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New measures to tackle alarming rise in gastrointestinal cancers among 25-50 age group

Global phenomenon is ‘a puzzle, not yet figured out’, says consultant oncologist

Deirdre Fleming on the beach at Portmarnock: 'My cancer is just asleep and I’m now on maintenance chemotherapy to keep it that way for as long as we can.' Photograph: Alan Betson

Paul Cullen
Sat Apr 6 2024 - 06:00

A concerning rise in gastrointestinal cancers in the under-50s has prompted the creation of a new programme aimed at pioneering new ways to prevent, detect and treat the disease in this age group.

People affected by cancer aged 25-50 will be the focus of the five-year collaboration between St James’s Hospital, Trinity College Dublin and the Irish Cancer Society.

The programme will provide clinical and non-clinical supports, via a team of professionals with diverse skills, to meet the particular needs of these patients.

Across the western world, there has been a marked increase in many types of internal cancers in people aged under 50, according to Prof Maeve Lowery, a professor of translational cancer medicine at Trinity and consultant medical oncologist at St James’s Hospital.

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In the US, gastric cancers in this age group are up 30 per cent in the past 20 years, she says. For oesophageal cancers, the increase is even more striking, at 50 per cent.

While pooled Irish data is still being prepared, the phenomenon is a global one, she says. “It’s a puzzle, not yet figured out. There are lots of hypotheses but no one fully understands the causes.”

The line-up of usual suspects includes obesity and lack of exercise, lack of dietary fibre, alcohol and smoking, but as Prof Lowery points out, young adults are not old enough to be exposed to these risk factors for long enough. Research is therefore also focusing on environmental factors in childhood, and changes in the gut microbiome.

[ Cancer: How to navigate the mental challenges of a diagnosis ]

Cancer is never an easy diagnosis but for younger adults it can be especially complicated, she says.

“For people in their early 40s, say – with mortgages, car loans, kids in school – there can be strong ripple effects, extending across generations,” she says. “If you’re in your 70s and you get a diagnosis, at least it’s more likely the kids are reared and the mortgage is paid off.”

Patients with new diagnoses also have to reckon with “financial toxicity”, made more difficult as they are likely to be in shock and unfamiliar with navigating the health system.

Along with dealing with the disease, they may have to give urgent consideration to other factors – fertility preservation, sexual health, mental health and the fear of recurrence.

Prof Lowery got the idea for the initiative from a centre for early onset colorectal cancer set up in the renowned Sloane Kettering Cancer Centre in New York, where she worked before returning to Ireland.

As well as offering the clinical infrastructure for treating cancer, the new approach will offer access to other essential services – including social workers, counselling, advice on accessing financial resources, genetic counselling and dietary advice.

Hiring this kind of expertise is not possible at present due to the recruitment freeze in the HSE, which makes the €4.5 million support from the Irish Cancer Society all the more welcome.

A programme manager has been hired, and nurses specialising in survivorship, sexual health and diet will be recruited soon. The idea is to develop the pilot at St James’s into a national model of care at a later stage.

A survivor’s advice to the newly diagnosed: embrace the reality of the situation

When cancer entered Deirdre Fleming’s life, it came early, hard and unexpectedly.

“It came completely out of the blue; no one in my family had had it. I had no pain and only two weeks before my diagnosis, I was playing sport with people half my age.”

There were some symptoms, nonetheless; a change in toilet habits, then a sudden loss of weight, before she was diagnosed with bowel cancer in February 2022.

Having been initially diagnosed by her GP with irritable bowel syndrome, she had changed her doctor and pushed for a referral for a colonoscopy.

Urgent chemotherapy and surgery followed.

“I went into shock. This was not on my radar. I was just 41 and I had thought it was just a gut infection. Then I said, ‘Just give me a plan and I’ll work on it’.”

Since then, she has undergone bowel surgery, intensive chemotherapy, liver surgery and more chemo. Though given the all-clear, she had another recurrence in her liver, requiring more chemo.

In March she became one of the six in 3,000 people who are living with stage IV cancer to get a No Evidence of Disease (NED) update from her latest scans.

“My cancer is just asleep and I’m now on maintenance chemotherapy to keep it that way for as long as we can.”

GPs need to listen to us more and not dismiss the possibility of cancer in younger patients with suspicious symptoms

Cancer patients have a choice on diagnosis, she says. “Either you go down the rabbit-hole of being angry and frustrated, or you try to strike a balance.”

Even younger adults need to be aware of the signs and symptoms of bowel cancer and to push their GP for a colonoscopy referral if they notice persistent changes, she says.

“This isn’t an old person’s disease. It can happen to a person of any age, size, nationality or colour. I think GPs need to listen to us more and not dismiss the possibility of cancer in younger patients with suspicious symptoms.”

Fleming, from Portmarnock in north Co Dublin, had been saving for a house but knows know that she will never qualify for mortgage protection because of her advanced cancer and recurrences. “I’d be fecked if I wasn’t living with the folks.”

Her advice to other people worried about symptoms is to demand a test, find out about entitlements, talk to friends and family and “embrace” the reality of the experience.

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Paul Cullen

Paul Cullen

Paul Cullen is Health Editor of The Irish Times

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