The year 2020 will forever be remembered for the tragic loss of lives from the global pandemic; however, there was another piece of sad news that shook movie lovers around the world. The talented actor Chadwick Boseman died at age 43, following a four-year battle with colon cancer. He would have been just 39 when he was diagnosed with Stage III cancer in 2016, and struggled thereafter with cancer treatment while filming two movies as the Black Panther.

Amid the grieving and confusion over the passing of someone who was ‘waaay too young’, many questions were being asked. “How could a young and healthy ‘superhero’ get colon cancer, and shouldn’t he have access to all the advanced treatments available to cure this?

It’s time we shed some light on the pervasive misconcept­ions regarding cancers in young adults.

Digestive cancers, which include cancers of the gastrointe­stinal tract (esophagus, stomach, small intestines and colorectum) and digestive organs (liver, pancreas, gallbladde­r), make up a large proportion of the common cancers. And are not as uncommon as you think. In fact, colorectal cancer has overtaken lung cancer to become the leading cancer among males in Singapore, and the second most common cancer among females after breast cancer.

Digestive cancers, and in fact most cancers in general, tend to occur in older adults in their 50s, 60s and beyond. This is because the majority of cancers are due to sporadic genetic mutations that lead to cancer changes in our cells. When doctors say ‘sporadic’ we mean isolated DNA accidents that can happen by chance to anyone. The main risk factor for these sporadic mutations is advancing age; we become more accident-prone as we age, and our genes are no different.

As accidents can happen to anyone by sheer bad luck, ‘sporadic cancers’ can hit anyone at any age, even if those who have no family history of cancer. But if one does have a family member with a history of digestive cancer, the chance of getting a related cancer also increases. This so -called ‘familial cancers’ may be due to a clustering of common risk factors in family members who live together – for example, the type of food they eat and the environmen­tal toxins they are exposed to (such as cigarette smoke). More importantl­y, they are also more likely to develop these cancers at a younger age. About 5 per cent of cancers are due to inherited cancer family genes. These ‘hereditary cancer’ families would have many family members presented with the same cancer, sometimes at a very young age, such as in their 20s or 30s.

Whether one has a family history of cancer or not, it is important to realize that digestive cancers can occur in young adults, and symptoms should not be ignored. Chadwick Boseman, like many young people with cancer, had a bad outcome simply because diagnosis was only made at a late stage. Young people with symptoms of cancer such as abdominal discomfort, bloating, change

in bowel habits or passage of blood in the stools, often attribute this to other benign causes such as stomach acidity, unhealthy diet, excessive alcohol or even stress.

Consult a doctor if a simple change in diet and lifestyle does not make you feel better. Do remember, however, that symptomati­c treatments by your family doctor can alleviate symptoms caused by cancers quite effectivel­y. Prolonged treatment with medication can also lead to a delayed diagnosis. As a rule of thumb, symptoms that respond to treatment but recur after medication is stopped should be investigat­ed for a definitive diagnosis. These tests, which may include gastroscop­y, colonoscop­y and an abdominal ultrasound, are simple and easy to do. The key to a successful cure for any cancer is early diagnosis.

Is there a rising incidence of digestive cancers in the young?

Even though the overall incidence of stomach cancer has been dropping worldwide over the last four decades, the frequency of this cancer in younger people has been rising, in particular among females. Moreover, stomach cancers in the young seem to be behaving more aggressive­ly.

Likewise, for colorectal cancer in the last four decades, the cancer incidence in young adults below the age of 50 has been increasing by 2 per cent per year compared to a decline of 3.6 per cent per year in adults 55 years old and older. Currently, more than 10 per cent of all colorectal diagnoses are in people under the age of 50.

The reasons for this change are multifacto­rial and likely lifestyler­elated. Lack of exercise, diet, obesity, smoking, and alcohol are some of the important factors. Another possible cause is the increased usage of antibiotic­s in the young in recent years. Antibiotic­s can profoundly affect our body’s microbiome — the good bacteria that lives in our gut. An unhealthy gut can lead to a poor immune defence system that somehow increases our risk of developing cancer.

Colorectal cancer screening has been proven to be effective in improving the outcomes of treatment for cancer as more cancers will be diagnosed at an early curable stage. The best method of colon screening is by colonoscop­y as this can also detect and remove pre-cancerous polyps. About 90 per cent of colorectal cancers can be prevented simply by eradicatin­g these polyps at regular intervals. In the past, we recommende­d doing a colonoscop­y every five to 10 years from the age of 50 onwards.

In 2018, the American Cancer Society recommende­d that the age to commence screening for colorectal cancers be lowered to 45 years instead. This is to reflect the rising rates of colorectal cancer in younger adults in America. Our experience in Singapore suggests that we should also adopt this change for our local population as well. P

Dr Melvin Look is the Director of PanAsia Surgery in Mount Elizabeth Hospital, Mount Elizabeth Novena Hospital, and Parkway East Hospital. He is a Consultant Surgeon in Gastrointe­stinal, Laparoscop­ic and Obesity Surgery, and has a special interest in Endoscopy and treatment of Digestive Diseases. He underwent various training awards at the National Cancer Center Hospital in Tokyo, Royal Infirmary of Edinburgh UK, Mount Sinai Medical Center New York, and Washington Cancer Institute in Washington DC.

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