Why Early-Onset Cancer Is Rising In The United States

This is going under anesthesia answer with Dr. Brian Schmutzler. I'm by Headsotters

Zade. We are brought to you by The Butterfly Network.

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And we appreciate them sponsoring this podcast, coming off the heels of a great podcast where

we talked about diabetes. Now we're kind of switching our focus to younger patients and

why we're seeing so many cancer diagnoses in the population, especially in the United States.

Yeah, it's crazy. Over the recent last couple of years.

It's crazy. So traditionally cancer, obviously there are some childhood cancers and some people

who rarely get cancer in their 20s, 30s, 40s, 50s. But usually cancers are diseases of the

elderly, older people, 60s, 70s, 80s, 90s even. And it's weird because really in the last

probably 15 or 20 years, and really in the last five to 10, there has been a huge increase

in cancers, aggressive cancers in young folks. So I mean, one of the biggest ones and the ones

that get the biggest press is colon cancer. And so we'll talk a little bit more about that later.

But there's increases in breast cancer for sure, pancreatic cancer, which is odd because

pancreatic cancer used to be an incredibly rare disease. And when I was a resident,

our surgery department did a lot of pancreatic cancer patient surgeries. And they were almost all

in their 60s, 70s, right? So why do you think this, I mean, do you think we can go down a few

rabbit holes there? We'll get there. We'll get there. But you know, cancer, what is the,

you know, I want to say, what is the research behind it? Now that the research is kind of

getting better, technology, what role is it playing in cancers of young patients? And maybe

is that why we're seeing so many of these? Yeah, it could be. So let's go back and just explain

what cancer is because cancer is not really accurate. It's cancers, right? So most cancer,

like a lung cancer is different than a pancreatic cancer is different than a GI cancer, colon cancer

is different than a breast cancer. So cancer just means that cells grow out of control

in a negative way, right? So, you know, like probably one of the most common things you can think of

that you can actually see is let's say melanoma, right? So you get a little what looks like a mole

and then all of a sudden it grows and it grows and it grows and it grows and it grows uncontrollably.

So that's like a local cancer and then that can metastasize, go through the blood and get to other

parts of the body. So let's just define what cancers are. But you know, so technology. So do we

think technology has something to do with it? You know, I don't know, maybe probably, probably not

colon cancer. I can't see a way that technology is causing colon cancer. But there's probably some

connection to modern society and brain cancers and maybe skin cancers as well. Like there's

there may be some pharmaceuticals or some things like that that may be causing some of that stuff.

But I mean, if you talk about colon cancer, you would have to assume whether the data says it

or not that there's something related to diet. Right. Okay. So, right. These are the two biggest

things that I think people are young people are doing differently than our ancestors. Right?

Now, they didn't live as long because they didn't have the medical technologies that we do.

Yeah. So a lot of people died of infection or heart disease stuff that we treat very well now.

Cell phones. Cell phones. Yeah. Cell phones. Watches. Yeah. Yeah. Metaglasses. Yeah. Right.

Headphones, computers, laptops. That's all part of the technology, right? And now they're saying,

have you seen the new thing where like if you put don't directly put the laptop on your lap

because it can cause heat on it? Yeah. They've been talking about that for years. Like they're

there's probably so so there is probably some detrimental effects of putting heat consistently

putting heat on your groin area, whether you're male or female. But I mean that doesn't have anything

to do with the electronics. It just doesn't. Yeah. That'd be like sitting in a sauna just putting

your groin in a sauna for six hours a day. I just don't know if there's enough research on

cell phone. I mean, we know that remember this whole thing in the 90s and early 2000 with

telephone lines and living under power lines and stuff like that, right? Yeah.

Causing cancer. Well, do we know enough research about cell phone data and what it does to not

yet? Probably not. And then how do you study that, right? Like you're going to have to do some

goofy retrospective. Like this guy got cancer. Tell me how often you used your cell phone.

It's self-report. It's going to be really hard to do, right? So, I mean, the electromagnetic

fields that are by, you know, there's there's, you know, there's a lot of discussion about that going

back and forth on both sides. But let's like, you know, I'm going to take my personal opinion out of it.

