Why is the cancer rate surging among the under-50s?

Charles Swanton, Cancer Research UK’s chief clinician, says that many of the cancers on the rise concern the digestive tract. “There is emerging evidence that specific E. coli bacteria in the bowel that release colibactin have the capacity to cause DNA mutations in cells of the bowel lining that might be one trigger for cancer initiation,” he says. Scientists are also “studying whether an increase in red-meat consumption or diets with high-fructose corn syrup may play a role”.

Beggs believes that while the gut microbiome is important, it’s only “a piece of the puzzle. We know that certain bacteria, in the right situation, can initiate a bowel cancer, but it is a complex interplay of the bacteria and other factors that cause this.”

As for ultra-processed foods, he says, other than their association with obesity, “It is unlikely that they contribute anything other than a very tiny increase in your risk of cancer.” It’s difficult enough, he says, to establish causation with what are regarded as “the big three” factors — obesity, smoking and excess alcohol consumption. “All of the big population studies looking at lifestyle and cancer outcomes have given inconclusive results.”

For those who already have a diagnosis, Beggs is involved in research to improve outcomes. By profiling the genetic changes in a tumour, oncologists can choose a more effective treatment, or discover what drives resistance to medications. Also, when the patient receives treatment is critical. For cancers that can be operated on, Beggs says that giving chemotherapy before rather than after surgery has a much better outcome, according to recent trials.

Here, three people who were diagnosed with young-onset cancer describe how they discovered they had the disease, what their symptoms were, the treatment they have received, and the impact that cancer has had on their life.

‘I don’t blame myself for getting cancer. I did at first’

Sarah Edmundson, 38: triple negative breast cancer

Around Easter 2021, I started to feel so dizzy that sometimes it felt like I was drunk. Blood tests established that I had critically low vitamin B12, so I started on booster jabs, which made me feel better. But six months later, after a top-up, my left arm was in excruciating pain. I started pressing around my armpit and felt a lump.

I called the doctor in a panic, and he sent me straight to the breast cancer clinic. I was lucky to be seen really quickly. Even before the biopsy results came back I was told to prepare for the worst. Ten days later I received the news — I had triple negative breast cancer.

Some types of breast cancer react to hormones, some of them feed on hormones, and some — like mine — don’t. Genetic testing revealed that I had a mutated gene, BRCA1.

I started on what would be seven and a half months of chemotherapy. The prognosis was good — the doctors said it was curable. A double mastectomy was recommended, followed by radiotherapy. At my first consultation, they discussed using tissue from my stomach to reconstruct my breasts. However, I didn’t have enough tissue, so we decided to take tissue from each of my thighs and reconstruct my breasts that way.

A few days before the operation, my surgeon got Covid, so the plan changed. I had a reconstruction using a silicone implant in my right breast, which was the non-cancerous side, and a tissue expander in my left breast, with the idea that I’d have radiotherapy, and then the tissue expander would be removed and replaced with a silicone implant.

I don’t blame myself for getting cancer. I did at first, but I was pretty much guaranteed to get it genetically. On June 30, 2022, I had my last round of radiotherapy. I hadn’t been drinking but I had a glass of champagne to celebrate, and by that night, I was already on a train to speak at a conference. I don’t have many regrets but my only one is that I didn’t throw myself into life — I threw myself into work.

I’d been on an awful breast cancer drug called goserelin (Zoladex), which put me in the menopause. That combined with the steroids I was on made me a hideous human being. Despite wanting to go back to pre-cancer Sarah, I couldn’t.

• The 16 things I wish I’d known before breast cancer

Fast forward to January 2023. I was on a work call. I was feeling around my collarbone and I noticed a lump in my neck. Oh my God, I thought.

My doctors referred me straight to the breast cancer clinic. Believe it or not I still went to a stand-up show that night. Trying to laugh was a struggle. It turned out that there was cancer in my lymph nodes. I needed surgery. I had a secondary cancer now, which was treatable but incurable. After the operation, I started chemo again. This time, I fasted for 24 hours before and after the infusions. I cut sugar out of my diet. I supplemented with functional mushrooms. I even joined a Facebook group where people shared costly protocols involving obscure supplements.

