Until September, Michael Washer had seemed fit and healthy.
Just this year, the 27-year-old software engineer had run two half marathons, travelled to four countries, started planning a wedding and built a life on Queensland’s Sunshine Coast.
So when he met with his GP complaining of abdominal pain, he didn’t expect to receive a devastating diagnosis.
Initially, he thought he might have ulcerative colitis like his sister, but a slew of tests confirmed the news nobody wants to hear: Michael has stage four colorectal cancer.
Michael Washer and his fiancée Aliesha McKillop. Source: SBS News / Terry Royan
“When you receive a diagnosis that’s terminal, my mind went a lot of different places,” he says.
“In the end, it’s everyone else that’s affected post-death … and so that makes me very, very sad.”
It’s a reality his fiancée Aliesha, 26, has also been grappling with.
“There [were] no words originally. I almost thought it was a joke and I’m still almost in a place where I’m waiting to wake up from this bad dream,” she says.
I wouldn’t say I have made peace with it yet. I don’t know if I will fully.
Young people increasingly at risk
Bowel cancer, also known as colorectal cancer, has long been thought of as a disease affecting older people. But stories like Michael’s are becoming more commonplace.
at the Union for International Cancer Control (UICC) congress in Geneva earlier this year found that rates of bowel cancer in young adults had increased in half of the 50 countries studied, including Australia.
This is despite colorectal cancer rates decreasing among older Australians.
An analysis of Australian Institute of Health and Welfare data by Bowel Cancer Australia found there’s been a 266 per cent increase in bowel cancer incidence rates among people aged 15 to 24 over the past three decades.
1,708 people aged under 50 are diagnosed with bowel cancer in Australia each year according to Bowel Cancer Australia. Source: SBS News
One in nine new diagnoses are among people under the age of 50, the analysis shows. Of those early-onset cases, around a third of deaths occur in people aged under 40.
Professor Jeff Dunn AO, who this year completed his tenure as president of the UICC, says the findings are “alarming”.
“Why is it going up? It certainly is a call to action about research and surveillance,” he says.
While the exact drivers are unclear, Dunn explains the increase in early-onset bowel cancer is most likely multifactorial, encompassing behavioural, environmental and genetic factors.
This includes things like sedentary lifestyles, alcohol consumption and sodium and red meat consumption. Environmental carcinogens may also play a role.
A of 3,000 studies found evidence linking exposure to microplastics to colon cancer, among other conditions.
Genetics is the most reliable indicator at present, with around 30 per cent of diagnoses occurring in people with a family history of colorectal cancer or polyps.
“We need to try and understand why this is happening so we can better focus on what we need to do to reverse the trend,” Dunn says.
Late diagnoses
Another challenge disproportionately affecting young people with bowel cancer is that the disease often goes undetected until it’s in its late stages.
Experts say there are a number of reasons for this.
Currently, the National Bowel Cancer screening program only sends testing kits to people aged 50 to 74. This year the program was amended to allow people aged 45 and over to opt in, but of those who received a kit, only around 40 per cent returned it.
Colorectal surgeon Dr Penelope De Lacavalerie works on Sydney’s northern beaches and is a spokesperson for Bowel Cancer Australia. She says she has personally witnessed the rise in young people presenting with colorectal cancer.
As a colorectal surgeon, and this is a personal view, I would love to see people having a colonoscopy much earlier than 45.
“It’s not uncommon for, within my community … to think that people should have their first colonoscopy at 40 or even 35, mainly because we’re seeing that people are getting diagnosed much younger than before.”
When young people do present to their GP, research shows there are . People may spend between three months and five years seeing multiple doctors before receiving a bowel cancer diagnosis — sometimes making 10 or more visits to the GP.
Associate professor Joel Rhee from the Royal Australian College of General Practitioners acknowledges there are particular diagnostic challenges for GPs.
“I think one of the issues here is that many of the symptoms of bowel cancer are also present in much, much, much more common conditions that affect a lot of people,” Rhee says.
Patients with concerning symptoms or people who are at risk should be further investigated with colonoscopy.
In Michael’s case, his GP took his concerns seriously, ordering a wide array of tests that ultimately led to his diagnosis. But he doesn’t believe every GP would have done so.
“I’ve had a GP approach me and say, ‘I wouldn’t have asked for these tests,'” Michael says.
Bowel cancer symptoms to look out for
The diagnostic challenges facing young Australians underline the importance of patient self-advocacy, both in seeking a diagnosis and treatment.
De Lacavalerie says any first-degree relatives of someone who has been diagnosed with bowel cancer or polyps should get a colonoscopy 10 years before the age their relative was when they received that diagnosis.
Inflammatory bowel diseases such as Crohn’s and ulcerative colitis can also signal an increased risk.
Signs and symptoms that could indicate bowel cancer. Source: SBS News
Symptoms to look out for include blood in stools, obvious changes to bowel movements, unexplained weight loss, extreme tiredness or an abdominal lump or swelling. De Lacavalerie says anyone who notices these changes should ask their GP for a colonoscopy.
“It’s not about scaring people, it’s about making people aware that we rationalise our symptoms so much that we tend to ignore them,” she says.
“If we detect bowel cancer early, we can actually completely treat you and completely cure you in 90 per cent of cases. The problem is that the more it gets delayed, the later stages they become.”
Michael says that throughout his treatment journey, the importance of self-advocacy has been “astronomical”, even if it’s also been “very, very, very hard”.
“The doctors have the best intentions at heart, but you definitely have to fight for yourself … because so many doctors disagree with each other about everything from chemo to staging to which studies to use the statistics from.”
Michael Washer has chosen an intensive chemotherapy regime to fight his bowel cancer. Source: SBS News / Terry Royan
Since starting chemotherapy, he’s changed oncologists and done copious amounts of research.
“I’m on a different chemo regime now because of self-advocacy because I would much rather fight it till the end than not deal with the side effects,” he says.
From the studies that I’ve been reading, I have maybe a 15 per cent chance of making it past here, so it’s bleak, but I’m being optimistic.
Michael and Aliesha are starting to settle into a new routine, which in his weeks off from chemo includes morning walks along their local beach and breakfast by the pool to keep their stress levels down.
With help from Michael’s oncologist, the pair hope to find enough time for a trip to Japan after their wedding in April.
“We’ve taken a big break from planning, but we’ve given everyone the save the date,” Michael says.
“We’ll probably focus on trying to organise that.”