Let's let's talk about what the what is actually potentially happening. So so I think colon cancer

is probably the best place to start. So they used to recommend long time ago getting colonoscopies

at like 55. And then it came down to 50. And now they say 45. And even that, they're talking about

reducing. So my doctor the other day, I literally turned 45 a few months ago. And he's like, so

what do you think? Yeah. Yeah. You're going to get it. There's different ways to do it now, though.

Well, you can do the colaguard. Colaguard is a it it picks up in your colon in your in your

stool, whether or not there's the DNA, but isn't there blood work now that you can do it? That just

came out. Yeah. Just came out. I just saw a commercial for that. I'll just wait till that. So

so here's the problem. And that's fine. It's a it's an okay screening test. If you're low risk.

Yeah. The problem is that it misses a lot. And it overdo it. So it's got a high false positive

rate, meaning that overdiagnosis is it and a high false negative rate, meaning that underdiagnosis

of certain types. So I mean, I'll I'll make the PSA right now. You need to get your colon your

colonoscopy at 45 really maybe sooner. If you have any family history, you've got to get a cold of

colon cancer, colon cancer. So so this is a screening test that used to be in older people. So now

we're finding more and more people at age 45 or even younger who have colon cancer. And the the

problem with colon cancer is that it's so advanced by the time it causes symptoms. So that's why

we have screenings. That's why even though you're healthy, you don't feel like you have any issue

with anything in your colon, you get that screening done early. So I mean, you know, I would even push

depending on what your family history is and depending on, you know, what your risk aversion is

to get it as soon as 40. I mean, look at like like the the poster child of like famous people who

had colon cancer was that Chadwick Boseman. Yeah. He like it was like 44 when he died. Right. He

was diagnosed very young 42. And it was metastatic when it got diagnosed. So a lot of them are

advanced. Yeah, they're catching them at much more advanced, advanced stages, which is James

Vanderbeek. Have did he have? I think it was one cancer too. Yeah. Yeah. And he was 48. Yeah.

Yeah. Yeah. So and you don't have to have a family history right? Or is this and why do you think

the numbers are increasing in colon cancer among younger patients? So there's a couple of things.

So I think diet is a huge part of it, right? So we're not. This was the other thing, right? Yeah.

Like electronics diet. Yeah. So I think you can really make the connection with it's hard to make

the connection with the cell phones and EMFs and that stuff. Not not dismissing that that's a

possibility. It's hard to make that connection. You can definitely make the connection with diet. We

went from eating like meat directly from the cow and mashed potatoes like a potato mashed up

to eating all these ultra processed foods. Like you there has to be something in these ultra

processed foods, including like refined sugars, preservatives, emulsifiers, artificial

additives. So like that I don't know that the data is fully caught up to it yet, but I think

most scientists agree that all those things do a couple of things. One, they change your gut microbiome,

which even though there's not direct evidence of it, probably contributes to colon cancer.

The other thing is they cause inflammation, right? So chronic inflammation, like if I take my hand

and I do this all the time and I cause chronic inflammation, that's going to cause an overgrowth

of cells. If you hit the wrong cell that overgrows, that's a cancer, right? So the fact that you're

that you're tearing up the gut over and over again with these inflammatory foods and things that

we put in foods, I think that is a that is a huge part of it. The other thing is obesity and

metabolic disease. Same thing, right? These are inflammatory states, you know, diabetes is inflammatory,

obesity is inflammatory in your body in general. That's part of the reason you get heart disease

with diabetes is because of the inflammatory portion. But which is crazy though to me because

Chadwick Boseman, yeah, young guy in shape. I didn't family history. I didn't go over his diet.

I don't I don't know his eating patterns. James Vanderbeak seemed like a pretty healthy guy.

Yeah, I don't know as much about Vanderbeak as I do about that. But Boseman was family history.

