There are a couple kinds of fiber. There's soluble fiber and there's insoluble fiber. And insoluble fiber appears to be the better choice for the health of our colon. And most of the bran cereals that are out there at the supermarket are the best choices for increasing fiber.

I commonly recommend to patients in my practice to have a half cup of a bran cereal every day, and that can give them a lot of fiber that they're missing otherwise. And so, reducing the meat, have more fish and chicken, less of the red meats. Look at the fat content and what we're eating and try to reduce the fat. And this even dates back-- again, we believe we need to be teaching our children and our teenagers these interventions. So, it's not too early at age 12 to have bran cereal every day.

Host: All right. Great thing to keep in mind. How about family history playing a role in the likelihood of developing colorectal cancer at a younger age?

Debora J. Fox-McClary, MD: So, we only see about one in five of these people that are young, who develop colorectal cancer actually having family history contributing. So, we think that four out of five of these are what we call de novo, meaning that they are just bad luck events that occurred. And so, we really do want to look back at the exercise, the diet, and the types of exposures we're having to antibiotics and bacteria in our environment.

However, in those people that have a family history, we have historically done a pretty good job of getting the word out to that. But if you have a first-degree family member, first-degree would be your brother, your sister, a parent, or even a child who has colon cancer at a young age, you want to go speak to your primary care doctor or a specialist about getting testing for genetic abnormalities that run in the family. That used to be extremely expensive. But now, as with all things, technology has allowed us to lower the price for those tests. And so, we can bring a person in and draw blood or have them give us a sample of saliva and have the results back within a week or two.

Host: Oh, wow. Okay. So when should someone consult a healthcare provider about symptoms that might indicate colorectal cancer? We covered some of those earlier. Where's the line there?

Debora J. Fox-McClary, MD: I think that, in general with my patients, if they've had more than a week or two of new bleeding, I encourage them to get in and get checked. I do colonoscopies, my partners do those. And in fact, we do those in the Wickenburg community, trying to keep as much as we can in that community. But it's probably a couple weeks. I tell my patients every one of us has had a situation where we have a hard bowel movement and, afterward, there's a little bit of pink on the toilet paper. And I don't know that we need to be concerned about that. But if you go to the bathroom daily for several days, there's blood in the toilet. That would be something where you want to contact your primary care doctor quickly.

And again, I encourage all of the trainees that I work with and the other physicians that I'm around to consider it early. It has to be partly the doctor saying, "Okay, I'm going to take this seriously." But nowadays, we all know that the patients also have to be their own advocate and say, "I am worried about cancer. I want you to check me out."

Host: Absolutely. And you led me beautifully there into my next question. You touched on this earlier, Doctor, but in terms of regular screenings for young adults and how crucial that is, when should those begin these days? Because you mentioned that age number has changed in recent years and we're not being melodramatic here, are we? When we say it literally could be the difference between life or death, right?

Debora J. Fox-McClary, MD: It is. Getting checked is critically important. Right now, under our federal guidelines, we are all entitled to a preventative care exam beginning at the age of 45. And that's important because preventative care means that, in under our present system, that insurance will cover the cost in almost all cases at a hundred percent. So, getting in at age 45 is very important.

Now, if you have a family member who's had colon cancers or even a major polyp, then the guidelines allow for you to get that preventative care exam at a younger age, and that is 10 years prior to the youngest person in your family who was diagnosed with colon cancer. So in other words, if you have a parent who had colon cancer at age 35, you are entitled to a preventative care exam at age 25.

The unfortunate part, I think, under the present insurance system is that, if you are one of the younger people, younger than age 45 and you have rectal bleeding, it can come across on your insurance where you are responsible for the deductible, which most of us find incredibly expensive. There are some groups out there that are available. I've heard of one on Facebook. And the social workers at the hospitals can be another resource where we can get funds to help people who simply can't afford this testing. But it is a problem that needs to get addressed as we see the rates rising in the younger populations.

Host: That's for sure. A couple of other things before we let you go, if it is diagnosed, in a nutshell, just so people have some idea, who are the key players on a young patients healthcare team if they need to deal with colorectal cancer?

Debora J. Fox-McClary, MD: So, a lot of times they'll be referred to gastroenterology or to surgery to get their colonoscopy. In a community like Wickenburg, we don't have regular presence of gastroenterology, so a lot of colonoscopies are done through the surgeons, Dr. Ripley and others, at the Wickenburg Community Hospital and our group who comes up weekly to see patients in office. That's going to be the first starting point.

If we find a lesion during a colonoscopy, we will biopsy that and we will be able to determine if that is a colon cancer or a major polyp. In many cases, we can remove those at the time of a colonoscopy if it's a polyp. If it requires surgery, then you would be referred to surgical specialists. Again, there are several general surgeons now coming to the Wickenburg community. And under my boarding under colon and rectal surgery, I'm a specialist who tries to minimize the use of bags, colostomy bags, ileostomy bags, which everybody dreads. So, once we've done a surgery and we've removed a cancer, we will refer then to oncology. And these are doctors who treat with chemotherapy and/or radiation to decrease the chance of any cancer coming back.

Host: Then, in summary here, Doctor, you've done such a great job of covering various details, but what are the most important few takeaways from this conversation that you want those joining us to keep in mind? We've talked about screening and some other things. What's the main thought that you want people to come away with?

Debora J. Fox-McClary, MD: The main thought, as I was preparing for my visit with you, Joey, was that I want us to really focus on our children, our younger generations. And it's not too early to add grains and fiber to the diet. Try to teach our children to eat more fruits and vegetables. Make exercise a family activity so it's a fun thing that everybody participates in. And you set those habits early with your children. And keep an eye on the news because we're still figuring out-- our scientists are working day and night trying to figure out what's causing this rise. And of course, as they come up with answers, we'll see it in the mainstream media.

Host: You know, right now, our 3-year-old so happens, Doctor, likes fruits and vegetables more than candy. Whether that will remain the case, that of course remains to be seen.

Debora J. Fox-McClary, MD: The children change rapidly. They do.

Host: Keeping our fingers crossed on that one. Folks, we trust you're now more familiar with colon and rectal cancer in young adults. Doctor, pleasure keep up all your great work and thank you.

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