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Doctor who is dedicating her career to solving mystery of colon cancer in young people reveals what could be causing explosion of cases - and the three warning signs of disease
Dr Kimmie Ng, an oncologist at the premier Dana-Farber Cancer Center has dedicated her life to the study of GI cancers and is particularly concerned about the rise in such cancers in people under 50
Dr Kimmie Ng has become a frontline witness to one of the greatest medical mysteries of her generation.
The Boston oncologist has launched the world's first center dedicated to studying an explosion of cancers in young people.
In the 1990s, doctors began seeing a rise in the number of otherwise healthy people under 50 being stricken with cancer, especially colorectal cancer.
Three decades later, scientists expect the number of early-onset colon cancer sufferers will double by 2030 in what some have labeled an 'epidemic'.
Dr Ng, who specializes in gastrointestinal cancers, which also include cancers of the stomach and pancreas, said the days of cancer being a disease of the elderly was over.
'That is not what we're seeing in our clinics. Actually, these very, very young people are often very healthy,' she said.
'They're very active, exercise a lot, follow healthy diets, and they don't have a history of cancer in their family and they don't have a background of a genetic syndrome.'
Rates of GI cancers rose most sharply in the youngest age group, followed by the 20-29 year old cohort. There were also more cases of GI cancers among older people, though in that case it is still considered early-onset cancer
This new alarming cohort don't have cancer in the family, don't smoke and drink less than previous generations.
Dr Ng said: 'Why are these otherwise healthy young people in the prime of their lives developing cancer and often very advanced stages of cancer?'
Among children ages 10 to 14 in America since 2000, colorectal cancers have increased 500 percent and among teens aged 15 to 19 the rise was 333 percent, even though the overall numbers of cases are still relatively low in these groups.
Dr Ng said that until doctors know more, patients under 50 must be vigilant for alarming symptoms of the cancer.
The main three signs that appear years before a diagnosis are: blood in stool, changes in bowel movements, and stomach pains.
She added that fatigue and unexplained weight loss are also highly suggestive.
Junk food, plastic pollution and the over-use of antibiotics are some of the factors theorized to be behind the rise in early onset cancers, but the evidence is inconclusive.
At the Young Onset Colorectal Cancer Center at Dana-Farber Cancer Institute in Boston, Dr Ng is exploring how dozens of factors, including diet, sleep, supplementation and drinking habits are playing a role in this increase.
'I see patients one day a week and the rest of my time is spent running the [new center], which really focuses on young people under the age of 50 who are diagnosed with colorectal cancer, as well as conducting research on the diet and lifestyle factors that may impact how long a patient lives with colorectal cancer.'
Dr Ng is shown. She has pioneered research into the causes of colorectal cancer in young people, establishing the Young Onset Colorectal Cancer Center at Dana-Farber
In her work, she has also discovered that vitamin D levels may play a role in cancer development.
Her research showed that higher levels of it in the blood was associated with longer survival in people with CRC cancer, especially in stages three and four, which suggests the vitamin plays a protective role.
But how that factors into the rise in young people is still a mystery.
So too is the apparent link between breastfeeding and colon cancer.
One 2023 study found that having been breastfed as an infant was associated with a 23 percent increased risk of colorectal cancer later in life, and Dr Ng said this corresponded with findings from other studies she's reviewed.
But Dr Ng said this is no reason to stop breastfeeding your baby.
'We did see an association between women who reported that they were breastfed as an infant in developing polyps [in their colon], including high risk polyps before they were age 50,' she said.
'And we know that these polyps are the precursor lesion to developing colorectal cancer later on. So that association was seen and does seem pretty consistent across different studies.'
The findings indicated a need for more research into how this association holds up in larger groups over a lifetime.
'And I think, again, this really is going to be pointing back to some environmental change that's happened recently that is likely contributing to why this is happening.'
In 2010, there were 306 cases of GI cancers per capita of adults aged 20 to 29. That rose to 485 in 2019, an increase of 58 percent. For people 30 to 39, the number rose 44 percent, from 1,184 cases per capita in 2010 to 1,710 cases per capita in 2019.
But among older people, who remain the most likely to get cancer, the rate of incidence and mortality has been falling.
Dr Ng said: 'So we know overall the silver lining is that colorectal cancer has been declining... if you consider people of all ages.
And that is largely due to successes of screening programs, better adherence to screening and also improved treatments.
'But this same benefit and improvement has not been seen in people under the age of 50.
'And we do think it's probably an environmental exposure or risk factor or combination of such that is likely leading to the rise of this disease in younger people.'
he has discovered that vitamin D levels may play a role in cancer development. Her research showed that higher levels of it in the blood was associated with longer survival in people with CRC cancer
She added: 'I think the take-home message is that there is an urgency to doing the research here to understanding what are the risk factors underlying this rise, what are the causes?