Yeah. And there actually is a higher incidence of colon cancer, especially advanced colon cancer

in the African American community. So like there's probably at some point going to be a recommendation

that and there are for other things too, like that African Americans get a get their colonoscopy

earlier than Caucasians. Like it's probably going to happen at some point because of like the

epidemiology of it. And then sedentary lifestyles big, right? So again, you create this insulin resistance

and you create chronic inflammation by not getting up and walking around and not, you know,

not have an active lifestyle. So what can we do? I mean, I think the preventative other than,

right? I mean, diet. Huge part of it. Anti-inflammatory diet. And is there like a diet that's like

an anti-inflammatory diet? Or like what are the best foods for that? Yeah. So I think the key is to

just eat whole foods to eat, you know, unprocessed foods or mildly processed foods, not ultra-processed

foods. That's the biggest thing. I don't think it's in general. It's not the food itself,

at least not with the data. Now like some people talk about FODMAP and all that kind of stuff.

I get it. Those are real things. But if you look at the data,

the foods, if you eat whole foods, if you eat salads and meat, sure, you're not likely to cause

inflammation in your gut and you're not likely to have an issue with colon cancer. Or I mean,

you're not likely to increase your risk of an issue with colon cancer. It's tough because,

you know, friends of mine and I used to have these discussions all the time. How can you slow down

genetics? Yeah. How can you, how can you reverse genetics? Or like, let's say my dad had

diet and diabetes. Like we talked about medicine, medicine. I mean, diet and food is medicine,

basically. My dad has diabetes. The likelihood of me getting diabetes. Well, when did he have,

when did he, when did he develop? 45, 50, and heart disease. Yeah, a little bit. Well,

the heart disease is probably from the diabetes. But the diabetes may or may not, is he the only one in

your family? No. Has it? Everybody. Okay. So you probably do have a history. Well, I mean, he's the

only like the kids don't have it yet. Yeah, but like just his brother or cousin or all that.

Correct. Correct. And then my other grandparents had it. Yeah. Okay. Yeah. So you got a family

history. So you're your higher risk. Right. So like the likelihood that I get it,

higher, higher, yeah, likelihood that are he gets it slightly higher? Yep. I mean,

generation, you go, so how do you break that cycle? How do you break the cycle of genetics to say,

like, you know what, like, well, you can't, you can't, you can't break the genetics, but you can,

you can do everything to mitigate the chances. So healthy weight, healthy diet, exercise. Again,

we talked last time about diabetes exercises. The biggest way, best way to prevent serious

diabetes and then complications from diabetes, once you get it, because every time you move those

muscles, lift weights, run that sugar goes into your muscles, it also increases the effectiveness

of insulin. So exercise is key, right? And diet is key too, right? Because that keeps a healthy

weight, but exercise is key for diabetes. I do think, and the conversations we've had on this

podcast, in particular, about some of the processed foods that companies are putting in these days,

that we don't even know about. I think those, that is why you're seeing this.

Probably. So, so let's talk about, so there's like three, like, controversial theories, although I

don't think they're as controversial as people say right now. So, so I think we can all agree,

there's a huge shift in the age of when cancer is diagnosed. So, so theory one, ultra-process foods,

we've talked about this already. So, it changes gut biology for sure. I think intestinal inflammation

is probably the biggest, the biggest reason why. I don't know that this is all that controversial,

but I don't think that there's big large scale randomized control trials that show this. So,

that's probably the least controversial one. All right, microplastics, right? So, this is a

controversial one, environmental chemicals, microplastics, PFAS, right, all that sort of stuff.

So, at least in the lab, these cause a lot of inflammation and cell changes and can cause

cells to change from normal cells to fast growing or cancer cells generally. But that's technology,

right? That's, that's environment. Okay, it's environmental. I just, I don't think there,

I don't think there is any, I don't think there's any data out there to show that the EMFs

or the cell phones or any of that sort of stuff are contributing to these types of cancers.

So, there, there is data that comes out from time to time with like brain cancer and,

and glaucoma and all that kind of stuff, but, but not, not colon cancer. Back in the day,

we're talking about this too, not you and I, but I was talking about this to a group of friends.

Back in the day in the 90s, guess what? You and I carried Nalgene bottles around. Remember those

clear plastic water bottles that everybody would, everybody was carrying around those PFAS?

