JOHN DANKOSKY: This is Science Friday. I’m John Dankosky.

KATHLEEN DAVIS: And I’m Kathleen Davis. We’re sitting in for Ira Flatow this week. Medical providers have noticed a strange trend over the past few years. More and more young people are being diagnosed with colorectal cancer.

It used to be really rare for anyone under the age of 50 to be diagnosed with colorectal cancer. But practitioners are increasingly seeing people in their 40s, 30s, and even 20s with this type of cancer. So what’s driving these cases? And what can people who are concerned about this do?

Joining me now to talk about it is my guest Jennifer Fijor, gastroenterology nurse practitioner at Virginia Mason Franciscan Health based in Seattle, Washington. Welcome to Science Friday, Jennifer.

JENNIFER FIJOR: Hi, thanks for having me. It’s a pleasure to be here.

KATHLEEN DAVIS: So nice to have you. So just to be clear, what are we talking about when we say colorectal cancer?

JENNIFER FIJOR: So colorectal cancer refers to a cancer of the colon, which is like the large intestine or the rectum, which is a very end of the colon prior to the anus. So it is a cancer that’s present within that area.

KATHLEEN DAVIS: And as far as cancers go, how common is this?

JENNIFER FIJOR: So colorectal cancer is becoming an increasing trend. Right now in the United States, colorectal cancer is the third leading cause of cancer related deaths in men, the fourth in women, but it is the second most common cause of cancer amongst men and women combined.

KATHLEEN DAVIS: Wow. So when did it become clear to you, as a nurse practitioner, that rates of colorectal cancer were rising among young people?

JENNIFER FIJOR: If you look at the data, you would actually see that it may suggest that there’s been kind of an increase in this trend since the mid ’90s. In my practice, though, I’ve kind of seen it pick up over the last seven years or so. Personally, I’ve been in GI since 2008, and I remember back in the day it was really rare to have a colorectal cancer in somebody under the age of 50.

I do remember somebody being diagnosed in their 30s, and I was– everybody was quite shocked. It was a travesty. And it was something that was just not heard of. And I even had a friend who was 38 when he was diagnosed with colon cancer, and he was an Asian male in 2015. And that was even a shock to us.

But it seems to be coming more and more prevalent over the last decade or so. And that’s even why they’ve rolled back the colorectal cancer screening guidelines from 50 to 45 more recently.

KATHLEEN DAVIS: Do we have any firm answers as to why young people are increasingly affected?

JENNIFER FIJOR: I think this is a really difficult question to answer, and I would say it’s multifactorial. And there’s a lot of theories right now but no definitive “one size fits all” answer. Most of it kind of comes from our diet and lifestyle, particularly our Westerners lifestyle. We typically have a diet that’s really high in processed foods, red meats, high-fat foods. Most Americans typically don’t get enough fiber, fruits, vegetables, whole grains.

I’ve read one study that showed that average American gets about 10 to 15 grams of fiber per day when the general recommended goal is anywhere from 20 to 35. So that’s one reason. Another reason may be some environmental exposures, for example, chemicals, pollutants, or even like pesticides.

We’ve also seen an increase in early childhood obesity, especially in the setting of things like technological advances and social media, so like computers, cell phones, things like that, which has created some physical inactivity. Additionally, there’s some theories to suggest that antibiotic exposure, especially the early onset, like prenatal years and leading up to adolescence period of life, will disrupt the gut microbiota and can make a pro-inflammatory state, which may make you more susceptible to things like colorectal cancers down the line.

Of course, there’s other environmental exposures, tobacco– I’m sure we all know that that one’s not good for us– and then excessive alcohol intake as well. In fact, I just did a TikTok on how excessive alcohol intake can disrupt the gut microbiota. So it’s something to definitely pay attention to.

KATHLEEN DAVIS: Wow. And it’s interesting that you talked about those environmental factors potentially playing in here. Just last week on the show, we talked to a cancer researcher about, quote, unquote, hidden carcinogens, like air pollution. I want to ask you about the, quote, unquote, “typical patient for colorectal cancer”. Before all these young people started getting diagnosed, who was sort of like, OK, this is sort of a normal patient that you would see?

JENNIFER FIJOR: The expectation is always going to be somebody over the age of 50, somebody who typically leads an unhealthy lifestyle. Tobacco, as I mentioned, was a definite risk factor, fairly obese, sedentary lifestyle, just poor diet in general, and that is still a part of this. But there are some things that we’re seeing that may play some other contributing factors, where they’re having young, healthy patients come in. And that’s kind of the more concerning thing, I think, for most people.

KATHLEEN DAVIS: Mhmm. So what kind of symptoms should people be looking out for?

JENNIFER FIJOR: Oh, that’s really important. So at this point, the hard part about colorectal cancer is that sometimes it doesn’t rear its head until it’s ugly. But with that being said, if you are under the age of 45 and you are not somebody who is, quote, unquote, “eligible for screening colonoscopies,” the big things to look out for are these red flag symptoms or warning symptoms of change in bowel habits, rectal bleeding. And when I say change in bowel habits, I want to clarify– change in bowel habits over like two-week period, three-week period, four-week period, not like I had an episode yesterday and it changed today.

