Welcome to Q and A with Dr. K, a podcast by Mountain Pacific Quality Health, where we sit down with Dr. Doug Kuntzweiler and get your health questions answered, because on Q and A with Dr K, the doctor is always in. Hello, everyone. This is Beth Brown, your host, and we are so excited to have Dr. K squared. Today we have two Dr. Ks joining us for this episode of Q and A with Dr. K, and so as usual, we're joined by Dr. Doug Kuntzweiler, our chief medical
officer at Mountain Pacific. And today we also have Dr. Tiffany Kniepkamp. So welcome both Dr Ks!
Thank you.
Thank you. Happy to be here.
Yeah, it's great to have you. So we are going to talk about early onset cancer today. That is what we're going to tackle a little bit. And people paying attention to the latest in health news, maybe have started noticing concerns about cancer cases in younger people are sharply on the rise. And so we want to talk today about why is this happening? Why should we be concerned? And can we do anything to get those numbers to either even out or go down, so that they aren't on the
rise anymore? So let's break down those questions and take them one at a time. So let's first start with what is early onset cancer? Because we know kids can get cancer. Unfortunately, you know cancer strikes at any age. So what the heck do we mean when we say early onset cancer?
Well, to some extent, it's semantics, but what we're talking about is seeing cancers that typically we used to see in people when they were in their 60s and 70s. Now we're seeing them show up in greater numbers when people are in their 30s, 40s, even 50s. That's my understanding. Tiffany, do you agree?
Yeah, I would. I would say we're even talking about people in their 20s at this stage. And I think it's important to note that some cancers, which we traditionally associate with older populations, they're now increasing in that younger
population. So we historically hadn't seen them in the younger and now we are, for example, like colorectal cancer, breast cancer, melanoma, they're showing up frequently in younger people, but childhood cancer is tragic and real, but early onset is just a little bit different. It's more that 20s, 30s, 40s and 50s,
And you already started to answer what my next question was, which is, are there specific cancers that are on the rise among these younger adults.
There are, but it's actually a pretty broad range. Colorectal is probably the leading one, and I've read that that is now the leading cancer death in males under the age of 50, which used to be, you know, lung cancer and prostate cancer. Now it's colorectal cancer, but colorectal and as Tiffany mentioned, breast, prostate, uterine, gastric cancer, pancreatic cancer, myelomas, it's a fairly broad range.
Yikes. Okay, and so before we just start honing in on how terrible America is when it comes with the way we eat and how much we weigh and all of that stuff. I think it's also important to note that this is not just a US. Problem. Is that correct? This is something that we are seeing worldwide. And one story that comes to mind is Kate Middleton. Everyone was paying attention. She's in her 40s. She was diagnosed with cancer and has been getting cancer
treatment. So what are we seeing worldwide, as far as statistics go?
So I would say yes. So it's absolutely a global issue. It's not just us. We might think of these trends as limited to the US, but they're not like colorectal cancer, as we talked about earlier, it's been increasing in countries like the UK, Canada, Australia, and even parts of Europe and Asia. It's not just one part of the world. It's all over, and especially high profile cases like Kate
Middleton. What that does is it really just brings attention to this issue, like when someone in their 40s, especially someone in the public eye, goes through a cancer diagnosis, it's a reminder that anyone, regardless of their lifestyle, their status, they can face this challenge, and it's kind of a wake up call for all of us to be aware of this rising rate of cancer in younger people and the importance of early detection.
And I think it probably goes to help us see, or help us find out what is behind all of this. Because if it were, let's say, just. In developed nations, then you would look at, well, maybe it's related to diet, or maybe it's related somehow to their industrial pollution or that sort of thing. But we're seeing it even in underdeveloped countries, East Asians, Pacific Islanders, South America. So there's something going on that
is affecting us worldwide. It's not limited just to the wealthier developed countries.
I had made the joke about, you know, diet and weight, because those are the things that we hear all the time when it comes to just about any health issue that's out there. We usually can, you know, point the arrow towards our lifestyle. So it's not clear cut with this that we don't really know why we're seeing these rates go up.
