Youthfulness should not be a barrier to timely bowel cancer diagnosis

Younger people self advocating as bowel cancer becomes the deadliest cancer for 25-44

30 May 2023

Early-onset bowel cancer patients perceive age bias as a barrier to diagnosis for the deadliest cancer in people aged 25-44.
Latest Australian research finds younger people may spend between 3 months and 5 years seeing multiple doctors before diagnosis. They may make 10 or more visits to GPs.
Over the past three decades, there has been a 266% increase in bowel cancer incidence rates in adolescents and young adults (15-24 years).

Latest Australian research^i,iireveals younger people with bowel cancer symptoms find themselves self-advocating as the only consistent and reliable resource for overcoming age bias, barriers to diagnosis, and optimising outcomes for the deadliest cancer in those aged 25-44.ⁱⁱⁱ

Published in the BMJ Open and BMC Primary Care, the studies are the first to investigate the perspectives of early-onset bowel cancer patients’ regarding ways to improve experiences of care in Australia, New Zealand, and the United Kingdom.

Chief Investigator, Dr Klay Lamprell, Australian Institute of Health Innovation, Macquarie University, said ‘Young people with bowel cancer say the same world over. Because they are young, they are overlooked for bowel cancer.’

‘The research found younger people may spend between three months and five years seeing multiple doctors before diagnosis. They may make ten or more visits to GPs.’

‘Even when younger people experience blood in their poo or rectal bleeding, GPs may not immediately refer them to specialists for further testing,’ Dr Lamprell added.

Early-onset bowel cancer patients differ from later-onset bowel cancer patients in their diagnostic trajectories; time to diagnosis can be 60% longer with a greater number of missed diagnostic opportunities, and younger people are more likely to be diagnosed in later stages of the disease.

Late-stage diagnosis increases the likelihood of aggressive treatment with physical, psychosocial, and quality of life outcomes that are uniquely challenging for this under-50 patient population, especially with regards to fertility and ostomy management.

‘Patients perceive their GPs’ low suspicion of cancer given their age as an age bias that shapes the nature of clinical assessments, influences the investigations conducted and referrals given, and creates tensions which obstruct shared decision-making,’ Dr Lamprell said.

Eventual referrals and lengthy wait times for non-urgent colonoscopies were also a common theme of delayed diagnosis and a cause of patient dissatisfaction with GPs.

‘Young people seeking diagnosis are also challenged by limited clinical awareness of early-onset bowel cancer.’

‘Our research concludes that with the rising global incidence of bowel cancer in people aged under 50, there is a mounting imperative for GPs to receive more information and clinical guidance on early-onset bowel cancer diagnosis,’ Dr Lamprell concluded.

Patients under 50 years have an increased risk of developing bowel cancer when they experience one or more symptoms of abdominal pain, rectal bleeding, diarrhea, and iron deficiency anaemia between 3 months and 2 years prior to diagnosis. iv

Bowel Cancer Australia CEO Julien Wiggins said, ‘Younger people need to be aware of, and act on, these potential signs and symptoms and have them investigated so as to rule out bowel cancer as an underlying cause.’

‘1-in-10 new bowel cancer cases now occur in people under age 50,’ he added.^v

‘Over the past three decades, there has been a 266% increase in bowel cancer incidence rates in adolescents and young adults (15-24 years),’ he said. ^vi

People born in 1990 onwards have double the risk of colon cancer and quadruple the risk of rectal cancer compared with people born in 1950.^vii

For further information or to arrange an interview with a medical expert or patient contact:

Stephanie Bansemer-Brown – Bowel Cancer Australia

stephanie@bowelcanceraustralia.org | 0412 915 797

References:

i Lamprell K, Fajardo-Pulido D, Arnolda G, et alThings I need you to know: a qualitative analysis of advice-giving statements in early-onset colorectal cancer patients’ personal accounts published onlineBMJ Open 2023;13:e068073. doi: 10.1136/bmjopen-2022-068073

ii Lamprell, K., Pulido, D.F., Arnolda, G. et al. People with early-onset colorectal cancer describe primary care barriers to timely diagnosis: a mixed-methods study of web-based patient reports in the United Kingdom, Australia and New Zealand. BMC Prim. Care 24, 12 (2023). https://doi.org/10.1186/s12875-023-01967-0

iii https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/about

iv Cassandra D L Fritz, MD, MPHS, Ebunoluwa E Otegbeye, MD, MPHS, Xiaoyu Zong, MPH, Joshua Demb, PhD, MPH, Katelin B Nickel, MPH, Margaret A Olsen, PhD, MPH, Matthew Mutch, MD, Nicholas O Davidson, MD, DSc, Samir Gupta, MD, MSCS, Yin Cao, ScD, MPH, Red-flag Signs and Symptoms for Earlier Diagnosis of Early-Onset Colorectal Cancer, JNCI: Journal of the National Cancer Institute, 2023;, djad068, https://doi.org/10.1093/jnci/djad068

v Australian Institute of Health and Welfare (AIHW) 2022 Cancer Data in Australia; Canberra: AIHW. <https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/>.

vi https://www.aihw.gov.au/reports/cancer/cancer-in-adolescents-young-adults-australia-2023/contents/summary

vii Rebecca L. Siegel, Stacey A. Fedewa, William F. Anderson, Kimberly D. Miller, Jiemin Ma, Philip S. Rosenberg, Ahmedin Jemal, Colorectal Cancer Incidence Patterns in the United States, 1974–2013, JNCI: Journal of the National Cancer Institute, Volume 109, Issue 8, August 2017, djw322, https://doi.org/10.1093/jnci/djw322

Media release supplied by Bowel Cancer Australia

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