It used to be called an ‘old person’s disease’. So how DID a super-fit 37-year-old like me who always avoided ultra-processed foods still develop stage 4 bowel cancer?

Rachael Wakely was in the middle of another punishing – but exhilarating – session at her local F45 gym when she noticed an unusual swelling in her stomach.

A 37-year-old married mother of two children, Rachael always put her health first – eating well, avoiding ultra-processed foods and working out several times a week.

Crucially, she knew to listen to her body – a lesson people learn when they routinely test their limits with exercise – and knew instinctively when something wasn’t right.

The uncomfortable bloating she had been experiencing for several weeks was out of tune with the usual rhythm of her body and immediately rang alarm bells.

Today, she is glad she trusted her gut. 

Three weeks after first seeing her GP, Rachael was being rushed in for surgery and chemotherapy. To Rachael’s horror and utter disbelief, doctors had found two large tumours in her bowel and liver – cancers rarely seen in under-50s and particularly uncommon among fit and otherwise healthy 30-somethings.

Her story adds to the worrying catalogue of cases of young people being diagnosed with bowel cancer.

One in nine bowel cancer cases occur in people under the age of 50 in Australia, with those aged between 40 and 49 accounting for 56 per cent of new cases and 64 per cent of deaths in the under-50s category.

It is an ‘epidemic’ that has left researchers baffled and led to speculation the surge could be caused by ultra-processed junk foods, childhood infection, antibiotics, lack of fibre, or even fungus.

Rachael Wakely (pictured with her husband, correctional officer Win Wakely, before her diagnosis) was diagnosed with bowel cancer in June 2023

Rachael (pictured at her gym with a chemo drip in her bumbag) went to her GP after noticing unusual bloating in her abdomen and was sent for bowel cancer tests, despite only being 37

Rachael’s bowel cancer was stage 4; there was no time to waste, and she began treatment straight away.

‘They found two tumours. The primary one was in my bowel and then a tumour spread to my liver as well,’ she told Daily Mail Australia.

‘They were so big they couldn’t properly measure them. I laugh now, but at the time it was so, so scary.

‘It didn’t feel real. I was thinking, “This doesn’t happen to people in real life. It just happens to random people on the internet”.’

While the alarming rise of young adults with bowel cancer is rarely out of the headlines, as a millennial with the disease, Rachael felt quite isolated. 

While undergoing treatment at her cancer centre, she noticed she was the youngest person there by at least 10 to 15 years.

So far, the surgery and chemotherapy has worked; the tumours have drastically reduced in size since they were detected 15 months ago. 

Australia lowered the screening age for bowel cancer from 50 to 45 in October 2023 in response to a surge of cases in under-50s.

Bowel Cancer Australia CEO Julien Wiggins praised the move but said the starting age for the National Bowel Cancer Screening Program (NBCSP), which locates polyps in the bowel that are or could become cancerous, should be even lower.

‘We are now calling on the Federal Government to approve, fund and implement a lower NBCSP screening start age to stop people dying from early onset bowel cancer.

‘Youthfulness should not be a barrier to a timely diagnosis.’

Rachael (pictured during treatment) always considered bowel cancer an ‘old person’s disease’

Pictured: Rachel’s tumours when she was first diagnosed, right, and after 11 months of treatment, left

Research from the organisation found bowel cancer patients between 25 and 44 years old spent between three months and five years going to doctors before receiving their diagnosis.

They visited GPs 10 or more times and considered their age a bias factor that prevented a quicker diagnosis.

Having her cancer detected early – because her GP noticed the significance of her unexplained bloating – made Rachael one of the lucky ones. 

The prolonged time to diagnosis presents a serious risk for bowel cancer patients as almost 99 per cent of cases can be successfully treated – if detected early. 

Dr Klay Lamprell, a Chief Investigator at Macquarie University’s Australian Institute of Health Innovation, last year found ‘young people with bowel cancer say the same the world over – because they are young, they are overlooked’.

‘Even when younger people experience blood in their poo or rectal bleeding, GPs may not immediately refer them to specialists for further testing,’ Dr Lamprell said.

‘Patients perceive their GPs’ low suspicion of cancer as an age bias that shapes the nature of clinical assessments, influences the investigations conducted and referrals given, and creates tensions which obstruct shared decision-making.

‘Young people seeking diagnosis are also challenged by limited clinical awareness of early onset bowel cancer.

‘Our research concludes that with the rising global incidence of bowel cancer in people aged under 50, there is a mounting imperative for GPs to receive more information and clinical guidance on early-onset bowel cancer diagnosis.’

Fortunately for Rachel, her GP thoroughly listened to her concerns and sent her for diagnostic tests the day after she reported her bloating.