No, I would say, in my reading, most people are still in the stage of forming hypotheses. And so you would think about sedentary lifestyle, you would think about processed food. Some people feel it's related to an increase in just general inflammation, related to diet and who knows what, maybe some environmental
pollutant. There are people who are saying that, well, this is something that has been discovered, is that if you look at younger people, their biome, that is the bacteria in their gut, has gotten simpler and simpler compared to older generations, and that is that the number of bacteria and the different species of bacteria has shrunk. And so some people think maybe that's related, at least to colorectal cancer, and maybe to others as well. So there are lots of theories, but
I don't, I don't know. Tiffany, what do you think from your reading?
Yeah, I think there's so much research that still needs to be had and completed, but it's, it's a complex mix of factors. Is what it seems to be like. We talked about poor diet and obesity definitely play a role, especially in the colorectal cancer, I think too, just lack of exercise. We're an amazing country who has technologically advanced tremendously, but what that has also done is we sit in front of a computer, we have less social interaction. We're on our
devices more. And one of the interesting topics I found was how it affects your sleep. Just having that light at night when you're looking at your phone, it affects your circadian rhythm, it affects your social interactions, which increases your stress, causes you to be
more sedentary. So I think with all of the technology advances we have, we do need to be careful that we're still getting out, we're still exercising, we're getting off of those screens before bed, because it definitely, from what I was seeing, that's some of the big new research that they're doing, which is really interesting to me, just affecting your sleep. So that was one of the most important things I looked at.
And then we do just age, you know, they're saying we age differently, and we're aging more rapidly than we have in the past. And that's linked to a lot of different factors as well, including, just when you get an early onset cancer, your cells are more rapidly dividing, and so those cancers become more aggressive faster. And so it's it's a very interesting topic, but I do think there's a lot of research that still needs to happen.
What advice can we give people at this point, then? We should be screening earlier and more? Or? Get more sleep, I'm hearing that. Make sure that you're getting off those devices and that, you know, same advice we always give, eat, right, exercise, be active, specifically towards cancer. Can we talk about the screening thing?
I think one thing that's important is to find out about your family history, because some of this is definitely genetically related, and if you have a family history, and primarily close relatives, parents, siblings, if you have a family history, your risk goes up, and your screening should probably start earlier. So I think that's one thing that
that we can tell people. The other is to see your primary care and make sure that you are getting the screening that you should especially for things like colorectal cancer and breast cancer. We know that we have fairly good early detection, but you have to take advantage of that, and the recommendations from organizations like the American
Cancer Society have changed. We were recommending colorectal screening at age 50, and now that's been lowered to age 45 breast cancer mammograms was recommended at age 45 and now that's lowered to age 40 and I've read advice that if you have a parent who, for instance, maybe had a cancer at, let's say, age 45 then you should start your screening 10 years
younger than that. So you should start your screening at age 35 and that's, I mean, this is somewhat based on your individual risk factors, and the best way to know that is to talk to your family and then talk to your primary care person.
We are typically not getting a primary physician until later in life. A lot of young people use our urgent cares and our ERs as because they just don't have, you know, you have your pediatrician up until 18, and then you have this age gap from 18 to 30 or 40 where you just don't feel like you need a primary doctor if you're fairly healthy or haven't had any
medical problems. And I think it's important that we do get into primary care and establish care with a physician earlier than we historically have, so that when issues come up, we can have those discussions. Or if there are risk factors that require you to get screening early, you're aware of that, and you recognize that, and the doctors can help you with that.
And also, there's genetic counseling, which is, I think, a big key in all of this that people don't realize, because there are some genetic testing that can be done to see if you have that increased risk, which some people want to know and some people don't. And there's a whole field that specializes in this to help you through that, but if we don't have those primary providers early, you don't even recognize this, and before you know it it's too
late. So I think that's one important point in the younger generation, is get get your doctors sooner, not just when you have a problem.
That's great advice. Anything else that we need to be talking about to help folks reduce their risk?