Those were a 100% PFAS, right? 100%. And now they're like, okay, we're getting away from that.

You're one of the metal. Okay, metal's probably a little better. Glass is probably the best,

honestly. Glasses? Yeah, because the, there's the chemicals in the glass, which are few anyway,

don't leech into the water. So like, it's inconvenient, but glass is probably the,

if you're worried about chemicals getting into the drinks that you're drinking, glass is probably

the best thing that you can drink from. But that's like, we're running around doing a thousand

different things. You're carrying a glass bottle around oops, I dropped it. It's like, it's not like

a can that just explodes like your glass ends up all over the place. So, is that practical? No,

although I, you know, I, I try as much as I can, although they're so expensive to buy

the like, boss water. Sure. Just because I, I love the boss water. Honestly, I think it tastes better

to do it as a glass bottle, but 100% at the end. So, okay. So, the environmental chemicals

we're talking about, I think the plastics are probably contributory. And then we've talked

about this a few different ways before our pesticides contributing. Like, the pesticides, not only

that are being sprayed for those of us out in rural Indiana, but also like, are we eating that

pesticide and is it causing an issue? Now, there is no data, but I think, you know, a lot of these

pesticides are hormone signaling blockers or activators. So, like, they could change some hormones

in your body that could potentially increase your risk of cancer. It's interesting because we,

we get, let's say we go to the shelf at Whole Foods and get a bag of mixed nuts. You have,

hold on, you, you have to say what's on the label? You have to say what foods and what chemicals

are in there, but not what pesticides. Correct. Yeah. And, and that's also true for the fruit

that we pick out, right? If you go to the, you're like, oh, I'm being super healthy and I'm

picking out this fruit and that idea. Yeah. Yeah. There could be more chemicals on that that there

is in the mix and nut bag. You know what I mean? The thing you can do, though, is with, with fruits that

aren't porous, like a strawberry is harder to do it with, but like an apple. Yeah. If you wash

it off well with soap and water, you can get most of that stuff off the top. Okay. A porous thing

like a strawberry, it's leeched in there, but so I mean, I would highly recommend cleaning off

your fruits, like definitely wash your fruits, but anything that's non porous, like clean it off,

let it sit, that sort of stuff. Better with skin off. I mean, if you wash it right, it probably

doesn't matter. It doesn't matter. Yeah. Okay. Yeah. Um, but okay. So here's the super controversial

one, right? And I'm not saying I, I ascribe to this at all, but early life exposure to things like

antibiotics, like environmental exposures, even stuff like in, there's ideas of, you know, like

baby formula. So again, I'm not, I'm not espousing all these. I'm just telling you what some of the

theories are out there. There is, there is very little, if any research on, on any of these.

So I think the likelihood of, of any of these, panning out is probably 50, 50.

But again, I go back to just like Tylenol, right? Like use the lowest dose possible as little as

possible. So don't take an antibiotic for every cold that you have, right? Only use an antibiotic,

right? And again, childhood obesity. So trying to make your kids go out and run around, good

diet, good exercise. Um, and then the exposures to things like formula. I mean, like, you know,

we've seen that there have been some issues with formula production and people getting formula

that's not got in it, what they think in it. So just, just be careful with, uh, with when you go

out and buy foods like that for your kids. Like I'm, I'm, you know, I've got two kids.

I'm exceedingly cautious with my kids as opposed to myself. Like I'll go out and, you know,

drink a plastic bottle and not think twice about it. But my kids, my kids, I'm like, yeah,

you probably shouldn't eat that. You probably shouldn't. Right. Which by the way, my younger kid,

this is cool. So I got to tell this story before we finish off this. We got a couple of little

things. So my younger kid, um, it has been allergic to peanuts since he was like one and a half.

