THE TWISTED TRUTH

Traditionally seen as an ‘old person’s disease’, bowel cancer has set its beady eye on a new target: people like you. Numbers of young British women being diagnosed with the condition are growing – we’re asking why

How bowel cancer became a real threat to young women

Let’s, even if only while you read the next four pages, cut the crap; none of this ‘number two’ nonsense or the idea that the word ‘stool’ ceases to exist outside the confines of a GP surgery. Because – for no other reason than that it could make an incredible difference to your health – it’s good to talk shit. When Ally Parry visited her doctor with major fatigue, she wasn’t surprised to hear her iron levels were low – being female, a vegetarian and a new mum all ticked boxes. But a series of events, including inconsistent blood-test results and perseverance from both Ally and her doctor, led to a diagnosis that nobody saw coming. She was iron-deficient because she had bowel cancer. She was 29 years old. ‘Hearing the news was harrowing,’ she recalls. ‘I had a CT scan the next day to see if the cancer had spread to my liver and lungs. I was so relieved when they didn’t find any. I’ve never cried so hard – I’d be able to be a mother to my son.’ Before the diagnosis that changed her life, Ally thought little of the C word. As for bowel cancer, she thought that was ‘an old man’s disease’. The latest stats reveal a different reality: that the cancer (symptoms of which can include gas, a change in bowel habits, bleeding and, as in Ally’s case, anaemia) has started affecting women like you. Bowel cancer among women is on the rise – rates are 4% higher than they were 20 years ago, while cases among men have remained stable. Right now, it’s the second most common cancer to affect women worldwide, third in the UK, with around 50 women receiving a diagnosis every day.

CAUSE FOR CONCERN

But the most worrying aspect of this whole situation? Many of these cases are in the advanced stages because they’re initially misdiagnosed or caught too late. ‘If it’s detected early, at stage one, 98% of people will survive bowel cancer for five years or

more,’ says Willie Hamilton, professor of primary care diagnostics at the University of Exeter Medical School, and medical adviser for charities Beating Bowel Cancer and Bowel Cancer UK. ‘But the sad truth is that many younger people have a lower chance of survival from bowel cancer because they often face a delay in their diagnosis. Three out of five people diagnosed under the age of 50 will be at stages three or four, with a third of those in an emergency situation.’ More on the cause of these delays later. As experts work to identify the causes of the unwelcome increase in sufferers, an inconsistency in healthy habits looks to be the main culprit. So, you went large on the Papa John’s last night, then decided this morning was more of a bath-than-shower scenario, leaving no time to make your scheduled workout class. And what? All fine – unless your good intentions fail to come to fruition more often than not. As workloads and personal stressors increase, it’s easy to lose track of how much you’re really eating and exercising. And a pile-up of this behaviour can clog your bowel. Hit-or-miss nutrition, for one, can rob your gut of the consistent fuel it needs to stay strong. Added kilos also court trouble: up to 11% of cases of bowel cancer were linked to obesity in a major review by the IARC Handbooks Of Cancer Prevention – an independent cancer agency that’s part of the World Health Organization (WHO). ‘Most of my patients don’t eat as well as they’d like because they’re always on the go and heavily processed convenience food is a welcome solution,’ says David Mcarthur, colorectal surgeon at Spire Parkway Hospital in Solihull. ‘But diet, alcohol intake and weight play a key role in determining your bowel cancer risk.’ According to a 2015 review by the WHO, there may be a link between red meat and bowel cancer – and an even stronger association if the meat is processed. The advice from the IARC is to limit consumption of red meat, particularly the processed stuff, in order to lower your risk. ‘Simply put, whatever you put in your mouth spends time in the bowel,’ says Stephen Fenwick, consultant hepatobiliary surgeon at Aintree University Hospital. ‘So, if there is any carcinogenic (read: cancer-causing) element in what you eat or drink, that will come into direct contact with the bowel.’ Think of it like putting smoke into your lungs and it suddenly feels a whole lot more real.

