Young patients are now dying from bowel cancer – and I think antibiotics could be behind it: Professor ROB GALLOWAY reveals how to protect yourself

Working in emergency medicine, I see many tragic cases – but one of the worst is the diagnosis of a young person with advanced and incurable bowel cancer. This used to be a rarity. Not now.

Not long ago I saw a farmer, in his early thirties, who had come to the emergency room at the insistence of his wife, who was concerned that he was so exhausted.

At first I dismissed his symptoms as being due to him being a new father and the sleepless nights that come with it. But he was pale, with a hint of yellow in the whites of his eyes. So just in case, I did some blood tests, although I fully expected them to be normal.

This showed that he had an extremely low red blood cell count and that his liver was not functioning properly, which explained the yellow tinge in his eyes (caused by a buildup of bilirubin, produced when the liver breaks down red blood cells).

I sent him for an urgent CT scan and it showed he had stage 4 bowel cancer, meaning the disease had spread to the rest of his body. He died in a hospice two months later.

When I was in medical school, I learned that colon cancer is something that only affects the elderly.

But in recent years the number of young patients – under the age of 50 – with colon cancer has increased explosively, rising by 2 percent every year since the 1990s. I see these patients in the emergency room, often because they have ignored the symptoms – cancer is not on their radar – until it is too late.

Just a few weeks ago, a college student came in because of blood in her stool. She too had ignored her symptoms until ChatGPT correctly advised her to seek medical attention during an internet search.

Dame Deborah James, also known as Bowelbabe, died of bowel cancer in 2022

The number of young patients – younger than 50 years old – with colon cancer has increased by 2 percent every year since the 1990s

Without an obvious cause, such as hemorrhoids, I urgently referred her for colon cancer testing in two weeks.

In the past I probably wouldn’t have done that, because of her age. But that has changed and I am hyper-vigilant about colon cancer.

What is driving this rise in cases? To try to find the answer, Cancer Research UK and the Bowelbabe Fund (founded by Dame Deborah James before she died of bowel cancer in 2022) have just launched a multi-million pound study. Over the next five years, researchers will look at all possible causes.

But for some, those five years may be too late.

I have no doubt that the rapid rise in Europe and the US points to lifestyle and environmental factors. For example, we now know that a diet high in ultra-processed foods and processed meat – and low in fiber – is a risk factor for colon cancer. The same applies to obesity, smoking, alcohol and not exercising.

And research has suggested that environmental factors such as pesticides, plastics and air pollution may also contribute.

But more recently, emerging evidence points to the role of our gut microbiome – the community of microbes found there – in protecting us from colon cancer. Damage those microbes and you run a greater risk of colon cancer.

And yes, it is not surprising that antibiotics are involved. A 2022 study published in the British Journal of Cancer compared antibiotic use in cancer patients with people who were identical in all respects except that they did not have cancer.

The results showed that young people under the age of fifty had an almost 50 percent greater chance of developing colon cancer if they had received antibiotics. But among people over 50, antibiotic use was only associated with an increased risk of 9 percent.

This isn’t necessarily proof that antibiotic use can increase the risk of colon cancer, but it is a revealing study with a good scientific explanation for what’s going on.

And that is that antibiotics reduce the amount of good bacteria that produce short-chain fatty acids (such as butyrate), which have anti-inflammatory and anti-cancer properties in the colon.

So why are young people more affected by antibiotics?

We don’t know for sure, but their microbiome may be more diverse, making the harmful effect of antibiotics more apparent. In addition, there is increasing evidence that vaping has a harmful effect on the intestines.

A 2021 study in mice published in the journal Environmental Science and Pollution Research showed that e-cigarette vapor directly damaged the intestinal lining of mice and caused inflammation.

This is what predisposes you to developing colon cancer. The good news is that four weeks after stopping the intestinal wall returned to normal.

As for what you can do now to protect yourself, my first port of call would be to take steps to improve your gut microbiome.

That means eating more fiber and fewer ultra-processed foods — and try to incorporate fermented foods like kefir and sauerkraut into your diet.

I also think a daily probiotic supplement is a good idea – look for one with at least one billion colony-forming units (or CFUs) per capsule.

There is evidence for this: A 2021 review of studies on the role of probiotics in cancer prevention, published in the journal Cancers, concluded: ‘There is a lot of evidence that the use of probiotics can play an important role in the prevention and support of cancer. cancer therapies.’

As for my patients, although I was once content to prescribe antibiotics quite liberally, I am now much more cautious – and I always tell them to take their prescription with probiotics, because I know this advice will do no harm and can very well reduce their risks. get colon cancer.

@drrobgalloway

New NHS rankings? Same old story

Last week, Health Minister Wes Streeting announced plans to introduce hospital performance league tables, including emergency department waiting times.

External oversight is a good thing, but beware of the risk of unintended consequences, because we’ve been here before.

When the four-hour emergency department target was introduced by the last Labor government, many hospitals moved patients to a ward – not because it was in the patient’s best interests, but because it meant the hospital was meeting its targets. In other words, the ranking position took precedence over patient care.

I also worry about the impact of the hospitals at the bottom of the rankings; this will damage morale among the staff who can make the necessary changes and make it more difficult to recruit the best people.

But my biggest concern is that a hospital’s wait times reflect complex problems that are beyond our control: in my ER we see patients quickly, but due to a lack of beds they can’t just go to the department. That lack of beds

is caused by delayed discharges due to a lack of community care – nothing to do with the hospital, which would be at the bottom of the table.

What we need is to improve health – and reduce the demand that is crippling the NHS – and these league tables will not help with that.