The Silent Surge: Understanding Early-Onset Bowel Cancer Among Young Adults

Commentary by Dr. Donald Greig

A recent article from The Times sheds light on a concerning trend: the significant rise in bowel cancer diagnoses in individuals under 50. As highlighted by the experiences of patients like Holly Masters, who was diagnosed at just 24, it's evident that both awareness and medical responses must adapt to this alarming reality.

Increasing Incidence of Early-Onset Bowel Cancer

Bowel cancer, predominantly affecting those over 50, is paradoxically finding a growing presence among the younger population. With a staggering increase noted since the early 1990s, researchers suggest that individuals born from 1960 onwards face escalating risks.

The figures are troubling: while approximately 2,600 under-50s are diagnosed annually in the UK, this represents a fraction of the 44,000 total cases. However, the rapid rise within this specific age group cannot be ignored. As Professor Trevor Graham notes, the increased incidence challenges long-held assumptions about risk factors being solely attributable to genetics or lifestyle choices.

The Role of Dietary Changes

One prominent theory emerging from the research points to dietary shifts as a fundamental factor. Professor Sarah Berry emphasizes how our food landscape has transformed dramatically over the last six decades. The correlation between obesity rates and bowel cancer is now backed by research linking specific dietary components—such as low fibre intake, high processed foods, and sugars—to increased cancer risks.

Berry's ongoing studies aim to further clarify these connections, prioritizing dietary fibre as a protective factor. As dietary habits evolve, public health recommendations suggest a return to nutrient-rich, fibre-heavy foods such as fruits, vegetables, and whole grains to mitigate risk.

Genetic Influences and Early Life Factors

Beyond diet, a deeper investigation into genetic changes and early life exposures promises further insights. The work spearheaded by scientists like Paul Brennan highlights potential links between early childhood bacterial exposure and the likelihood of developing bowel cancer in adulthood. The connection to bacterial strains, particularly certain E. coli variants associated with genotoxic effects, opens new avenues for understanding how early environmental factors may predispose young individuals to cancer later in life.

The implications of changing childbirth practices, such as increased caesarean deliveries and the rise in antibiotic use, are areas requiring focused study. These factors could play crucial roles in shaping gut microbiomes that influence health outcomes decades later.

A Call for Action

The testimonies of young patients like Holly Masters reflect the human side of this data. Her determination to raise awareness highlights the necessity for increased vigilance in recognizing symptoms, particularly in younger patients who may be dismissed due to their age. The urgent need for improved diagnostic tools and protocols for this group is evident.

Moreover, ongoing research into nutritional, genetic, and microbiome influences can provide comprehensive strategies for prevention and education. Encouraging healthy dietary habits and lifestyle changes can serve as a protective barrier against rising cancer rates.

As we confront this burgeoning crisis in young-onset bowel cancer, the collective response from healthcare providers, researchers, and the public is critical. By fostering awareness, promoting early diagnosis, and funding research into environmental and genetic factors, we can strive toward a future where no young person has to navigate the challenges of cancer as Holly did. We should unite in this effort to change the narrative and safeguard the health of subsequent generations.

Source

Bowel cancer has doubled in under 50s- do the reasons lie in birth?

Article by Ben Spencer

Holly Masters was diagnosed with bowel cancer aged 24

When Holly Masters first contacted her GP she was assured her symptoms were not a cause for concern. “I think it was my age — I was 23 at the time — and also because it was the pandemic. Every time I tried to ring the GP I was told it was IBS [irritable bowel syndrome] or some other minor thing.”

But her symptoms became progressively worse. “My bowel habits were all over the place, I was really bloated and the bleeding when I went to the toilet continued,” she says. “Unfortunately I was never seen at my GP practice.”

In September 2021, more than a year after she first reported problems, Masters went to A&E at Addenbrooke’s Hospital in Cambridge and was diagnosed with stage-three bowel cancer.

It is perhaps understandable that GPs struggle to spot cases among the young. Of the 44,000 people who are diagnosed in the UK each year with bowel cancer, or colorectal cancer, to give it its medical term, 94 per cent are over the age of 50.

But although the number of people like Masters, struck by bowel cancer in their youth, is relatively small — about 2,600 are diagnosed each year at the age of 49 or under — it is a group that is steadily growing.

Its members include high-profile cases such as Deborah James, who became famous for her awareness work as “Bowelbabe” before she died aged 40 in 2022, and Nathaniel Dye, a well-known assisted dying campaigner whose death aged 40 was highlighted by Wes Streeting, the health secretary, last week.

“Bowel cancer in young people has doubled since the early 1990s,” says Trevor Graham, professor of genomics and evolution at the Institute of Cancer Research in London. Yet at the same time rates of bowel cancer among older people have started falling.

Deborah James died of bowel cancer aged 40 in 2022

Last year an investigation of early-onset bowel cancer cases in England, Australia, Canada and the US revealed that this change has been taking place over decades, among men and women.

The findings, published in the Journal of the National Cancer Institute, suggested that those born in 1995 in England are at least eight times more likely to develop bowel cancer before they turn 50 than those born in 1960.