'And if we understood that, then we can identify the young people who are at high risk and target them for earlier screening.'
Colorectal, stomach, and pancreatic cancers are among the most aggressive, especially if the diagnosis is delayed, which they often are due to how common their main symptoms are: sore stomach, nausea and changes to toilet habits.
GI cancers include those in the stomach, esophagus, colon and rectum, liver, pancreas, gall bladder, and small intestine.
Dr Ng has advocated for years for the government and doctor groups to lower the age at which screening begins in people under 45 — something which came to fruition in 2021.
And while there has been some chatter about even younger groups getting regularly tested, Dr Ng said the youngest groups still account for a small share of cases.
Approximately 150,000 patients are diagnosed each year with colorectal cancer in the US. About 18,000 of them are under the age of 50, Dr Ng said.
But she is raising awareness about the early warning signs.
'So the most common symptom that young patients present with is actually seeing blood in their stool. The second most common is abdominal or pelvic discomfort and a sense of bloating.
'And other red flag symptoms may include a change in your bowel habits. So new diarrhea, new constipation, a change in the caliber of the stool, including thinner pencil thin stools.'
She added that unintentional weight loss, fatigue, and shortness of breath when physically exerting oneself 'may indicate that anemia is present. Those are the most common symptoms that often lead to a diagnosis of colorectal cancer.'
Cancer is often thought of as an older person's disease. Throughout one's life, cell damage builds up and causes cells to behave differently. Sometimes, they refuse to die off or replicate beyond what is normal, contributing to a build-up of what become cancerous cells.
Thirty-three year old Alyssa Burks was diagnosed with extremely aggressive stomach cancer in 2021. Repeat lab tests and blood panels came back normal, despite her fatigue, unintentional weight loss, trouble swallowing, and severe heartburn.
The above graph shows colon cancer cases among under 50s by year. There is a drop in 2020 because the Covid pandemic led to fewer people coming forward for screenings
It wasn't until 2023 that she underwent a colonoscopy, which uncovered a cancerous polyp. It set off a domino effect of doctors appointments, rounds of chemo, surgery to remove her stomach where the cancer had spread, and surgical removal of her reproductive organs.
After the surgery to remove her ovaries at 33, her doctor told her that her cancer was 'very angry': 'It expanded throughout my stomach and climbed further into my esophagus. It was detected in 27 lymph nodes, which indicated it metastasized to other parts of my body. I wasn't cancer-free at all—instead, I was dealing with an extremely aggressive form.'
Most recent testing showed that the cancer was still in her body, doctors just could not determine where. It's a symptom of gaps in the medical community's knowledge of how and why cancers spread so ferociously in people under 50.
She said: 'Currently, I'm in this strange position where I know I still have cancer, but it's not being treated. It feels weird to just leave it alone.
'I'm going to get a full-body scan to see where it might have spread in my body, but imaging tests aren't great at picking up my type of cancer. Still, I'm hoping it will give me some answers so that I can press my team for other treatment before it gets worse.'
Cases of colorectal cancers in young people are expected to double by 2030. And while obesity – which affects 42 percent of Americans – is a driving factor of CRC and other cancers, it cannot be the sole explanation.
Dr Andrea Cercek, an oncologist at Memorial Sloan Kettering Cancer Center, said: 'The rise in obesity alone does not explain the growth of GI cancers in younger people.
'We are also looking at other possible factors, including toxins we may be ingesting in our food, like hormones, or changes caused by antibiotics to the microbiome in our bodies, which are bacteria and other microbes that help us digest our food. All of these and more are being investigated.'
Scientists have recently begun to focus on forever chemicals, including microplastics, which have penetrated the bodies of 97 percent of Americans, as a driving force.
The chemicals devised by home goods giant 3M in the 1940s are extremely persistent in the environment and the human body, taking months or even years to break down.
Studies have suggested that these chemicals can cause widespread inflammation in bodily tissues, high blood pressure, hormone interference, thyroid disease, high cholesterol, and a weakened immune system.
All of this raises the risk of developing a wide array of cancers beyond just gastrointestinal, including ovarian, kidney, breast, and testicular cancers.
Cancers that have spread beyond organs in the GI tract are far more likely to be fatal.
Late stage colon cancer has a five-year survival rate of about 13 percent, and that of rectum cancer is 18 percent.
Pancreatic cancer than has spread, meanwhile, has a surival rate of about 15 percent.
Dr Ng said thanks in part to her pioneering research, the future in medical advancements looks bright: 'The hope in science is limitless and it has resulted in discoveries that have changed the way patients are treated and that has more than doubled the survival of patients with colorectal cancer.
'There are advances being made everyday. The longer you are around, and thriving on treatment, the more new advances will be made.'