November 21, 2024 • 23 mins
Early-onset cancer cases are on the rise. What do we need to know about this concerning trend? How are early-onset cancers different from other cancers? Who is at risk? And what are researchers saying? In this episode of Q&A with Dr. K, we get expert insights from two Dr. Ks: Dr. Doug Kuntzweiler and Dr. Tiffany Kniepkamp.
If you have a question for Dr. K, email QandAwithDrK@mpqhf.org. Your question will remain anonymous.
Additional resources for this episode
Yale Medicine: https://www.yalemedicine.org/news/early-onset-cancer-in-younger-people-on-the-rise
Mayo Clinic: https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/addressing-the-rising-incidence-of-early-onset-colorectal-cancer/mac-20541392
Johns Hopkins: https://www.hopkinsmedicine.org/news/articles/2019/06/an-earlier-onset-for-colorectal-cancer
Memorial Sloan Kettering Cancer Center: https://www.mskcc.org/cancer-care/types/colorectal/center-for-young-onset-colorectal-gastrointestinal-cancer
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Beth Brown (00:10):
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 healthquestions answered, because on Q
and A with Dr K, the doctor isalways in.
(00:34):
Hello, everyone. This is BethBrown, your host, and we are so
excited to have Dr. K squared.
Today we have two Dr. Ks joiningus for this episode of Q and A
with Dr. K, and so as usual,we're joined by Dr. Doug
Kuntzweiler, our chief medicalofficer at Mountain Pacific. And
today we also have Dr. TiffanyKniepkamp. So welcome both Dr
(00:57):
Ks!
Dr. Doug Kuntzweiler (01:00):
Thank you.
Dr. Tiffany Kniepkamp (01:01):
Thank you. Happy to be here.
Beth Brown (01:02):
Yeah, it's great to have you. So we are going to
talk about early onset cancertoday. That is what we're going
to tackle a little bit. Andpeople paying attention to the
latest in health news, maybehave started noticing concerns
about cancer cases in youngerpeople are sharply on the rise.
And so we want to talk todayabout why is this happening? Why
(01:25):
should we be concerned? And canwe do anything to get those
numbers to either even out or godown, so that they aren't on the
rise anymore? So let's breakdown those questions and take
them one at a time. So let'sfirst start with what is early
onset cancer? Because we knowkids can get cancer.
(01:45):
Unfortunately, you know cancerstrikes at any age. So what the
heck do we mean when we sayearly onset cancer?
Dr. Doug Kuntzweiler (01:53):
Well, to some extent, it's semantics, but
what we're talking about isseeing cancers that typically we
used to see in people when theywere in their 60s and 70s. Now
we're seeing them show up ingreater numbers when people are
in their 30s, 40s, even 50s.
That's my understanding.
(02:14):
Tiffany, do you agree?
Dr. Tiffany Kniepkamp (02:16):
Yeah, I would. I would say we're even
talking about people in their20s at this stage. And I think
it's important to note that somecancers, which we traditionally
associate with olderpopulations, they're now
increasing in that youngerpopulation. So we historically
hadn't seen them in the youngerand now we are, for example,
(02:36):
like colorectal cancer, breastcancer, melanoma, they're
showing up frequently in youngerpeople, but childhood cancer is
tragic and real, but early onsetis just a little bit different.
It's more that 20s, 30s, 40s and50s,
Beth Brown (02:54):
And you already started to answer what my next
question was, which is, arethere specific cancers that are
on the rise among these youngeradults.
Dr. Doug Kuntzweiler (03:03):
There are, but it's actually a pretty broad
range. Colorectal is probablythe leading one, and I've read
that that is now the leadingcancer death in males under the
age of 50, which used to be, youknow, lung cancer and prostate
cancer. Now it's colorectalcancer, but colorectal and as
Tiffany mentioned, breast,prostate, uterine, gastric
(03:27):
cancer, pancreatic cancer,myelomas, it's a fairly broad
range.
Beth Brown (03:33):
Yikes. Okay, and so before we just start honing in
on how terrible America is whenit comes with the way we eat and
how much we weigh and all ofthat stuff. I think it's also
important to note that this isnot just a US. Problem. Is that
correct? This is something thatwe are seeing worldwide. And one
story that comes to mind is KateMiddleton. Everyone was paying
(03:53):
attention. She's in her 40s. Shewas diagnosed with cancer and
has been getting cancertreatment. So what are we seeing
worldwide, as far as statisticsgo?
Dr. Tiffany Kniepkamp (04:02):
So I would say yes. So it's
absolutely a global issue. It'snot just us. We might think of
these trends as limited to theUS, but they're not like
colorectal cancer, as we talkedabout earlier, it's been
increasing in countries like theUK, Canada, Australia, and even
parts of Europe and Asia. It'snot just one part of the world.
It's all over, and especiallyhigh profile cases like Kate
(04:25):
Middleton. What that does is itreally just brings attention to
this issue, like when someone intheir 40s, especially someone in
the public eye, goes through acancer diagnosis, it's a
reminder that anyone, regardlessof their lifestyle, their
status, they can face thischallenge, and it's kind of a
wake up call for all of us to beaware of this rising rate of
(04:46):
cancer in younger people and theimportance of early detection.
Dr. Doug Kuntzweiler (04:49):
And I think it probably goes to help
us see, or help us find out whatis behind all of this. Because
if it were, let's say, just. Indeveloped nations, then you
would look at, well, maybe it'srelated to diet, or maybe it's
related somehow to theirindustrial pollution or that
sort of thing. But we're seeingit even in underdeveloped
(05:12):
countries, East Asians, PacificIslanders, South America. So
there's something going on thatis affecting us worldwide. It's
not limited just to thewealthier developed countries.
