Why More and More Young People in Singapore are Being Diagnosed with Colon Cancer

Is Colon Cancer an “Old Person’s Disease”?

The recent cancer diagnosis of Catherine, the 42-year-old Princess of Wales, has highlighted the alarming global increase in certain cancers among those below the age of 50. Not only is the news a stark reminder that cancer can strike anyone regardless of age, but this phenomenon of young-onset cancer is also prevalent in Singapore. Although many types of cancer are common in Singapore, this blog article will focus solely on colon cancer, the second leading cause of death in both men and women locally.

Contrary to popular belief, colon cancer is certainly not an “old person’s disease”. In fact, gastrointestinal specialists have noticed a worrying rising trend in the number of young people, particularly millennials, being diagnosed with colon cancer in Singapore. This shift has turned colon cancer into a significant medical concern that requires immediate attention and action. The alarming increase poses serious societal implications, including elevated healthcare costs, increased emotional and financial burdens on families, and a potential decrease in workforce productivity.

Locally, we notice the problematic trend of young Singaporeans going under the radar for colon cancer screening since they have not met the age recommendation. Although the Ministry of Health Singapore (MOH) recommends routine screening for colon cancer for those from age 50 onwards, that is merely a general guideline that does not factor in other individual risk factors. This blog article will feature a more nuanced screening guideline for colon cancer.

What is Colon Cancer?

Colon cancer, which is also called bowel cancer or colorectal cancer, begins as a polyp on the inner lining of the large intestine or rectum. While the polyps start as noncancerous (benign) growths of cells, they can grow out of control and develop into colon cancer if left untreated.

Has There Been a Higher Incidence of Colon Cancer Among Young People in Singapore Lately?

According to the Singapore Cancer Society, the incidence of cancer (including colon cancer) among individuals under 50 rose by 10.4%, from 11,416 cases in the period between 2008 and 2012 to 12,600 cases in the period between 2017 and 2021. In particular, more and more millennials, those who are aged 28 to 43 in 2024, are being diagnosed with cancer. This staggering increase has prompted gastrointestinal experts to investigate the underlying causes behind the rising cases of young-onset colon cancer. At the moment, it is not fully known what has been driving this upward trend, as more conclusive research findings are yet to be found. However, we do understand the causes of colon cancer, as the research behind this is well-established.

What are the Causes of Colon Cancer?

The development of colon cancer can be attributed to a multitude of factors spanning lifestyle, environment and genetic predisposition. These changes cause cells to overproduce uncontrollably. When cells in the colon grow and divide without regulation, polyps can form, which might become cancerous if not removed.

Lifestyle Factors Contributing to Colon Cancer

Unhealthy Diets

One of the primary lifestyle factors that makes people more prone to getting colon cancer is an unhealthy diet. The modern diet, particularly in urban areas like Singapore, often includes a high intake of foods with the following nutritional properties:

• High Fat and Low Fibre: Diets rich in fat and limited in fibre, namely fast food, can lead to constipation and other gastrointestinal issues. This is because fatty foods take longer to digest than other types of foods, resulting in slower bowel movements and potentially constipation. In a similar vein, inadequate consumption of vegetables can contribute to harder, more difficult-to-pass stools due to the lack of dietary fibre. Therefore, such diets may lead to prolonged contact of carcinogens with the colon lining, increasing the risk of cancer.
• High Sugar: Sugary foods can lead to obesity, which is a known risk factor for many cancers, including colorectal cancer.
• Preservatives and Additives: Processed foods, such as bread, cheese, and canned vegetables, may contain preservatives and additives with carcinogenic properties. 

Sedentary Lifestyles

Another significant lifestyle risk factor for colon cancer is inadequate physical exercise. Many young people in Singapore spend a substantial amount of time sitting, whether at work, school, or home, often engaging in screen-based activities like watching TV, playing video games, or using computers and smartphones. Lack of exercise can lead to obesity, which is associated with a higher risk of colon cancer. Physical activity is beneficial for regulating hormone levels and enhancing immune function, both of which can reduce cancer risk.