Yeah. And um, he got, there's all this testing you can do now for like all the different, um,

all the different, um, antibodies and like IGE and IGA and all the stuff that they can kind of tell

you how allergic you are. Well, about six months ago, he had one that showed he was like way less

allergic. So this past week, he goes in and has, uh, that basically a challenge where he eats

peanut butter and sits there in the doctor's office and they wait for him to react. So he did

that. I don't know how many times I wasn't there. But, um, so when, when he left, they're like,

yeah, you're not really allergic to peanuts anymore. Get it up. That's awesome. Yeah. So that was

cool. So we had like, we had like a, a Reese's together and like a spoon of peanut butter and stuff.

So that was cool. That's cool. Anyway. So back to that. That's actually something we, we

should do a whole episode on like allergies. Well, peanut allergies, but yeah, childhood allergies

in general. Yeah, we'll talk about that because my kid has a cashew. Yeah. Yeah. Yeah. His is

much more, his is, yeah, his is projectile vomiting. I've got to throw it. I've got to dig

it. So okay. So what are physicians seeing? Um, what are you seeing? Well, so I do mostly orthopedics

anesthesia for orthopedics. Yeah. So I don't see a ton of this. But overall,

basically every area of medicine is seeing more patients with colon cancer. And I guess I do see

that, you know, when I'm looking at a patient history, I might have somebody coming in for like a

shoulder rotator cuff repair, who's 40 and already has had colon cancer. Is that more men?

Yeah. So I think it's slightly skewed towards men, but it's both. I think colon cancer.

In women, colon cancer. Yeah, colon cancer and women as well. Yeah. So, um, not the number one

in women though, that's still breast cancer. So, so breast and prostate are still number one.

Uh, colon may be catching up though. I'd have to look through the data. I mean, in recent years,

yeah, there has definitely been an up to colon cancer. And it's interesting because colon cancer

doesn't get like, uh, it's a whole month. Breast cancer awareness month and like, you know,

prostate month is called rectal cancer month. Yeah. There is one, but it's just not as popular,

right? Um, and so I, a part of that's marketing. Right. Um, you know, I think colon cancer is

catching up. It used to be prostate for men. Sure. And, um, and that's a whole another issue. We

should do a, we should do an issue or I do an episode about prostate cancer because that's an

interesting one. Most men die with prostate cancer, not from it. So it's a very slow growing

usually not aggressive cancer. And so there, there's a lot of discussions that happen with that. But

anyway, yeah. So, um, so I think it's a little bit more in men than women, but it is in both. Um,

and then so the other problem is that a high percentage of these, and I say, high percentage,

30 to 40 percent, don't have any genetic history of it. Don't have any, any family history of it.

Like I, we don't understand what's going on. So if it's, if it's not family history,

it's got to be some sort of exposure. So anyway, yeah. Um, all right. So what's this mean for

the future? So I think screening guidelines are going to change again. They're probably going to

drop it to 40 would be my guess. Now you got to balance that if you're the, if you're the, um,

payer, meaning the government, you got to balance that with how much it's going to cost to,

to take all those additional people and screen them sooner against why they haven't done it because

of, so I mean, why is that the official reason why they haven't done it? No, is, do I think

that contributes? Yes. So the reason you don't screen. Sure. Like why don't we, why don't we do

uh, colonoscopies on 25 year olds? Right. You're going to have, there's risk to it, right?

Because it's a procedure, just like anything else. And you're going to have a decent amount of

false positives with that. So you're going to go in, you're going to find a polyp. You're going to

buy up, see that pop and it's going to be nothing. But then you're going to have to continue to watch

it and then have colonoscopies every couple of years and all that sort of stuff. So you, you've

got to find a, the, you've got to find a place, an age, a risk factor profile that makes sense for

catching it, but not so much that you're going to have a ton of, of risk to false positives and doing

procedures on people who don't need it. So my guess is it drops to 40. And that's, that may be more,

that may be more political pressure or like advertisement pressure than it is actual data.

But like you look, again, you look at all these, all these people celebrities who are showing up with

colon cancer 40, 41, 39. So, um, and again, it, it is having the understanding that you can be 45

and get colon cancer. I mean, we've seen the celebrities, you know, most recently, James Van Der

who went through it and it's quick. Oh, yeah. I mean, it's, it's, you're looking at six to 12

months. Once you have metastatic, metastatic colon cancer, metastatic colon cancer is, is very, very lethal.

