Having tragically lost his son Dylan at the tender age of 23, Lawrence W. Cappel Ph.D. is painfully aware of the fact that colon cancer is no longer a disease of older people. 

As Chair of the Peninsula Health Care District Board, he knows all too well the importance of sharing health information so others can make changes in their own lives. One example is his former employee Maria Rodriguez who was moved by Dylan’s story and got screened for colon cancer after procrastinating for many years. Now, as a colon cancer survivor herself, she also makes a concerted effort to raise awareness about the importance of screening. 

With March as Colon Cancer Awareness Month, it is particularly timely to read about the intersection of Dylan, Larry and Maria and their shared journey. Here is their story as told by Larry:

Colon Cancer No Longer A Disease of Older People

“Dylan is my angel,” says Maria Rodriguez. Dylan Cappel died of colon cancer at 23 while training for the US Olympic Rowing Team. “I wear a t-shirt with his name and wings on it. He was so strong and I can pass that strength onto others. His symptoms were not recognized in time, and this meant Dylan died an untimely death. His legacy is to raise awareness of colon cancer at every age in order to prevent this from happening to others.”

Dylan was my son and Maria worked for me. About three years after Dylan’s death, Maria herself was inspired to get screened for colon cancer. She had put it off because the thought of it was so unpleasant, and the fear of the unknown kept causing her to delay making the appointment. It is good she did, because she, too, was diagnosed with colon cancer. Now, a survivor, she works tirelessly to inspire others to get screened.

With 1 in 7 colorectal cancers diagnosed in patients younger than age 50, it’s high time for a paradigm shift from colorectal cancer being perceived as a disease of older people to a real risk for younger people.

This is a wake-up call for a disease that is the third most common cancer in the US and the second deadliest cancer. In fact, based on current trends, by 2030, the predicted rate of incidence will increase 90% for ages 20-34 and 28% for ages 35-49.

There is a push to uncover underlying lifestyle, genetic or environmental factors. Research is on-going to discern whether a diet high in red or processed meat, a lack of physical activity or prolonged use of antibiotics are factors.

Strangely enough, while the risk of dying from colon and rectal cancers has been declining in the population overall, death rates among adults aged 20 to 54 has increased. There is an urgent need to raise awareness amongst both patients and physicians. Compared with older patients, those under 50 were 30% more likely to be diagnosed with tumors that had spread to lymph nodes, and 50 % more likely to have cancer that had advanced to other organs. Younger patients, often misdiagnosed as suffering from hemorrhoids can end up with more aggressive treatments, surgeries and radiation by the time colon cancer is identified as the issue.

This is a controversial health challenge because colorectal cancer in younger adults is different from those seen in older people, and it is unclear whether they can be detected and treated with the same tools. New ways to detect this insidious disease earlier in younger people are needed. These innovations are required because a colonoscopy is not a risk-free procedure. Sustaining injuries or other harms is a remote but serious possibility. Some call for stool screening tests followed by colonoscopies where indicated, although this carries a risk for both false positive and negative results.

Unless there is a family history of disease or chronic conditions like inflammatory bowel disease, most recommendations call for screening to start at age 50. Even with a call for older people to get screened, the stunning fact remains that only 65% of individuals are up to date for screening.

Indeed, about 1 in 3 adults ages 50-75 years of age have never been screened. So if screening works, why aren’t people doing it? Embarrassment, awareness, fear, time, cost, and access all play a role.

What can you do to be more informed?

Learn about the warning signs and how to stay healthy:

What are the warning signs?

  • 
Rectal bleeding
  • Bloody stools
  • Unexplained weight loss
  • Fatigue
  • Digestive complaints
  • Persistent changes in bathroom behavior
  • Anemia

How can I be pro-active?

  • Know your family’s medical history including not only whether they had colorectal cancer, but whether they had benign 
polyps which can be precancerous
  • Tell your doctor if you have inflammatory bowel disease
  • Maintain a healthy weight
  • Get a lot of physical activity
  • Eat a healthy diet
  • Do not smoke
  • Do not engage in excessive alcohol use
  • Be aware that African Americans and Jews of Eastern European descent carry a higher 
risk

Lawrence W. Cappel, Ph.D.

Chair, Peninsula Health Care District Board

Occupation: Founder and current President and CEO of Pacific Health Alliance.

Education: BA Sociology/Physical Education, Humboldt State University; MA Physical Education, Humboldt State University; Ph.D. Community Health Services, University of Utah; Post-Doctoral studies in Health Care Marketing and Ambulatory Care, University of Washington

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