Dr Kimmie Ng, an oncologist at the premier Dana-Farber Cancer Center has dedicated her life to the study of GI cancers and is particularly concerned about the rise in such cancers in people under 50
Dr Kimmie Ng has become a frontline witness to one of the greatest medical mysteries of her generation.
The Boston oncologist has launched the world’s first center dedicated to studying an explosion of cancers in young people.
In the 1990s, doctors began seeing a rise in the number of otherwise healthy people under 50 being stricken with cancer, especially colorectal cancer.
Three decades later, scientists expect that the number of early-onset colon cancer will double by 2030 in what some have labeled an ‘epidemic’.
Dr Ng, who specializes in gastrointestinal cancers, which also include cancers the stomach and pancreas, said the days of cancer being a disease of the elderly was over.
But she said: ‘That is not what we’re seeing in our clinics. Actually, these very, very young people are often very healthy.
‘They’re very active, exercise a lot, follow healthy diets, and they don’t have a history of cancer in their family and they don’t have a background of a genetic syndrome.’
Rates of GI cancers rose most sharply in the youngest age group, followed by the 20-29 year old cohort. There were also more cases of GI cancers among older people, though in that case it is still considered early-onset cancer
This new alarming cohort don’t have cancer in the family, they don’t smoke and they drink less than previous generations.
Dr Ng said: ‘Why are these otherwise healthy young people in the prime of their lives developing cancer and often very advanced stages of cancer?’
Dr Ng said that until doctors know more, patients must be vigilant for alarming symptoms.
The main three signs of the cancer that appear years before a diagnosis are: blood in stool, changes in bowel movements, and stomach pains.
She added that fatigue and unexplained weight loss on top of those signs are highly suggestive.
Junk food, plastic pollution and the overuse of antibiotics are some of the factors theorized to be behind the rise in early onset cancers, but the evidence is inconclusive.
At the Young Onset Colorectal Cancer Center at Dana-Farber Cancer Institute in Boston, Dr Ng is exploring how dozens of factors, including diet, sleep, and drinking habits are playing a role in this increase.
‘Currently, I see patients one day a week and the rest of my time is spent running the [new center], which really focuses on young people under the age of 50 who are diagnosed with colorectal cancer, as well as conducting research on the diet and lifestyle factors that may impact how long a patient lives with colorectal cancer.’
One study found that having been breastfed as an infant was associated with a 23 percent increased risk of colorectal cancer later on, but they’re not certain why.
Dr Ng said this is no reason to stop breastfeeding your baby.
She said: ‘We did see an association between women who reported that they were breastfed as an infant in developing polyps [in their colon], including high risk polyps before they were age 50.
‘And we know that these polyps are the precursor lesion to developing colorectal cancer later on. So that association was seen and does seem pretty consistent across different studies.’
The findings indicated a need for more research into how this association holds up in larger groups over a lifetime.
In her work, she has also discovered that vitamin D levels may play a role in cancer development. Her research showed that higher levels of it in the blood was associated with longer survival in people with CRC cancer, especially in stages three and four.
Hers was the first randomized clinical trial of vitamin D in colorectal cancer.
‘And I think, again, this really is going to be pointing back to some environmental change that’s happened recently that is likely contributing to why this is happening.’
In 2010, there were 306 cases of GI cancers per capita of adults aged 20 to 29. That rose to 485 in 2019, an increase of 58 percent. For people 30 to 39, the number rose 44 percent, from 1,184 cases per capita in 2010 to 1,710 cases per capita in 2019.
Dr Ng is shown. She has pioneered research into the causes of colorectal cancer in young people, establishing the Young Onset Colorectal Cancer Center at Dana-Farber
Dr Ng said: ‘So we know overall the silver lining is that colorectal cancer has been declining in incidence and mortality if you consider people of all ages. And that is largely due to successes of screening programs, better adherence to screening and also improved treatments.
‘But this same benefit and improvement has not been seen in people under the age of 50. And we do think it’s probably an environmental exposure or risk factor or combination of such that is likely leading to the rise of this disease in younger people.’
When she started college, she wanted to focus on complex biochemistry looking at how cells divide and how cancer spreads.
But as she progressed in her training, seeing more patients, she decided she wanted to be on the frontlines.
In addition to seeing patients with a range of GI cancers, she has played a major role in designing clinical trials and research projects that pertain to sequencing cancer genes, testing treatments in young patients, and screening for colorectal and pancreatic cancers.
Dr Ng is helping the wider scientific community overhaul screening methods and recommendations and gets to the bottom of what is driving this alarming rise of aggressive GI cancers in young adults.
Dr Ng has conducted and co-led research probing the potential causes of GI cancers and how they spread rapidly throughout the body, penetrating the blood and the lymph nodes in the most fatal cases.
She said: ‘I think the take-home message is that there is an urgency to doing the research here to understanding what are the risk factors underlying this rise, what are the causes?
‘And if we understood that, then we can identify the young people who are at high risk and target them for earlier screening.’
Colorectal, stomach, and pancreatic cancers are among the most aggressive, especially if the diagnosis is delayed. Screening standards for several types of cancers recommend that adults 45 and up take measures to monitor their risk through colonoscopies and ultrasounds if signs appear.