She vows her children – five-year-old Kaiwin and three-year-old Evelyn – will never go to another doctor.

Rachael began chemotherapy for her bowel cancer on July 17, 2023, and has managed to stay on top of her health – both mental and physical – by going to her local gym seven times a week.

She has also been supported by her dedicated husband, Win Wakely, who’s managed to keep their family afloat while working as a correctional officer. 

She was a fitness fanatic and attended high-intensity interval training (HIIT) classes at F45 alongside her twin sister for years before her cancer diagnosis.

Rather than focusing on rest, Rachael believes the best way she can help the chemo do its job is by continuing her rigorous health routine.

On some occasions, she has even loaded her chemo drip into a bumbag to bring to her workouts.

‘For me, it’s a mental thing that if I don’t go, I’m not doing my part to get better,’ she said.

‘My sister and I go to the gym with this incredible group of supportive people. They all wear special shirts to the gym for me and we do a little photo shoot every other Monday.

‘I do high-intensity workouts – deadlifts, burpees, box jumps and pretty much whatever else.

‘I had that routine before cancer. I’m lucky I’ve not been too sick to keep it up.’

Rachael (pictured with her husband during treatment) believes it is vital for all Australians, not just those over 45 years old, to know and monitor the symptoms of bowel cancer

Rachael (pictured during treatment) began chemotherapy at Wollongong hospital in mid-2023

Rachael’s story isn’t uncommon among young bowel cancer patients, many of whom are health-focused and would never expect to be stricken by an ‘old person disease’.

So why are so many young people being diagnosed with a cancer that used to be vanishingly rare in their demographic?

Some experts blame the increased amount of ultra-processed foods being eaten every day – often without people even realising.

Stephanie Wood, a nutritionist for Bowel Cancer Australia, explained that while the consumption of ultra-processed foods has been called a modifiable risk factor associated with the cancer, more research needs to be done to firm up the theory.

‘There needs to be more research; it just hasn’t been done,’ she said.

‘I think we all tend to eat more processed food than we should – most of the time it comes down to convenience and saving time.

‘However, we all know we should be eating five to seven serves of fruit and veggies a day and most Australians aren’t doing that.’

As for what Australians should be eating, Ms Wood placed heavy emphasis on the benefits of natural grains and fibres.

‘Dietary fibre is critical. We need to be making sure we’re getting adequate amounts every day – on average 30 grams for men and 25 grams for women,’ she said.

‘That amount can be across the whole day in many different forms – Fruits, vegetables, brown rice, quinoa, oats.

‘The bulk that food adds to the bowel is important as a structural component.

‘Wholegrains are also incredibly important because they contain fibre that do several things for our health, including fermenting in our gut to create short-term fatty acids with the ability to modulate our immune system.’

Ms Wood encouraged Aussies to steer away from processed foods, particularly soft drinks, as much as possible to help maintain overall better health.

‘Essentially, you should be label to look at the labels of your foods and recognise more of the ingredients than chemicals,’ she said.

‘There’s no real food in there and sometimes these foods filled with chemicals can upset the microbiome of the gut.’

Rachael (pictured in March 2023) urged young Australians to be confident when pushing their GPs to find the cause of their health issues

Rachael’s workout buddies wear special shirts (pictured) to encourage her fight against cancer

Ms Wood also warns against the overconsumption of alcohol and red meat, particularly when cooked quickly and blackened.

‘The heme iron component in red meat is something that has been researched as a link to bowel cancer. Also, high cooking temperatures could add to its potential to be carcinogenic,’ she said.

‘So barbecuing at high, high heat and blackening is potentially problematic. Slow cooking processes are good – like marinades, stewing, braising. 

‘Over the course of a week, certainly under 500 grams would be the recommendation for red meat.’

Rachael believes it is vital for all Australians, not just those over 45, to know and monitor the symptoms of bowel cancer. 

‘If I didn’t know my body as well as I do, it may have been too late by the time it got picked up,’ she said.

‘It takes five to 10 years for bowel cancer to properly form. In the last decade I’ve had two children, surgeries and ultrasounds and they never found a polyp.’

Rachael also hammered home the importance of young people requesting proper testing if they bowel cancer symptoms.

‘I think the most important thing is knowing your body and if you think something is wrong, it probably is,’ she said.

‘It’s really important that young people understand they shouldn’t be embarrassed to push their GP.

‘If you’re not getting the answers that you want out of your GP, go to somebody else because the GP is the most important part where it starts.

‘The GP is the doorway to the surgeons and the oncologists and the experts, you know.

‘If you don’t trust your GP, find a new one.’