PR ISSUES

Diagnosis delays compound the problem. Bowel cancer isn’t on the health radar of the average twenty- or thirty-something woman. Awareness is low and awkwardness high. ‘The symptoms are potentially embarrassing: rectal bleeding, discharge and diarrhoea,’ says Mcarthur. ‘And because bowel cancer is rarer in younger people – despite the rise in cases – it can easily be missed by GPS.’ Plus, this cancer plays dirty; many of us struggle with gut issues – they’re more common among women – and typical symptoms of bowel cancer can overlap with more innocent and treatable conditions. ‘Many of my young advanced-disease patients had been complaining of symptoms for more than two years – they’d been told they had haemorrhoids,’ says Mcarthur. Signs like abdominal pain and cramping could be misattributed to irritable bowel syndrome, so getting any digestive problems diagnosed and under control could be life-saving. Screenings are one way to take such speculation off the table. In the UK, this involves either a direct bowel cancer test – a thin tube with a camera at the end is used to look for and remove any polyps inside your bowel – or an at-home testing kit, which

AWARENESS IS LOW AND AWKWARDNESS HIGH

will flag any need for further tests. But you’ll only be invited to complete a test if you’re over the age of 60 (or over 50 in Scotland). The advice for anyone else with symptoms or a family history of the disease is to speak to your GP, who will refer you for tests, such as a colonoscopy.

DON’T LET IT SLIDE

When it comes to prevention, the stuff that works is the stuff you already know. Don’t smoke and check your alcohol consumption, since drinkers are more vulnerable to the disease. As mentioned, diet plays a major role, too – enjoy plenty of fibre-rich foods, such as legumes, whole grains and vegetables, to keep everything flowing as it should. Oh, and go easy on the bacon, too. But there is also growing evidence to suggest that gut health plays an important role. ‘Inflammation in the body can lead to an increased risk of developing cancer,’ says Mcarthur. ‘A strong gut microbiome has been shown to reduce inflammation, so there’s reason to think that it might also minimise your risk of bowel cancer.’ Improve yours by eating natural cheerleaders of gut bacteria, such as artichokes, apples and sauerkraut. And, as if you needed an excuse, exercising for just two and a half hours a week could slash your risk by 24%, according to a study in the British Journal Of Cancer. The other simple strategy? Be proactive: look out for any new, persistent below-the-belt aches. If your doctor delivers a rushed diagnosis – like it must be period-related or it’s just stress – seek a second opinion. Detailing every symptom, however awkward, and insisting on tests could be a lifesaver. ‘If you do have

persistent symptoms, never be afraid to get them checked,’ adds Mcarthur. ‘Bowel cancer has one of the highest survival rates with treatment. If you’re not happy with your GP’S diagnosis, definitely push for a referral.’ Inflammatory gastrointestinal disorders, such as ulcerative colitis or Crohn’s disease, can also increase your odds. Ally implores women to trust their instincts. ‘It’s so important to know and pay attention to your body,’ she says. ‘It’s all too easy to put health symptoms down to a crazy-busy life. I could have easily dismissed the low iron, but I knew that something else was going on, so I persevered.’ Ally had a right hemicolectomy to remove the cancerous part of her bowel and is now undergoing chemotherapy. ‘I’ve been told my chance of survival is about 85%,’ she says. ‘It’s clichéd, but it really makes you stop and focus on the present.’ The bottom line? In 90% of cases, bowel cancer can be treated successfully. Symptoms shouldn’t be cause for panic – blood in the toilet bowl doesn’t automatically equate to bowel cancer. But it is cause for

‘NEVER BE AFRAID TO GET SYMPTOMS CHECKED’

investigation and possibly a colonoscopy to rule out anything serious. People of any age with a family history of bowel cancer, other risk factors or symptoms should always get themselves checked. If in doubt, talk it out with someone you trust. It might be awkward, but it might just save your life.