After several months, my doctors did scans and said: “We might have no evidence of disease.” With things looking good, I had my breast implant changed. The tissue expander had metal in it, so I’d not been able to have an MRI, but when I had one, the results weren’t good. My cancer had come back, in my liver.

I’d never asked for time frames on anything, but I foolishly asked the doctors: “How long do I have?” People live for an average of 14 months with the treatment I was going to be on. I started a new drug called sacituzumab govitecan (Trodelvy), and when I had a scan, guess what? The cancer was shrinking!

I decided to go on a few dates. I went skiing. But when I got back, my legs were aching. The cancer had spread to my pelvis. I was in severe pain. I couldn’t comprehend this new version of me — somebody who needed walking poles to go anywhere.

I had two options: a drug called eribulin (Halaven), or trastuzumab deruxtecan (Enhertu). However, despite charity campaigns, the latter is still not approved by the NHS as it is not deemed cost effective. The bill for me would be £12,197 every three weeks — an eye-watering amount that no one with cancer should be expected to fund.

Along with eribulin and a bone drug called denosumab, which helps to strengthen bones against the effects of cancer or cancer treatment, I’m on a very low dose of the opioid oxycodone. It got me back to being pain free. I have regular chemotherapy and every third week I try to go on holiday or plan something fun. I’m quite stoic about it all. My life is cut short, but in a way, I’m happier. I’ve cashed my investments and sold one of my properties, which was my self-employed pension.

You have a choice every day. We all do. I wake up, open my eyes, and I’ll be honest with you, that’s a really positive situation.
Sarah Edmundson’s podcast How Long Have You Got? with Jeremy Langmead is available on Spotify and Apple

Finn O’Mahony: “How do I cope? I have to focus day by day, action by action, hour by hour”

‘I thought it might be due to an old rugby injury’

Finn O’Mahony, 22: osteosarcoma

In May 2020 I started limping because of a pain in my leg. I was working 40 hours a week in the local supermarket before going to university, so I thought it might be due to being on my feet a lot, or an old rugby injury that was playing up. I went to a physio and was given some stretches, but I was taking five or six lots of painkillers every day, just so that I could hobble about.

I asked my GP for a referral and had a CT scan the following day. It turned out that I had a big tumour just underneath my knee. The doctor said: “There’s no way for us to know if it is malignant or benign. And this isn’t my speciality.” I soon discovered that there are only about 160 cases of osteosarcoma a year in the UK.

I went into that appointment thinking I’d hurt my cartilage. I still went to work after, because I hadn’t processed anything. After telling my manager, “I have a tumour”, I broke down. He sent me home.

I live in Beaconsfield, Buckinghamshire, and one of two osteosarcoma specialists in the country is in Oxford, which isn’t far away. My parents came with me to the appointment. The oncologist sat us down and said: “I’m 99 per cent sure that this is going to be cancer.”

There was nothing in my lifestyle that could have explained it. I was an 18-year-old who had played rugby six times a week since I was four. There’s no proof that genetics play a role.

• How to cope financially with a career-threatening illness

What followed my diagnosis was countless blood tests, kidney scans, lung and heart function tests. They do an MoT of your body before killing you with chemotherapy. I shaved my head before I even started. Often, the side-effects were so bad that I’d stay in hospital for two weeks at a time. I had six cycles of chemotherapy. My healthy weight is about 80kg and I was down to 55kg after two months. I was almost always the youngest person on my ward. It was very lonely. And because of Covid, on Christmas Day my mum was only allowed to visit for an hour.

Surgery on my leg took nine hours. It was limb salvage surgery, which is the step before amputation. I lost my whole knee mechanism, half of my tibia, half of my fibula and half of my femur. They removed all the cancer — but the recovery was gruelling.