But anemia of unknown causes, especially in somebody who is a non-menstruating person, bloating, unintentional weight loss, these are all signs that you should at least discuss with your primary care doctor or your gastroenterologist if you already have a relationship with them for further evaluation.

KATHLEEN DAVIS: Mhmm. So you mentioned some preventative screenings. Are colonoscopies typically covered by insurance?

JENNIFER FIJOR: So a screening colonoscopy, meaning I have no symptoms, I am just looking for the possibility of polyps or growths inside the colon that could potentially become a colon cancer or, of course, colon cancers, those are usually covered by insurance companies. Currently, the CDC recommends adults beginning at the age of 45 undergo colon cancer screening tests. This can be done via colonoscopies, but that’s not the only test to detect the possibility of colon cancers.

However, it is not only the best at detecting but preventing colon cancers. And that is the key. So there are some other options for those who are afraid of colonoscopies, such the at-home stool studies, like a fecal occult test, and now they’re even coming out with blood DAN tests that might pick up on some detection.

With that being said, the diagnostic colonoscopies, however, those are the ones where we’re performing for not routine screening, meaning I have symptoms like those ones I had just mentioned. So if you’re under the age of 45 and you are experiencing these symptoms, it’s really important to talk to your doctor as you may still qualify for a colonoscopy. However, the difference is this is called a diagnostic colonoscopy.

What that means really is based upon billing. A diagnostic colonoscopy is subject to out-of-pocket costs, and this is dependent on the insurance company, your co-pay, what you’ve already determined for out-of-pocket expenses that year. So it does depend on each individual, but these are not routinely covered by insurance at 100%.

KATHLEEN DAVIS: Mhmm. So what advice do you have for patients who are freaked out about this?

JENNIFER FIJOR: Well, there is a decent reason to be aware. I wouldn’t say to freak out quite yet. There are some things that we can do to prevent colon cancer, and that’s mitigate those risk factors. So the best advice I can give to people is remain healthy overall, keep good gut health.

What does that mean, good gut health? I know that’s a buzzword for everybody, but what I tend to mean with that is make good dietary and lifestyle choices, so high fiber diets, rich in fruits, vegetables, whole grains. And a good way to keep that gut bacteria as diverse as possible is by eating the rainbow, making sure, as I mentioned before, to eliminate tobacco, limit alcohol, limit those red meats, high fatty foods, highly processed foods.

And of course, make sure you get adequate sleep. Try to reduce stress. I know that’s tough this day and age.

KATHLEEN DAVIS: [LAUGHS]

JENNIFER FIJOR: But of course, things like that, and then exercise is also important. And the other thing is avoiding unnecessary medications or supplements. Unfortunately, with this, there’s no magic bullet.

But one important other thing to know is your family history. Family history plays a large part in this, and there has been an increase in these genetic cancers. Our genes haven’t changed, but a lot of the stuff that we do or what’s in our environment has been able to turn on those genes. So we’ve been seeing increase in these hereditary GI cancers such as Lynch syndrome, FAP.

Actually, what they determined is those new onset-early colorectal cancers, about 20% or a little less than 20% are due to these genetic variants. So it’s really important to know your family history. And what I mean by that is, family history, first-degree relatives is very important, especially if they’re diagnosed under the age of 50 or if you have multiple first-degree relatives, meaning parents, siblings, offspring. And then based on your family history of cancer, as GI professionals, oftentimes we’re able to determine if further testing is needed, such as genetic testing or what cancers you might be at risk for.

The other thing to know is if your parents or your siblings have colon polyps, especially those advanced colon polyps. The general recommendation is to get a colonoscopy 10 years prior to the onset of their colon polyps, especially if they’re advanced. To be clear, an advanced colon polyp is not a cancerous polyp but one that is precancerous and has a higher risk of turning into colon cancer if left untouched in the colon.

There’s not as much of a known impact with colon polyps as there is with colon cancers, so it is still important to understand the role of genetics. And of course, it’s really complicated.

KATHLEEN DAVIS: You are active on social media @gutgalz with a z on TikTok and on Instagram. Why was it so important for you to get on social media and start spreading awareness about colorectal cancer and gut health?

JENNIFER FIJOR: Well, I realized I am one individual who is only able to see so many people in a day, and this just gave me a broader reach to people. I do it in my free time after work. I don’t get paid for it. It is just a way to reach a wider audience and not only talk about colorectal cancer but talk about other GI diseases, digestive health in general, to help prepare people to be an advocate for themselves.

It’s tough to walk into a doctor’s appointment and try to advocate for yourself, especially when you don’t know the right questions to ask. So this is just kind of a tool that I would hope that people are able to utilize when they go into their doctor’s office. That’s why I want people to have an open conversation if they’re experiencing these symptoms. And again, I mentioned in my video if people are finding that they’re having a hard time talking to their provider, sometimes advocating for yourself is really important, and having these tools of information and knowledge is also really important to utilize that in your self-advocacy.

KATHLEEN DAVIS: That’s all the time that we have for now. I’d like to Thank my guest, Jennifer Fijor, gastroenterology nurse practitioner at Virginia Mason Franciscan Health based in Seattle. Thank you so much for joining me.

JENNIFER FIJOR: Thank you so much. I appreciate it.

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