By Adaira Landry, MD MEd, Contributor. A physician who writes about challenges with navigating healthcare.
James Van Der Beek, lead actor in 1990s hit Dawson’s Creek, died on Thursday at age 48 after a multi-year battle with colorectal cancer. His death highlights a growing crisis of young adults being diagnosed with colorectal cancer.
Colorectal cancer is a malignant disease, often arising from slow-growing polyps in the lining of the large intestine or rectum. It primarily affects adults over 45 and is a leading cause of cancer-related deaths worldwide.
Van Der Beek, who died less than 2 1/2 years after being diagnosed with stage 3 colorectal cancer, used his platform to urge screenings from age 45 and warned people to watch for even subtle symptoms.
While diagnostic strategies and treatment regimens evolve, the fundamental problem persists among the general population: inadequate education of risk factors, symptoms and screening timelines.
“Someone born in the 1990s is four times more likely to have rectal cancer than someone born in the 1950s,” says Dr. Shruti Patel, gastrointestinal medical oncologist at Stanford Cancer Institute. It is clear that there is a concerning pattern. There will be 100,000 new cases of colon cancer and 50,000 new cases of rectal cancer this year, according to the American Cancer Society. And while the rate of colon cancer in the United States has decreased overall, due to screening and lifestyle changes, the rate is steadily increasing for adults under age 50. The rate for that group has increased by 3% per year from 2013 to 2022.
“We know certain patterns increase risk, like sedentary behavior and diets high in ultra-processed foods," adds Patel. But she has noticed something curious: many of her young patients are in excellent health otherwise. They eat well, exercise and are focused on their lifestyle.
Patel, like many other clinicians and researchers, suspects that multiple factors contribute to the increase: microbiome, microplastics and environmental exposures.
“We just don’t know yet, partially because there is not enough awareness of this epidemic and because studying complex biologic and environmental shifts is extremely difficult,” she says.
The critical symptoms to look out for are rectal bleeding, changes in bowel habits (such as frequency and size), unexplained anemia, abdominal pain and unintentional weight loss.
We all should “know our normal,” Patel says. Paying attention to your own baseline is critical. “The most overlooked sign is rectal bleeding," she adds. “Many people assume it’s from hemorrhoids.”
After dismissing bowel changes in 2023 as a diet issue, Van Der Beek learned via colonoscopy that he had colorectal cancer, a stark warning for younger adults.
While the goal is not to panic over and exaggerate every symptom, it is important to notice when your body is changing and symptoms are persisting. Symptoms that persist for more than a few weeks or are progressive likely deserve evaluation where you can discuss need for a colonoscopy.
“One of the biggest risk factors people underestimate is family history," says Patel. She and I have both seen patients who deny any family history, but when we start digging, more information comes out: an uncle with stomach issues, a grandparent with an unusual abdominal cancer or a sibling with multiple polyps in their intestines. Other risk factors are inflammatory bowel disease, sedentary lifestyle, smoking, a low fiber diet and high alcohol use.
Adults at average risk are advised to start screening at age 45, lowered from the previous recommendation of age 50 to help detect more cases earlier as rates of early-onset colorectal cancer continue to rise."Anyone with a first-degree relative with colorectal cancer will need to start 10 years before their family member was diagnosed," says Patel. Anyone with symptoms, inflammatory bowel disease, certain hereditary conditions, unexplained anemia should start earlier.
While it would be ideal to start screening all adults even earlier than 45, the healthcare system is not able to handle such a large volume. Colonoscopies are invasive and costly procedures that require time and trained experts for both the scope and the sedation. Because of this bottleneck, clinicians, researchers, and investors are looking for alternative solutions.
“Blood tests and stool-based tests are moving in the right direction, and they are easier to scale, but they are not perfect, especially in early-stage disease," Patel says. There are various testing available. Cologaurd, which tests DNA from stool, and Colosense, which tests RNA from stool, are commonly used alternatives. Van Der Beek spoke about Shield, a blood test, for adults over 45, that detects DNA fragments in the blood that have been altered by the colorectal cancer. However, if any of these non-invasive screening tests return positive, the patient still needs a colonoscopy as a follow-up definitive test.
“Young patients often present with more advanced disease, and in many cases the tumor biology appears more aggressive," says Patel. Like Patel, in my emergency room associated with a local cancer center, I often see patients in their 20s and 30s with Stage 3 or 4 colon cancer.
“Age alone doesn’t determine outcome, but stage and tumor biology does,” says Patel. Stage 1 colorectal cancer is typically cured with surgery alone. Stage 3 typically requires surgery and chemotherapy with a goal to cure. Stage 4 is more complex and often requires multiple additional treatment options, such as immunotherapy and targeted therapy. As the cancer progresses on treatment, doctors like Patel have to make difficult decisions.
“We think about stopping cancer-directed treatment when it is no longer helping control the disease or when the side effects are causing more harm than benefit," says Patel. She’s looking for signals that someone is growing weaker, spending more time in the hospital than at home or if their body is not able to tolerate the treatment (such as extreme nausea or kidney damage).
Clinical trials are a form of research that helps advance the field altogether. All standard chemotherapy today was once part of a clinical trial. When standard treatments are limited or have stopped working, “clinical trials give patients access to new treatments that may be more effective than what is currently available," says Patel. Some patients may benefit directly, while others are able to help answer clinical questions that shape care for future patients.
Listen to your body. Do not ignore new and persistent symptoms. While they may not be caused from cancer, seek expert evaluation from a physician to get the workup you deserve.
Understand your risk factors. Not everyone is average risk for colorectal cancer. Pay attention to your family history, environmental exposures and lifestyle choices that might increase your risk. Discuss with your doctor the need for colonoscopy.
Become an advocate. As this epidemic continues, awareness is key. Share your story with family members and friends. Encourage them to get evaluated and to take symptoms seriously.
