Colorectal cancer keeps rising among younger adults. No one's sure why

After giving birth to her third child at 35-years old, Alexis Juliao began noticing blood in her stool.

"Everyone said to me, it's hemorrhoids, you just had a baby," the London, Ont., mother recalled. "Everyone explained it, or dismissed it, as being normal."

But Juliao knew it wasn't normal. And she knew she didn't have any hemorrhoids.

What followed was a lengthy, frustrating process to figure out what was actually going on. For more than six months, Juliao kept experiencing the same bleeding, but most people simply brushed it off because of her age. She eventually took photos of the blood in her stool, prompting her physician to refer her for a colonoscopy.

Once Juliao finally had her scope — after nearly nine months of experiencing symptoms — she learned what was causing her bizarre bleeding while breastfeeding her youngest daughter in her hospital bed: a tumour. 

She had Stage 1 colon cancer, despite only being in her mid-30s.

"I was actually relieved they had found what was wrong," she said, "which very quickly turned into realizing the gravity of the whole situation."

Juliao required major surgery to remove a roughly 30-centimetre stretch of her lower colon, had to take more than half a year off her work as a midwife to recover, and is now learning to live with life-altering changes to her digestive system.

While her situation remains rare, it's increasingly clear to gastrointestinal specialists that colorectal cancer is on the rise among younger adults. The trend has been observed for years, in multiple countries including Canada, with no clear cause — though there are plenty of swirling theories that it could be linked to dietary or lifestyle changes in recent decades. 

Whatever the reason, doctors are worried that younger patients may be slipping through the cracks of a medical system that screens older adults — and asking whether that needs to change.

"One of the challenges for young people is that, when presenting with symptoms, [they] are often told that they have hemorrhoids or some benign condition that's causing bleeding," said Vancouver-based colorectal surgical oncologist Dr. Carl Brown.

"But we feel strongly that all those patients, all of those people, should have [an] endoscopic evaluation to rule out cancer."

New data from the American Cancer Society paints a stark picture: The incidence of colorectal cancer went up two per cent each year in people under 50 between 2011 and 2019, even though U.S. incidence rates have either dropped or stabilized for older adults who are eligible for screening programs.

Deaths have also gone up by one per cent each year since 2005 for people younger than 50, according to a report released this month, while advanced disease now appears to be increasingly common across the board.