The answer is we do not know.

Often, lifestyle factors such as an unhealthy diet or lack of exercise is canvassed around as a causative factor. While this is potentially a risk factor for older people getting colorectal cancer, young people have not lived enough to face the consequences of such lifestyle factors. There is also new research showing that colon cancer in young people is distinctly different. They show that they have unique mutations in the cancer and also their gut biome is uniquely different to other young people who don’t have cancer. So there is a lot that we do not know and research is acutely needed in this area so we can address prevention of colon cancer in young people in a more comprehensive, informed way.

In the meantime, we already have the tools necessary to pick up colorectal cancer before it becomes a cancer, at a polyp stage. And that is colonoscopy. At the moment, there’s no clear guidelines to help young people get easy access to colonoscopy as a screening tool. We need to do this. There’s also new research that a simple blood test could pick up cancer DNA and detect colorectal cancer at early stages. In the future, potentially a blood test followed by colonoscopy will be the way to diagnose cancer early. Of all the GI cancers, this is the one preventable cancer because a polyp can be detected and removed by colonoscopy before it had a chance to grow into a cancer. So there’s a lot of work that needs to be done in this space to make policy changes to allow young people to have state of the art screening tests readily available.

Unfortunately, a large number of young people get diagnosed with colon cancer at an advanced stage (stage 4 or metastatic) because of various reasons. We need to look at barriers or road blocks in our healthcare system that allows this to continue.

Stage 4 colon cancer that has spread to other organs, is of course much harder to treat. But harder treatment is possible for younger people because they do not have other illnesses and also because, well … they are young.  Therefore, even if they are diagnosed at a later stage, the potential for cure for young people is much higher than it is for older people. International guidelines need to catch up to reflect this difference. Then we can have informed conversations with patients about what is important to them, what our treatment intent should be, what treatment options are available to get us there and work as a team to get the best possible outcome for any young person with stage 4 colon cancer.