Westmead Hospital surgeon Amy Cao says that like most colorectal specialists, she finds it very normal to talk about poo.
“It’s a very natural process. I talk about poo just like I talk about my weekend or my hair,” Amy said.
While everyone may not be as comfortable talking about their poo, changes in bowel habits can be an indication of bowel cancer.
“There is a bit of stigma or social taboo, but really there shouldn’t be any shame in this,” Amy said.
Amy is hoping that a willingness to talk about poo could help turn the tide of rising numbers of young-onset colorectal cancers.
“Traditionally colorectal cancers are an older person’s disease, whereas now we’re seeing it in much younger patients, in their 20s, 30s, 40s” Amy said.
Young-onset colorectal cancers are defined as cancer affecting the colon or rectum in people under the age of 50.
Globally, colon cancer is the second leading cause of cancer-related deaths.
“In the last three decades, we are noticing that the proportion of those that have young colorectal cancer is significantly higher than generations before,” Amy said.
Prior to this research, Amy says the long-term survival outcomes in young patients was minimal and inconsistent.
“We found was that there’s a lot of discrepancies in the literature about the outcomes for young patients with colorectal cancers,” Amy said.
She conducted the largest study of young-onset colorectal cancer in Australia to date, where data from Queensland was analysed which spanned a 20-year period.
The study was supervised by Professor David Clark from Royal Brisbane and Women’s Hospital and looked at long term outcomes in more than 52,000 adult patients from 2001-2020.
The research compared survival outcomes in people under 50 years of age, to those over 50 years of age.
The research uncovered a range of new information for the Australian population.
Younger people tend to be diagnosed with more advanced colorectal cancer, for example in stage III or IV of the disease.
“It comes back to the level of clinical suspicion, having that red flag in your head to say, I actually need to see a doctor for that or for a GP to refer a patient to a specialist,” Amy said.
Population based screening with faecal occult blood testing and general awareness are factors contributing to the decline in colorectal cancers of over 50-year-olds.
The study uncovered that despite the later diagnosis of cancer, the survival rate was better.
“Young colorectal cancer survival is actually better, and that’s both overall survival and cancer specific survival at every stage. Age is the strongest protective factor in survival” Amy said.
“We know younger patients tend to survive longer but they will have survivorship issues that are very different to older patients,” Amy said.
Survivorship issues are problems or complications which may arise in the wake of surviving cancer, such as putting a career on hold, being a breadwinner or raising a young family.
“There’s a whole gamut of survivorship issues that are very different to someone who’s retired with adult children looking forward to their grandchildren,” Amy said.
The reason for the increasing rates of young-onset colorectal cancer remains unknown.
“Young-onset colorectal cancer is a really hot topic at the moment, not only in Australia but worldwide we’ve seen this huge upward trend,” Amy said.
Symptoms that present in a younger patient or older patient are often similar, but younger patients may not be aware of their cancer risk.
“If anyone has any symptoms of bowel cancer such as bleeding, new changes in bowel habits, like constipation or diarrhoea and the change is more than two weeks, abdominal pain, weight loss, or new iron deficiency that should be looked at by a doctor,” Amy said.
Amy is hoping to see the same awareness of bowel cancer symptoms for older patients to filter down to the younger cohort, for doctors to treat symptoms in a young person with similar suspicion as they would an older patient.
“I certainly think the newer generation are much more open to talking about these issues,” Amy said.
Willingness to discuss the symptoms is an incredible asset for help young people detect the cancer early.
“I hope that increased community awareness does introduce the topic into family discussions, to say it’s out there and we can talk about it,” Amy said.