Obesity and Metabolic Conditions

Unwholesome diets coupled with insufficient physical exercise typically lead to obesity, an important risk factor for colon cancer. Excess body weight, particularly around the abdomen, can promote cancer cell growth due to the following reasons:

• Insulin Resistance: Obesity often leads to insulin resistance, where the body's cells do not respond well to insulin. This condition can cause higher levels of insulin and glucose in the blood, creating an environment that encourages cancer growth.
• Chronic Inflammation: Obesity is associated with chronic inflammation, which can cause DNA damage and promote the development of cancer cells.

Stress

Additionally, a stressful lifestyle can contribute to the development of colon cancer. While the exact mechanisms are not entirely clear, chronic stress is believed to impact cancer risk through several pathways:

• Immune Suppression: Chronic stress can weaken the immune system, reducing its efficacy in detecting and destroying cancer cells.
• Hormonal Changes: Stress may lead to hormonal imbalances that promote the growth of cancer cells.

Environmental Factors Contributing to Colon Cancer

Carcinogens present in polluted air and food can initiate mutations that lead to cancer development. 

• Air Pollution: Emerging research suggests a positive association between prolonged exposure to certain air pollutants and suffering from colon cancer. While Singapore generally maintains good air quality, periods of haze can significantly increase pollution levels and pose health risks to the colon. 
• Industrial Chemicals: Certain chemicals used in food manufacturing and agriculture, such as pesticides and herbicides, have been linked to a heightened risk of colorectal cancer.

Hereditary Factors Contributing to Colon Cancer

Genetics play a paramount role in the risk of developing colon cancer. People with a family history of colorectal cancer are at a higher risk. Specific hereditary conditions, such as Lynch syndrome and familial adenomatous polyposis (FAP), significantly raise the likelihood of having colorectal cancer at a younger age.

• Lynch Syndrome: This genetic condition, also called hereditary nonpolyposis colorectal cancer (HNPCC), increases the risk of colorectal cancer and other cancers. People with Lynch syndrome often develop cancer at a younger age.
• Familial Adenomatous Polyposis (FAP): FAP is a condition that causes hundreds to thousands of polyps to form in the colon and rectum. If left untreated, these polyps are likely to become cancerous.

How Does Colon Cancer Screening Work?

Colorectal cancer screening is a critical tool in the early detection and prevention of cancer, and the process is as follows:

1. Undergo Preliminary Testing

At-risk groups, especially people 50 and older, are typically encouraged to do yearly screenings by collecting stool samples. They can opt for either a Guaiac Faecal Occult Blood Test (gFOBT) or a Faecal Immunochemical Test (FIT), which are both preliminary tests that can detect gastrointestinal abnormalities.

2. Schedule an Appointment with a Colorectal Surgeon in Singapore

Patients with positive stool test results will typically be referred to a colorectal specialist who will conduct further testing to confirm the preliminary results. Colorectal specialists are medical doctors who specialise in the diagnosis and surgical treatment of gastrointestinal disorders. Depending on your medical history and the extent of the positive FOBT result, your colorectal specialist may recommend that you go through a more sensitive test, namely a colonoscopy.

3. Follow Pre-colonoscopy Procedures, Relax During the Colonoscopy, and Follow Post-Colonoscopy Guidelines

In order to prepare for your colonoscopy, you have to adhere to some pre-colonoscopy procedures for a successful and stress-free colonoscopy.

During a colonoscopy, a long, flexible and thin tube with a miniature camera and attached light (colonoscope) is inserted into the rectum to examine the colon for polyps or cancerous growths. The minimally invasive procedure typically takes less than 15 minutes and is often performed with mild sedation to reduce discomfort.

After the colonoscopy, you need to rest for about an hour to recover from the sedative used during the procedure. Our experienced staff from Alpine Surgical Practice will monitor you to ensure that you are waking up safely and not experiencing any immediate complications.

What are the Benefits of Screening for Colon Cancer in Singapore?