Those recommendations do not apply to people in their 20s and 30s, though, despite the fact that cancer rates are rising fastest among these age cohorts, leaving them more likely to have a rapidly growing cancer that spreads widely before oncologists detect it.
Dr Ng has advocated for years for the government and doctor groups to lower the age at which screening begins in people under 45.
An analysis published last year of GI cancers in adults under 50 showed that GI cancer rates have grown 15 percent over a decade. In people under 19, that rate ballooned by 109 percent.
GI cancers include those in the stomach, esophagus, colon and rectum, liver, pancreas, anus, gall bladder, and small intestine.
Approximately 150,000 patients are diagnosed newly each year with colorectal cancer. About 18,000 of them are under the age of 50, Dr Ng said.
So it is a small proportion of all colorectal cancer patients right now who are diagnosed at a young age.
Dr Ng broke down the most suggestive signs of GI cancer: ‘So the most common symptom that young patients present with is actually seeing blood in their stool. The second most common is abdominal or pelvic discomfort and a sense of bloating.
‘And other red flag symptoms may include a change in your bowel habits. So new diarrhea, new constipation, a change in the caliber of the stool, including thinner pencil thin stools.’
he has discovered that vitamin D levels may play a role in cancer development. Her research showed that higher levels of it in the blood was associated with longer survival in people with CRC cancer
She added that unintentional weight loss, fatigue, and shortness of breath when physically exerting oneself ‘may indicate that anemia is present. Those are the most common symptoms that often lead to a diagnosis of colorectal cancer.’
Cancer is often thought of as an older person’s disease. Throughout one’s life, cell damage builds up and causes cells to behave differently. Sometimes, they refuse to die off or replicate beyond what is normal, contributing to a buildup of what become cancerous cells.
Thirty-three year old Alyssa Burks was diagnosed with extremely aggressive stomach cancer in 2021. Repeat lab tests and blood panels came back normal, despite her fatigue, unintentional weight loss, trouble swallowing, and severe heartburn.
The above graph shows colon cancer cases among under 50s by year. There is a drop in 2020 because the Covid pandemic led to fewer people coming forward for screenings
It wasn’t until 2023 that she underwent a colonoscopy, which uncovered a cancerous polyp. It set off a domino effect of doctors appointments, rounds of chemo, surgery to remove her stomach where the cancer had spread, and surgical removal of her reproductive organs.
After the surgery to remove her ovaries at 33, her doctor told her that her cancer was ‘very angry’: ‘It expanded throughout my stomach and climbed further into my esophagus. It was detected in 27 lymph nodes, which indicated it metastasized to other parts of my body. I wasn’t cancer-free at all—instead, I was dealing with an extremely aggressive form.’
Most recent testing showed that the cancer was still in her body, doctors just could not determine where. It’s a symptom of gaps in the medical community’s knowledge of how and why cancers spread so ferociously in people under 50.
She said: ‘Currently, I’m in this strange position where I know I still have cancer, but it’s not being treated. It feels weird to just leave it alone.
‘I’m going to get a full-body scan to see where it might have spread in my body, but imaging tests aren’t great at picking up my type of cancer. Still, I’m hoping it will give me some answers so that I can press my team for other treatment before it gets worse.’
Cases of colorectal cancers in young people are expected to double by 2030. And while obesity – which affects 42 percent of Americans – is a driving factor of CRC and other cancers, it cannot be the sole explanation.
Dr Andrea Cercek, an oncologist at Memorial Sloan Kettering Cancer Center, said: ‘The rise in obesity alone does not explain the growth of GI cancers in younger people.
‘We are also looking at other possible factors, including toxins we may be ingesting in our food, like hormones, or changes caused by antibiotics to the microbiome in our bodies, which are bacteria and other microbes that help us digest our food. All of these and more are being investigated.’
Scientists have recently begun to focus on forever chemicals, including microplastics, which have penetrated the bodies of 97 percent of Americans, as a driving force.
The chemicals devised by home goods giant 3M in the 1940s are extremely persistent in the environment and the human body, taking months or even years to break down.
Studies have suggested that these chemicals can cause widespread inflammation in bodily tissues, high blood pressure, hormone interference, thyroid disease, high cholesterol, and a weakened immune system, all of which raise the risk of developing a wide array of cancers beyond just gastrointestinal, including ovarian, kidney, breast, and testicular cancers.
Cancers that have spread beyond organs in the GI tract are far more likely to be fatal. People who have stomach cancer are about 36 percent more likely than a healthy person to survive longer than five years.
Late stage colon cancer has a five-year survival rate of about 13 percent, and that of rectum cancer is 18 percent.
Pancreatic cancer than has spread, meanwhile, has a surival rate of about 15 percent.
Dr Ng said, though, that, thanks in part to her pioneering research, the future in medical advancements looks bright: ‘The hope in science is limitless and it has resulted in discoveries that have changed the way patients are treated and that has more than doubled the survival of patients with colorectal cancer.
‘There are advances being made everyday. The longer you are around, and thriving on treatment, the more new advances will be made.’