Well, one thing we haven't mentioned yet is the HPV vaccine, the Human Papilloma Virus. There is a very good vaccine for this now you get it in younger age children, and it prevents them from getting that virus. And that virus specifically is linked to cervical cancer and also probably some head and neck cancers, especially in males. So that's an easy thing to do, and it can make a huge difference. So maybe at some point we will have vaccines for other cancers
there. There certainly is a lot of research in that area, but right now that's available, and it's not being taken advantage of, as it as it should be okay.
So let's talk about - you two are definitely the experts here. And I know Tiffany mentioned earlier that more research needs to be done, but I know in a little the little bit of reading that I did, there is some research being done based on what is happening. Do you know what those next steps need to be in research? What are we learning now, and where is that taking us?
There are a lot of medical centers that have developed special research units just to look at these younger onset cancers, and that's fairly new. So I would say the research is still in its infancy. Trying to figure out why this is happening is one aspect of it. The other aspect is that you have to realize that if you have colorectal cancer and you're 80 years old, it doesn't have that huge an impact on your life, because those extra years come at the end
anyway. But if you have that at age 40, you know you probably have young children at home, you have family planning that's going on, you're at sort of the peak of your productive years of work, and it has a huge, huge impact. And also there's a longer time when your cancer might recur, and so it has a
huge impact on your life. And these centers are realizing that, and they're sort of tailoring their approach to this new situation where the cancer has much greater impact on a person's life than we were used to seeing
And I would say that, yeah, some of the key areas of research is what we talked about and what they're looking at right now is environmental toxins, like pollution and the chemicals we used in our food lifestyle factors, which we talked about, you know, sleep devices, diet, exercise and then the genetic
mutations. There's also this growing interest, when I was looking through all of this research in just the molecular biology of early onset cancers, and I alluded to it earlier, where it was talking about, we're aging biologically faster than we historically had, and so they're looking at, why is that? But honestly, we just we need better ways to predict who is at risk, so even researching screening options so that we have earlier recognition and
diagnosis. And then we need more research on targeted therapies, because they do act differently in early onset cancer than older. They're, you know, more rapidly dividing. There's more cell growth, and the cancers are more aggressive. So how do we hit those harder, early, but also knowing that chemo radiation, those tree. Moments
affect your life long term. And so how can we minimize your lifestyle effects and your just life effects after the fact, but also be aggressive in treating it, since they are more rapidly dividing. So I think just large scale studies and clinical trials are critical. They're starting to get done. There's this amazing researcher at Memorial, Sloan Kettering, who recently published in JAMA, and they're doing some really interesting work on
immunotherapy. And so it's it's recognized, and they're working on it, but we're kind of in the infancy of really figuring out how to move forward.
So some hope there, but it might be a ways down the road. So if there is one or two main things that you want to make sure our listeners take away with them today about this topic of early onset cancer, what do you want to make sure we all hear?
Well, I'm going to sound like my mother on some of these.
That's okay. Moms are smart.
So know your family history, get the screening that you need, and then the usual things that I harp on, exercise, healthy diet, eat your fruits and vegetables, your whole grains, the ranchers hate me, minimize your red meat consumption. Stop smoking. That's probably the single most important thing you could do, drink less than I do so, minimize your alcohol intake, get to get an adequate amount of good rest, you know, make your bedroom dark, put your phone
away. So these are all things that we know are generally helpful, whether or not they are specific to this early onset cancer is yet to be really determined, but, but these are good things to do anyway, and it may it may help. Certainly won't hurt. And get your HPV vaccine. Keep up on all of your other vaccinations. I'm done.
I was gonna say that was more than one or two things but all really good. Would you have anything to add to that big old list that Dr K just gave us?