As pre-cancerous polyps and early-stage colon cancer tend to be asymptomatic, at-risk groups have to attend routine screenings even if they are feeling perfectly fine. Detecting abnormalities early usually leads to an improved prognosis as preventive action like removing polyps can be done.

• Early Detection: Identifying cancer early allows for less invasive treatments and a stronger likelihood of speedy recovery.
• Polyp Removal: Removing polyps or other growths during a colonoscopy can prevent them from turning into cancer.

Why Do Young People Delay Colorectal Screening?

Despite the clear benefits, young people may avoid screenings due to various barriers:

• Anxiety about Colonoscopy: Some may repeatedly delay attending their colonoscopy appointments due to worries that the process is painful. Rest assured, you will be sedated to minimise discomfort, and most patients report that the procedure was pain-free.
• Misinterpretation of Symptoms: Symptoms such as changes in bowel habits or abdominal discomfort are often attributed to less serious conditions, such as irritable bowel syndrome, leading to delays in seeking medical advice.
• Lack of Awareness: Some young adults are unaware of the importance of colorectal cancer screening and the availability of procedures like colonoscopy.

Should Young People Undergo Colonoscopies?

Colon cancer may affect younger individuals as well as older people. Despite the majority of colon cancer patients falling within the 55 to 65 age range, a significant number of cases seen by doctors today involve young adults. A 2022 study from the Hematology/Oncology Clinics of North America even projects that by 2030, roughly 15% of colon cancer cases will be diagnosed in younger adults.

Moreover, younger patients often face delayed diagnosis compared to older individuals because colorectal cancer is commonly perceived as rare in this age group. By the time most younger patients are accurately diagnosed, many are already in the advanced stages (stage 3 or 4) of cancer.

While colonoscopy is typically recommended for average-risk patients from age 50 onwards, Alpine Surgical Practice  advises scheduling one if you have:

• A first-degree relative with colon cancer or polyps.
• Two relatives with colon cancer or polyps, regardless of degree.
• A personal history of inflammatory bowel disease, namely Crohn's disease or ulcerative colitis.
• A personal history of colon polyps.

According to the American Cancer Society, as many as 33 % of patients who develop colorectal cancer have family members who have also suffered from the illness.

Summary

Old age is but one of the many risk factors for the development of colon cancer. That is, those below age 50 can still be prone to cancer, especially if they have other risk factors, like a family history of colon cancer. Therefore, colon cancer is certainly not an "old person's disease".

The rising rates of colon cancer among young people in Singapore highlight the urgent need for increased awareness and proactive health management. Annual screenings, such as those available at Alpine Surgical Practice, can play a crucial role in early detection and prevention, potentially saving lives. It is advisable for individuals to maintain a healthy lifestyle and undergo regular screenings to optimise colon health.

Visit Alpine Surgical Practice 

In order to book a colonoscopy screening or specialist consultation with Dr Aaron Poh, Alpine Surgical Practice’s Consultant General Surgeon and Medical Director, please get in touch with us. Dr Poh is an experienced general surgeon with a subspeciality in colorectal surgery. He has conducted numerous colonoscopies, enabling patients to gain clarity about their condition and effectively treating them.

At Alpine Surgical Practice, our specialist clinic in Singapore provides a colonoscopy screening package with the following components:

• Pre-screening Consultation
• Colonoscopy including Polypectomy & Histology
• Post-screening Clinical Evaluation
• Specialist Report & Recommendation

Take charge of your colorectal health by scheduling a screening today.

References

1. Pooja Dharwadkar, Zaki TA, Murphy CC. Colorectal Cancer in Younger Adults. Hematology/Oncology Clinics of North America. 2022;36(3):449-470. doi:https://doi.org/10.1016/j.hoc.2022.02.005

‌2. Colorectal Cancer Risk Factors | Hereditary Colorectal Risk Factors. www.cancer.org. https://www.cancer.org/cancer/types/colon-rectal-cancer/causes-risks-prevention/risk-factors.html#:~:text=Most%20colorectal%20cancers%20are%20found