Deputy Managing Editor
sampson.nanton@cnc3.co.tt
For many people in Trinidad and Tobago, conversations about bowel habits remain deeply uncomfortable. Blood in the stool is often dismissed as haemorrhoids. Persistent abdominal discomfort is brushed aside as something that was eaten. Screening is frequently delayed because of fear, embarrassment or the belief that colorectal cancer is a disease that affects only older people.
But according to Mayo Clinic colorectal surgeon and researcher Dr Jeremy Jones, that assumption is becoming increasingly dangerous.
Researchers have documented a worrying rise in colorectal cancer among adults under the age of 50, with incidence in this age group increasing by approximately 50 per cent since around 1990. While older adults remain the most affected, the growing number of younger patients has forced doctors worldwide to rethink both screening recommendations and public education.
For T&T—where diets rich in red meat, processed foods and increasingly sedentary lifestyles have become commonplace—the message is particularly relevant.
“We’ve seen dramatic increases in younger patients,” Jones said. “Colon cancer is still predominantly a disease of people in their 60s and 70s, but a 50 per cent relative increase in patients under 50 is very alarming. That’s why we’re changing our screening and outreach programmes.”
Lifestyle matters—but it is not the whole story
Jones, who recently visited T&T during the establishment of Mayo Clinic’s local liaison office, said lifestyle choices certainly influence cancer risk, but they are only part of a much more complex picture.
He acknowledged the country’s culinary culture, where meats and processed foods often feature prominently on the menu, but cautioned against believing that any single food causes cancer.
“We do know that diet plays a role,” he explained. “Red meats increase risk. Processed foods increase risk. The increase isn’t enormous for any one individual, but across a large population, it translates into more people developing colorectal cancer.”
Rather than demanding drastic dietary changes, Jones advocates moderation.
“If you really like eating red meat—and steak is one of my favourite foods—there are risks I’m willing to take. But I try to do that in moderation. I don’t want to eat steak every day or twice a day.”
Regular physical activity also appears to provide protection.
“Exercise is good for your health generally,” he said. “There is also evidence suggesting it reduces the risk of colorectal cancer.”
However, despite years of research, scientists still cannot explain every case.
“The most common answer I give patients who ask why they developed colon cancer is simply, ‘I don’t know.’”
Known risk factors include smoking, heavy alcohol consumption, inherited genetic mutations and certain medical conditions, but many patients have none of these.
Researchers suspect additional environmental and biological factors are involved, but these remain under investigation.
Symptoms to never ignore
One of the greatest challenges, Jones said, is that early colorectal cancer often develops silently.
While severe abdominal pain, obvious bleeding and dramatic changes in stool shape are considered warning signs, many younger patients experience only subtle symptoms— or none at all.
“The unfortunate reality is that many patients don’t present with those classic alarm symptoms,” he said. “The most common story I hear is someone who had blood in their stool for years before finally having a colonoscopy and receiving a diagnosis.”
Even symptoms commonly blamed on haemorrhoids deserve proper medical assessment.
“Haemorrhoids are common, especially in younger people,” Jones noted. “But just because they’re common doesn’t mean you can assume that’s the cause. If you have bleeding in your stool, it needs to be examined by a physician.”
That assessment may include a physical examination, sigmoidoscopy or colonoscopy, depending on the patient’s circumstances.
Screening saves lives
Perhaps the most significant shift in colorectal cancer prevention has been lowering the recommended screening age.
In the United States, average-risk adults are now advised to begin screening at age 45 rather than 50—a direct response to increasing cancer rates among younger adults.
Jones emphasised that colonoscopy remains the gold standard. “It not only detects cancer, but in some cases, an early-stage cancer can actually be removed during the procedure. So you may wake up from your colonoscopy already cured.”
For those reluctant to undergo colonoscopy, newer alternatives are making screening more accessible.
Stool-based DNA tests and recently approved blood tests can help identify people who require further investigation.
“The most important screening test is the one that people are actually willing to do,” Jones said. “We could have the perfect screening test, but if nobody takes it, it won’t help.”
However, he stressed that people with strong family histories of colorectal cancer require a different approach.
“If multiple close relatives have had colon cancer, or there’s a known inherited mutation, we generally recommend going straight to colonoscopy rather than relying on less invasive tests.”
Breaking Caribbean taboos
For Jones, perhaps the greatest obstacle isn’t technology or treatment—it’s silence.
Across much of the Caribbean, discussing bowel habits remains uncomfortable, delaying conversations that could ultimately save lives.
He believes changing that culture is essential. “I jokingly tell my patients that pooping is normal for everyone,” he said. “Sometimes uncomfortable conversations lead to life-saving diagnoses.”
That openness also extends to family medical history.
Knowing whether parents, grandparents or siblings have had colorectal cancer can significantly influence screening recommendations and identify families who may benefit from genetic counselling.
A new era of personalised treatment
Treatment has also changed dramatically over the past two decades.
Rather than treating every tumour the same way, doctors increasingly tailor therapies based on the tumour’s unique genetic makeup, its location, how aggressive it appears and the patient’s overall health.
“What we’ve learned is that there aren’t just one or two types of colon cancer,” Jones explained. “There are hundreds of different types driven by different mutations.”
Modern treatment combines tumour genetics with patient-specific factors.
“Our goal is to match the intensity of treatment to the aggressiveness of both the tumour and the patient’s individual circumstances.”
This personalised approach aims to maximise cure while avoiding unnecessary treatment.
Early detection changes everything
Ultimately, Jones said the greatest opportunity lies not in better treatments, but in finding cancers before they spread.
The difference in survival is striking. Patients diagnosed with Stage I colorectal cancer have cure rates approaching 95 to 100 per cent. Once the disease reaches Stage IV and spreads to distant organs, cure rates fall dramatically.
“Our goal should always be to catch these cancers as early as possible,” Jones said.
“That gives us the best opportunity to cure them and make cancer a memory of the past instead of something patients have to live with.”