Yes, yeah, I would say I agree with everything Doug said, but, and it's just never too early to start thinking about prevention and early detection. If you're concerned about your risk, make sure you get that physician early. Talk to your health care provider. Just take control of your health, and just know that the things that are unhealthy, that you know are unhealthy, are unhealthy, and do affect your
health long term. And so yes, and I would say one other comment that I feel like we didn't touch on that is very important in early onset cancer and could play a role. Is smoking, so which also correlates to vaping or E cigarettes. There is still a lot of research being done in this field, but it does look like it
is linked to cell damage. And so I think there's a big thought in our younger generation that I'm not smoking, because that has all the bad cancer causing stuff, but I'm vaping, which is healthier. It's actually not. It does damage the cells. It's just it hasn't been around long enough for us to have all of the data we have behind smoking cigarettes, but all of the early data does suggest that it does damage the cells at an alarming rate and can contribute to early
onset cancer. So just keep that in mind, sometimes it can be too good to be true.
And I will add, sometimes people say the screening is is so uncomfortable, like referring specifically to colonoscopy, they've heard horror stories about it, and they don't want to do it, just because it doesn't sound like very much fun. I've gone through it, and it's not that bad. I'm not saying it's fun, but it's really not that bad. And the valuable thing about colonoscopy is they can find polyps that 10 years from now, could turn into cancer, and
they can remove them. And so it's it's more than just screening, it's actually also prevention and treatment. So don't be afraid of the colonoscopy. You know, they sedate you, so you're not really even aware of what's going on. The prep, I was told the prep was going to be awful, and it really wasn't bad at all, so don't be afraid of the screening. It may prolong your life.
Perfect. Thank you. And for those people who are concerned, maybe they do have cancer in their family history, what are the resources that you would advise that they can take advantage of if they want more information?
The American Cancer Society has good information, the National Cancer Institute. And then the usual things we talk about, like Johns Hopkins' website, Yale's website, Tiffany mentioned Memorial Sloan Kettering, they have a really good website.
And I would say the typical website that Montanans love is the Mayo Clinic. Which also has a lot of really good data and information for people looking into that. And then just another plug for your health care provider, they tend to stay up on all of this and know the recommendations and can help you through that family history and whether you need early screening.
Tiffany, I'm interested in having a discussion with you. I in my last well, maybe 10 years or so of er medicine, I felt like I was seeing more brain cancers. Not to say I didn't find one occasionally earlier in my career, but it got to the point where I was finding two or three a year, and I knew if I were seeing that, my partners were probably seeing that. Do you feel like you're seeing any cancer more frequently than in the past?
Yes, Doug, I would say the brain cancer has been alarming to me, but more so the colorectal cancer we have been finding on CAT scan in the ER whether it's a bowel blockage or a tumor that we actually see on the CAT scan. We're finding some of these late and that is the one that has surprised me that I didn't see early in my career, and I've only been in practice for 13 years. We're seeing it and diagnosing it in 30 year olds, and it's aggressive, it's already visible on the CAT scan.
And so that's the one that's really shocked me, but yes, brain cancer as well, but I feel like now that it doesn't shock me as much anymore, because we are seeing it more, and it has been an increased rate. But the colorectal has really been a surprise to me in the younger people. It's shocking.
One thing I've read about colorectal cancer in particular is that as you look at each cohort every 10 years or so, the rate of colorectal developing increases. So if, if you look at the 40 to 50 age range compared to the 30 to 40 to the 20 to 30, the risk, or the incidence, is going up by, you know, 15 to 20% each time you look at a younger cohort, which means whatever is happening is sort of accelerating, and I find that pretty disturbing. Yeah, get your screening.
Yes, absolutely.
I was gonna say that goes back to talk with your primary care provider and and get screened. Definitely, whatever your provider says, Because of your risks, you need to be paying attention so that we can catch those things early. Okay, perfect. Thank you so much both of you, both Dr. Ks, for being with us today. This is a serious topic, but it's one that doesn't have to scare us if we take the right steps to protect our own health.
Absolutely.
And thank you so much for listening. We'll put some resources for you with this episode, as always, if you would like more information about this topic, and if you have a question for Dr K. or Dr K., we can, we can do this again and invite both Dr Ks to be on an episode. Please email us, and that email address is QandAwithDrK@mpqhf.org, and that email address will be with this episode as well. Thank you so much and be well.