One of the authors of that study, Paul Brennan, the head of the genetics team at the World Health Organisation’s International Agency for Research on Cancer, says: “It is a genuine cohort effect. Each year the risk goes up. In a country like the UK you can track it. It started to increase among kids born from about 1960 onwards.”

The diet theory

For years humanity has assumed that developing cancer is either bad luck, rooted in the intertwined mysteries of genetics and fate, or caused by clear lifestyle factors such as smoking or drinking.

But experts are trying to unpick the links between cancer and what they call the “exposome”, the raft of environmental exposures we face throughout our lives, from the food we eat to the infections that make us ill.

Bowel cancer provides researchers with the ideal test case because the change is so clear-cut. “It is obviously not human genetics because that does not change over this kind of timescale,” says Graham.

Sarah Berry, professor of nutritional sciences at King’s College London, believes dietary changes are the most obvious cause. “Our diet and lifestyle, in my opinion, have changed beyond recognition over the past 60 years,” she says.

There is a strong link between obesity and bowel cancer, and particular food types are known to be risk factors, including alcohol, red and processed meat, sugar, low fibre intake and the additives and emulsifiers found in processed foods.

While she dislikes the term “ultra-processed food” (UPF), Berry believes food processing has played a key role by removing healthy components such as fibre while adding unhealthy ones, such as salt, sugar and saturated fats.

Berry is involved in two studies which she hopes will more firmly establish a link.

Her team is recruiting 100 identical twins aged 18 to 50 to see how they react to different levels of fibre in their diet. She says: “One twin in each pair will follow a control diet, which is basically the advice on the government’s ‘Eatwell’ plate that advises about 30g of fibre a day. And the other twin will follow our intervention diet, which is 40g of fibre a day.”

Berry, who alongside her academic work is the chief scientist for the Zoe nutrition and health app, is recruiting for a second, much larger, trial in which she hopes to track the dietary intake and daily habits of millions of people in granular detail. It will be modelled on the Zoe Covid-19 tracker project, in which nearly five million volunteers logged their daily symptoms during the pandemic.

“It means we can ask really targeted questions that aren’t usually asked,” Berry says. “Do you typically have alcohol with your meal or at another time? How many hours a day are you seated versus how many are you up and about?” The aim is to capture brand-level data. Researchers would also have access to participants’ health records.

For now, the NHS suggests that to lower the risk of bowel cancer people should eat a healthy diet, including plenty of fibre-rich sources such as fruit, vegetables, beans and whole grains, stay active and cut down on alcohol and red meat.

The childbirth theory

Paul Brennan is looking elsewhere to understand the rise in young-onset bowel cancer. He believes the smoking gun is likely to be in a child’s early years, potentially as early as childbirth.

He is part of a large international group of scientists who in 2024 examined the genetic make-up of bowel tumours from 981 patients in 11 countries. Their findings, published in the Nature science journal, found a distinct DNA signature kept popping up in the samples — and was three times more common in patients diagnosed before the age of 40 than in those over 70.

This signature was caused by a particular strain of E.coli bacteria in the gut which releases a genotoxin called colibactin. “Colibactin is a self-defence mechanism for the bacteria. It protects it from other bacteria,” Brennan says. “But a by-product is that it causes mutations in the cells of the colorectum.”

He believes the balance of bacteria in babies’ intestines has changed over time. “And one of the bacteria that we think may have become more frequent in the microbiome of kids is the type of E.coli which produces colibactin. Kids end up with a mutation load far higher than they otherwise would have and that means they’re on kind of a fast track to developing colorectal cancer maybe 40 or 50 years later.”

At the moment, this is a hypothesis, Brennan says, and he believes it may be linked to the manner in which babies come into the world and what happens in their earliest weeks. “So much has changed in the way children are born. Two generations ago many babies would have been born at home — in the bed of their mum. Since then the rates of caesarian sections have increased. Could it be due to a decline in breastfeeding? Could it be the rise in the use of antibiotics? Could it be infant diet? We don’t quite know.”

In northwest London, Trevor Graham is part of a team trying to fill in the gaps. He is examining samples of bowel tumours dating back to the 1950s to determine whether the balance of bacteria in the gut changed over time. The specimens, stored in the basement of St Mark’s Hospital, a specialist bowel hospital in Northwick Park, are a “time machine”, he says. “It allows us to go back into past decades and see what was there and then compare that to what’s here today. If E.coli is driving the increase, then we should see this particular damage increase at the same rate through the decades that the rate of bowel cancer in young people is also increasing.”

Holly Masters believes that discovery is desperately needed. After she was diagnosed she had radiotherapy and chemotherapy, followed by major surgery to remove the tumour. Today, aged 28, she is cancer-free and pursuing her career as an actress in London. But she is left with the permanent side-effects from her treatment, including a stoma that requires meticulous daily management.

“It’s a huge thing to happen at such a young age,” she says. “It completely changes everything. The more we can do to get younger people diagnosed earlier, the less they will have to have aggressive treatment which has such life-changing consequences. So we need to figure out what’s happening. Ultimately I want a world where no other young person has to go through what I have.”

Disclaimer: This newsletter is for informational purposes only and does not constitute medical advice. Always consult your healthcare provider for any medical concerns.