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Are we failing young people with cancer?

Are we failing young people with cancer?

By James Gallagher and Philippa Roxby
Health correspondents

12 hours ago

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Deborah James paid to have a private exam before bowel cancer was diagnosed

When you think of cancer, a glamorous mom in her thirties isn’t the first image that comes to mind.

But Dame Deborah James, podcaster of You, Me and Big C, was just 35 when she found out she had bowel cancer. Blood and stool tests had come back normal and her GP had laughed “not once, but three times in six months” at the thought that she might have a tumor in her intestines. The diagnosis only came when she paid to have her colon examined privately.

His experience has raised questions about our ability to detect and treat cancer in people under 40. Simply put, are we failing young people with cancer?

There’s a big challenge here – cancer is rare when you’re a child or young adult.

Cancers in toddlers do happen, but they’re incredibly rare. The risk increases with each birthday, then increases rapidly after age 55.

Are we failing young people with cancer?

The longer we live, the more time our body’s cells have to accumulate the mutations that turn healthy cells into cancers. At the same time, our immune system, which also mop up cancer cells, becomes less efficient.

So overall, around 4.3% of cancers diagnosed in the UK are in people under 40, while people over 75 account for more than a third of all cancer cases.

This represents a challenge for us and the doctors who care for us.

When we are young, we are less likely to attribute poor health to cancer. Changes in our bowel movements could just be stress, blood in the toilet after pooping could be inflammatory bowel disease or hemorrhoids. Because, for most people, cancer is something that happened to our parents or grandparents.

Are we failing young people with cancer?source of images, Charlotte Maden

Charlotte Maden has had surgery for bowel cancer and is waiting to find out if she needs chemotherapy

Charlotte Maden, 38, from Lancashire, was shocked when she was diagnosed with bowel cancer in February.

“I never thought bowel cancer would be a problem for me – I’m young, healthy, not overweight, I don’t smoke, I don’t drink a lot – I’m a really fit person “, she says.

Charlotte says her friends “think they are invincible and this will never happen to them”.

Your doctor should be alert to the main warning signs of cancer, but there is a medical saying: “When you hear hooves, think of horses, not zebras.” It’s a call to look for the most common or likely explanation, and the younger you are, the less likely cancer is to be behind your symptoms. This helps channel limited health service resources to those who need them most.

But that means some younger people aren’t seen quickly enough, although the problem can affect older people too. Bowel Cancer UK’s Never Too Young report in 2020 found that four in 10 people surveyed needed to see their GP three or more times before being referred for further tests to see if they had cancer.

“I don’t think GPs are a problem,” says Genevieve Edwards, chief executive of Bowel Cancer UK. ” This [bowel cancer] is rare in young people. It will usually be something else. »

The question is – what if you were the zebra, that relatively rare case that got cancer at a young age?

Charlotte, who has two children aged five and seven, credits her GP with being “very thorough” when she noticed blood in her stool on a few occasions. She was diagnosed after two colonoscopies and underwent surgery less than three weeks later.

“If the doctor had said it was probably just piles, I might not have come back. I probably owe him a lot really. »

One of the most important things is to diagnose cancer at an early stage. The earlier tumors are detected, the easier they are to treat.

Data from Cancer Research UK shows that, overall, cancers in young people are detected earlier than in older people.

His analysis for the BBC shows that 74% of cancers are diagnosed at stage one or stage two in people under 40 in England. This figure drops to 46% among people over the age of 40.

This also affects the survival figures. If you look at the five-year survival figures for almost all cancers, 15 to 40 year olds have the highest survival rates and the odds decrease with age.

Only 1% of cancer deaths – about 2,200 a year – are in people under 40.

Are we failing young people with cancer?

There are notable exceptions to this pattern. Cancer Research UK says survival rates improve in breast and bowel cancer once people reach screening age and apparently healthy people are examined to see if they have a tumor that develops in their body.

For example, bowel cancer is more likely to be found at stage 4 in people not screened (one in four cases under 50) than in those eligible for screening (one in five more 50 years old).

But everyone agrees that you can’t screen everyone and it should be focused on those most likely to benefit. Testing is not 100% accurate, costs money, and can lead to harm and unnecessary treatment when many healthy people are tested.

Screening ages:

Are we disappointing everyone?

There is clearly room for improved diagnosis and treatment of cancer for people, young and old.

The International Cancer Benchmarking Partnership has the difficult challenge of comparing cancer statistics between different countries. It compared seven cancers in seven similar countries – Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK.

The UK is bottom for survival in five of the cancers, analysis in the Lancet Oncology has shown.

Finding cancers is a problem. Before the pandemic, around a fifth of cancers in England were only diagnosed when someone got so sick they ended up in an accident and emergency. It could be bowel cancer that grows so large that it blocks the intestines, causing a medical emergency. It’s no surprise, but the cancers discovered under these circumstances are mostly (about three-quarters) late-stage tumors that are harder to treat, meaning survival is less likely.

The pandemic has made matters worse, with people not getting checked and health services under intense pressure. GPs in England made more than a quarter of a million urgent cancer referrals in March – the highest figure since records began in October 2009. Cancer charities fear queues for tests and procedures that help diagnose cancers take longer than ever. This creates pressure and delays, and deters people from seeking medical help.

In an ideal world, according to Cancer Research UK, people should wait no longer than 28 days after being referred by their GP to find out if they have cancer – and start treatment within a month of diagnosis.

But to achieve these waiting time targets, the charity says GPs need good, rapid access to tests: “This will support and encourage [GPs] to refer patients as soon as possible,” says Executive Director Michelle Mitchell.

And to improve early diagnosis, she wants the government to ensure “the NHS has the manpower and equipment it desperately needs”.

Cancer charity Trekstock says it should be more important to help young adults live well during treatment and enjoy life after it has finished. It means connecting people, giving them useful information and helping them to thrive, says Jemima Reynolds, program manager.

Are we failing young people with cancer?source of images, Getty Images

A tiny capsule containing a camera transmits images from inside patients

What are the solutions ?

New tests could help speed up the diagnostic process.

For bowel cancer, a FIT (fecal immunochemical test) — which looks for hidden blood in poo — can be done at home and used by your doctor to determine if further tests are needed.

If there is bleeding, you will be offered a colonoscopy to find out the cause – when a tube with a camera on the end is placed in your back passage to look inside your large intestine.

A new, less invasive alternative is being used by some hospitals in England and Scotland. A capsule endoscopy of the colon involves a tiny camera the size of a pill swallowed by the patient. It then takes thousands of images as it travels through the gut, allowing doctors to find the cause of symptoms.

The NHS is also running a trial of a new blood test that looks for fragments of cancer cell genetic material to see if it can help diagnose 50 types of cancer at an earlier stage. But it is not yet known whether the test can help save lives.

Some say greater awareness of cancer symptoms is needed – but knowing the symptoms of each cancer is also a challenge.

“General awareness is incredibly difficult and very expensive,” says Genevieve Edwards, from Bowel Cancer UK. “Just know your body and trust your instincts, and if something is wrong go see your GP. »

Related Internet Links

  • Cancer research in the UK

  • Bowel cancer – Bowel cancer France

  • Trekstock

  • NHS Screening – NHS

The BBC is not responsible for the content of external sites.

Related Topics

  • Cancer screening
  • bowel cancer
  • NHS
  • Cancer

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