Yeah, you're, it's, that's not, not good. Um, now, if you catch almost all colon cancer, if you catch it

early enough, you can either have, uh, you know, a, a polypectomy where they just go in with the

scope and pull it out and you're okay or even like, small segments of your colon removed, uh,

you know, partial or hemicolectomy or partial colectomy or whatever. So like, there's a lot of ways

that you can prevent colon cancer if you catch it soon enough, just like, um, you know, there's a

bunch of other cancers you can do that with. So, um, prevention strategies are going to be key.

What do we mean prevention strategies? Well, screening colonoscopies, but also diet exercise,

that sort of stuff. And then I'm making this, uh, again, kind of a public health priority,

meaning that we're talking about it. Instead of just talking about, oh, you know, do yourself exams

for breast cancer and, you know, get your PSA checked and have a prostate exam. We're gonna have to

start saying like, look for these signs of colon cancer. Are your bowel's changing? Do you have blood

in your stool? Like, there are a lot of things that maybe show up kind of in that early to middle

phase that you could catch it, you know, 35 or 36 that maybe is going to prevent you from waiting

that nine years and then end up with a big colon cancer. So, um, all right. Uh, and then, and then

obviously there's the colaguard, which is, yeah, which is the test of the stool and now the blood test.

And I can't remember what it's called. It's brand new, but it is brand new because, yeah, as recently

as three months ago, my physician was like, hey, you need a colon, you need a colonoscopy. You're 45.

Now you can get it done, but the easiest way is it, it's not full proof. It's going to be the

blood work. Yeah. Um, if you don't want to do all the other brink of a roll colon, but you could do

the colaguard. That's available stuff like that. And so those tests, the technology will get better.

And so 10, 15 years from now, we may be saying, you know, only five percent of people actually

get a colonoscopy because our technology caught up right now, though, it's still the gold standard

to get a colonoscopy. So colaguard, if a colaguard pops positive, that is a good indication that you

need to get a colonoscopy. If it pops negative, it means that you don't have advanced disease currently.

So it really doesn't tell you a whole lot. I don't know enough about the blood test to tell you

exactly what that says. So, uh, but I think as technology improves, I think, I think this is going

to be a huge area of research. And I think there's going to be a lot of medical device companies

who are going to come out with new ways to do this because now it's a huge population that has

a risk for colon cancer. So, but I still still the biggest thing prevention, right? Diet, exercise,

you know, those two things are going to prevent more than anything. And then I will make my plug that

I always make anytime we talk about health stuff. Don't smoke. Smoking increases your risk of every

single kind of cancer, including colon cancer. So number one, preventable risk factor for basically

everything, heart disease, lung disease, but also cancer. So, um, all right. Questions for

where we close it? I don't, I don't think so. I mean, that was pretty thorough. Hey, I think so.

And again, if you want to listen to any of our podcasts from previous seasons where we do talk

about these things, prevention, uh, leading all the way up to the diabetes episode last week,

you can go on, uh, Dr. Brian Schmonser's YouTube page, check it out, Instagram, Facebook, give it a

follow, give it a like, uh, like and subscribe, like and subscribe. Like, like, uh, like, uh,

like, click, like, I can't remember what the three things I click, like and subscribe, I think.

So that'll do it for this episode. So we got two, we got two more, we got two more podcasts. We

got to do now. We got to do the allergy one peanut allergy one. Yep. And we've got to do the

prostate cancer one. Let's do allergies next week. All right. Yeah, perfect. And we'll do,

we'll come, circle back. We'll circle back. Let's circle back to that. What, what was, uh, uh,

Jen Saki, right? Yeah. See the press secretary was like, let me circle back to that. I'll circle

back to that. Well, we'll circle back. We're going to circle back the same time next week. Thanks

for listening for Dr. Brian Schmonser. I'm by heat side or Zadi. We're brought to you by the

butterfly network. This is going under anesthesia answered with Dr. Brian Schmonser. See you next time.

Beat me to it.