The traditional profile of a colorectal cancer patient is shifting.
Colorectal cancer, which usually develops slowly over a period of 10 to 15 years, is the fourth most commonly diagnosed cancer in men and women and the second leading cause of cancer deaths in the United States, according to the American Cancer Society.
While brochures may depict a man with gray hair, the number of 30- and 40-somethings being diagnosed with the cancer is growing.
“Therein lies the real challenge,” said Dr. John Ward, an oncologist at the Huntsman Cancer Institute who also works with St. John’s Oncology.
“Colon cancer is typically associated with age,” he said. “We don’t think of it in young people.”
Colorectal cancer, when caught early, is curable.
In the past 10 years St. John’s Medical Center reported 91 cases of colorectal cancer, including colon, rectum, rectosigmoid, anus and anal canal. These cases were either diagnosed and treated at St. John Medical Center or just treated locally.
TGR raises awareness
Teton Gravity Research’s recent film, “Mountain in the Hallway,” chronicles two men’s battles against cancer and their dreams of summiting the Grand Teton. The film hit home for many because Tate MacDowell, 36, and Brian McDonnell, 46, were diagnosed with colorectal cancer last summer three weeks apart.
The two seemed perfectly healthy — outdoorsy, adventurous, eating right and exercising often. MacDowell even went to doctors several times for his condition, periodic blood in his stool.
“It’s not a totally unusual story,” said Dr. Eric Wieman, a general and laparoscopic surgeon at St. John’s and a survivor of colorectal cancer himself. “Someone is having symptoms and they’re told they have a minor problem, like hemorrhoids or something like that, and they don’t really get a complete evaluation, unfortunately, because really, traditionally, they don’t fit the profile of people who would have an advanced disease.”
That needs to change, he said.
“You can have two problems at once,” he said. “You can have ticks and fleas. You can have hemorrhoids, and you can have polyps.”
Polyps, precancerous growths, can be removed before they turn into cancer if caught during a colonoscopy.
Many young men, Wieman said, have some level of hemorrhoidal disease due to a poor diet. But potential of a misdiagnosis aside, he’d like to see a higher level of interaction between doctor and patient before more attention is needed at an older age. Seeing someone on a regular basis and starting early means they can “steer you in the right direction.”
“Young people in general, and young men in particular, they don’t see physicians very regularly,” he said. “Men, they may not see a physician from their sports injury in high school until they’re maybe their 40s or 50s.
“So if you’re going to ask that their first encounter with medicine or a physician is, ‘Hey, you need a colonoscopy,’ there’s not been a lot of rapport to build up to that,” he said.
From study to experience
Wieman, 38, was diagnosed with colorectal cancer at age 31. The way he caught it in time, he said, was a stroke of luck.
Wieman has a family history of colon and other cancers. As a medical student completing a summer project, he worked for Henry Lynch, a physician studying hereditary cancer. His mother underwent genetic testing and, eventually, so did Wieman, finding he, too, had the genetic mutation for Lynch Syndrome.
Lynch Syndrome is “an inherited condition that increases your risk of colon cancer, endometrial cancer and several other cancers,” according to the Mayo Clinic.
“The odds are obviously phenomenally low,” Wieman said. “I ended up having Lynch Syndrome, and I worked for the guy. There’s no way to describe the level of luck involved in that.”
After a first colonoscopy at age 26 that came back negative, Wieman had a second colonoscopy at 31. They found a golf-ball-size tumor in his colon.
“I was totally asymptomatic,” Wieman said. “No bleeding, no constipation, no bloating.”
His cancer was Stage 1 at the time, with no lymph node involvement. After a subtotal colectomy, which removed all but 60 centimeters of his colon, he’s in remission. He schedules annual MRI scans of his head, abdomen and pelvis, as well as a yearly colonoscopy.
Which, by the way, is nothing to be afraid of, he said.
“I’ve taken care of a few guys with colorectal cancer, and their story is always the same,” he said. “They say, ‘I never wanted to get a colonoscopy and now that I’ve had colon cancer I get colonoscopies all the time. I should’ve done it to begin with.’”
While there may be a lot of apprehension around the prep for a colonoscopy and the cleansing process, Wieman said “medications have gotten a lot better” and the surgery — adequately sedated — is the equivalent of falling asleep on the couch while watching TV.
“They are not quite as much of a vigorous cathartic,” he said. “They’re a little bit more gentle. We have really refined the process.”
Screenings typically start at 50
Whether or not insurance will pay for a colonoscopy depends on a variety of factors. A diagnostic colonoscopy, following symptoms like rectal bleeding, for example, is always covered. But for a screening colonoscopy, one performed without any symptoms, it depends on a patient’s age and family history.
Those over 50 are typically covered without question. Those with a family history are often eligible for an insurance-covered screening 10 years before the earliest incidence historically.
Ward said he’s satisfied with the guidelines. Huntsman’s recommendation for those with average risk and no symptoms or history of cancer is also 50 years old.
“I don’t think we’re at the point where everybody at a certain age under 50 should have a colonoscopy,” he said.
One organization, the American Cancer Society, announced this summer that it was lowering the recommended age of preventative, asymptomatic screening from 50 to 45.
The guidelines come on the heels of a study that found colon and rectal cancer rates are rising sharply in Americans under 55: Someone born in 1990 has twice the risk of colon cancer and four times the risk of rectal cancer at the same age had they been born in 1950.
Wieman doesn’t know exactly why that is but pointed to industrialized societies having higher rates of colon and other cancers as a hypothesis.
“I don’t really have a good feel for that,” he said. “It may be something about how we live or how we eat that may increase that risk. There are all sorts of things you can come up with.”
Whether or not the lower recommended screening age will become common practice enough to influence insurance companies remains unclear. In Wyoming Blue Cross Blue Shield follows the recommendations of the U.S. Preventive Services Task Force.
Under the Affordable Care Act, it is required to cover all recommendations in the A and B category of the task force.
“We’ve always used these guidelines as an evidence-based, consensus statement on services,” said Wendy Curran, vice president of care delivery and provider affairs for Blue Cross Blue Shield of Wyoming. “We have not moved to the lower age recommended by the American Cancer group, but certainly as more and more research and evidence is compiled, the task force will revisit its recommendations.”
Curran said a doctor’s explanation will suffice if an individual’s situation is outside the guidelines.
“We don’t prohibit that,” she said. “We would just need the doctor to say, ‘Here’s why this is necessary for a 42-year-old,’ or ‘Here’s why I need to do another one in three years.’”
Wieman, Ward and others will be watching.
“We’re big fans of early diagnosis of colorectal cancer,” Ward said. “Surgery is often curative if caught early, and then you don’t need to consider challenging interventions like chemotherapy. I think it’s a good thing to bring to people’s attention. If you’re aware, hopefully, at the first sign of trouble, you’ll act.”
Catching the disease early, doctors realize, is the best way to survive it.
“You really do not want to find it at an advanced stage,” Wieman said. “That is a completely different problem. People are always talking about fighting cancer. Fighting cancer is when you’re operating or getting chemotherapy.
“What you really want to do is eliminate the need to fight cancer. You want to get there first. Because fighting cancer is a real contact sport for the patient.”