I was in a wheelchair for 23 weeks. I wasn’t allowed to bend my leg. If I wanted to go to the toilet, I’d either have to use a bottle or someone would carry me out of bed, wheel me into the bathroom, lift me onto the toilet and then lift me back onto the chair.

My surgeon said that in the short term, amputation is going to be easier, but you’ll have problems in the longer term. I was in hospital for 13 days after surgery. Then I got sepsis due to ulcers in my mouth, which is a side-effect of the chemo. My body was shutting down. But even if that final cycle made a fraction of a difference, I wasn’t going to quit. The doctors were concerned I wouldn’t be able to handle it. I told them — do it anyway.

Since leg surgery I’ve had my knee reconstructed and two recurrences in my lung, which were operated on. The survival rate for osteosarcoma once it has spread to other parts of the body is very low, which sends me into a spiral.

How do I cope? I have to focus day by day, action by action, hour by hour. I became so used to breaking down my days into the tiniest manageable chunks. If anyone ever didn’t know what to say to me, I would just tell them: “Please, say anything.” I’ve been to the place where people die. Remember that there’s a light at the end of the tunnel. I have a very different outlook on life than an average 22-year-old.

‘The diagnosis was a shock to everyone, including my doctor’

Dr Anisha Patel, 44: bowel cancer

Dr Anisha Patel: “I had PTSD and anxiety just trying to cope with my new normal”

I was 39 when I was diagnosed with stage 3 bowel cancer. I’m a GP and my husband is a consultant gastroenterologist, so we were aware of the symptoms. The difficulty was that all I had was a bit of constipation on and off for about eight months. I thought that I was getting blood on the toilet paper because of it. I assumed that the piles that I’d had in childbirth had returned. When the symptoms got worse, I saw the GP. He gave me some laxatives.

Over a month during the summer everything changed. We were in Italy at the time. I was feeling really knackered. I was eating everything under the sun but I was getting thinner. I had bad bouts of stomach cramps. There was a lot more blood in the toilet. I went to the doctor as soon as I got back.

I was immediately referred under the cancer pathway. The diagnosis was a shock to everyone, including my doctor. We thought I might have inflammatory bowel disease. I had no family history of bowel cancer. I ate well, exercised and wasn’t overweight. I didn’t eat loads of red meat.

• Why are more young people getting cancer?

I ended up requiring two major surgeries: one to remove the tumour, so I had a stoma bag; and then my bowel was joined back together, and the stoma was removed. I was left with low anterior resection syndrome (LARS) because the surgeons cut through nerves around your bowel. You never go to the toilet again normally. I know people that don’t leave the house because of it. Three months of gruelling chemotherapy followed. I’m five years in remission. I’ve had regular scans and colonoscopies throughout that time.

Often, cancer patients will scrutinise their life after they’re diagnosed, but there are hundreds of other people living in exactly the same way or worse who don’t get cancer. I’ve made some changes, however. I’m conscious of eating more fibre, because a third of preventable bowel cancers are due to a low-fibre diet. I started drinking a coffee a day for its health benefits, and I only drink alcohol in moderation on the weekends.

Having cancer has a huge impact at every age, but when you’re young, the ramifications relating to fertility and sexual function can be greater. I’ve gone into early menopause as a result of treatment. I was asked if I wanted any more kids before starting chemo, and my answer was no. I’m well aware that some people lose out on the opportunity or have to find alternative ways to start a family.

I’ve needed a lot of therapy because I had PTSD and anxiety just trying to cope with my new normal. I felt incredibly lonely, which is why I wrote a book and started my Instagram account @doctorsgetcancertoo. As a GP, your first instinct isn’t “OK, I’m suffering with this”, it’s “What am I going to do?” That’s been the basis of my work with a number of bowel cancer charities. If you catch bowel cancer early, it is treatable and curable.
Everything You Hoped You’d Never Need to Know about Bowel Cancer by Dr Anisha Patel (Sheldon Press, £16.99). To order a copy go to timesbookshop.co.uk. Free UK standard P&P on orders over £25. Special discount available for Times+ members