Beth Brown (05:24):
I had made the joke about, you know, diet and
weight, because those are thethings that we hear all the time
when it comes to just about anyhealth issue that's out there.
We usually can, you know, pointthe arrow towards our lifestyle.
So it's not clear cut with thisthat we don't really know why
we're seeing these rates go up.
Dr. Doug Kuntzweiler (05:44):
No, I would say, in my reading, most
people are still in the stage offorming hypotheses. And so you
would think about sedentarylifestyle, you would think about
processed food. Some people feelit's related to an increase in
just general inflammation,related to diet and who knows
what, maybe some environmentalpollutant. There are people who
(06:07):
are saying that, well, this issomething that has been
discovered, is that if you lookat younger people, their biome,
that is the bacteria in theirgut, has gotten simpler and
simpler compared to oldergenerations, and that is that
the number of bacteria and thedifferent species of bacteria
has shrunk. And so some peoplethink maybe that's related, at
(06:30):
least to colorectal cancer, andmaybe to others as well. So
there are lots of theories, butI don't, I don't know. Tiffany,
what do you think from yourreading?
Unknown (06:39):
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 belike. We talked about poor diet
and obesity definitely play arole, especially in the
colorectal cancer, I think too,just lack of exercise. We're an
amazing country who hastechnologically advanced
(07:02):
tremendously, but what that hasalso done is we sit in front of
a computer, we have less socialinteraction. We're on our
devices more. And one of theinteresting topics I found was
how it affects your sleep. Justhaving that light at night when
you're looking at your phone, itaffects your circadian rhythm,
(07:22):
it affects your socialinteractions, which increases
your stress, causes you to bemore sedentary. So I think with
all of the technology advanceswe have, we do need to be
careful that we're still gettingout, we're still exercising,
we're getting off of thosescreens before bed, because it
definitely, from what I wasseeing, that's some of the big
(07:43):
new research that they're doing,which is really interesting to
me, just affecting your sleep.
So that was one of the mostimportant things I looked at.
And then we do just age, youknow, they're saying we age
differently, and we're agingmore rapidly than we have in the
past. And that's linked to a lotof different factors as well,
including, just when you get anearly onset cancer, your cells
(08:05):
are more rapidly dividing, andso those cancers become more
aggressive faster. And so it'sit's a very interesting topic,
but I do think there's a lot ofresearch that still needs to
happen.
Beth Brown (08:18):
What advice can we give people at this point, then?
We should be screening earlierand more? Or? Get more sleep,
I'm hearing that. Make sure thatyou're getting off those devices
and that, you know, same advicewe always give, eat, right,
exercise, be active,specifically towards cancer. Can
we talk about the screeningthing?
Dr. Doug Kuntzweiler (08:39):
I think one thing that's important is to
find out about your familyhistory, because some of this is
definitely genetically related,and if you have a family
history, and primarily closerelatives, parents, siblings, if
you have a family history, yourrisk goes up, and your screening
(09:00):
should probably start earlier.
So I think that's one thing thatthat we can tell people. The
other is to see your primarycare and make sure that you are
getting the screening that youshould especially for things
like colorectal cancer andbreast cancer. We know that we
have fairly good earlydetection, but you have to take
(09:20):
advantage of that, and therecommendations from
organizations like the AmericanCancer Society have changed. We
were recommending colorectalscreening at age 50, and now
that's been lowered to age 45breast cancer mammograms was
recommended at age 45 and nowthat's lowered to age 40 and
I've read advice that if youhave a parent who, for instance,
(09:41):
maybe had a cancer at, let'ssay, age 45 then you should
start your screening 10 yearsyounger than that. So you should
start your screening at age 35and that's, I mean, this is
somewhat based on yourindividual risk factors, and the
best way to know that is to talkto your family and then talk to
(10:03):
your primary care person.
Dr. Tiffany Kniepkamp (10:07):
We are typically not getting a primary
physician until later in life. Alot of young people use our
urgent cares and our ERs asbecause they just don't have,
you know, you have yourpediatrician up until 18, and
then you have this age gap from18 to 30 or 40 where you just
don't feel like you need aprimary doctor if you're fairly
(10:27):
healthy or haven't had anymedical problems. And I think
it's important that we do getinto primary care and establish
care with a physician earlierthan we historically have, so
that when issues come up, we canhave those discussions. Or if
there are risk factors thatrequire you to get screening
early, you're aware of that, andyou recognize that, and the
(10:50):
doctors can help you with that.
And also, there's geneticcounseling, which is, I think, a
big key in all of this thatpeople don't realize, because
there are some genetic testingthat can be done to see if you
have that increased risk, whichsome people want to know and
some people don't. And there's awhole field that specializes in
(11:11):
this to help you through that,but if we don't have those
primary providers early, youdon't even recognize this, and
before you know it it's toolate. So I think that's one
important point in the youngergeneration, is get get your
doctors sooner, not just whenyou have a problem.
Beth Brown (11:28):
That's great advice.
Anything else that we need to betalking about to help folks
reduce their risk?
Dr. Doug Kuntzweiler (11:36):
Well, one thing we haven't mentioned yet
is the HPV vaccine, the HumanPapilloma Virus. There is a very
good vaccine for this now youget it in younger age children,
and it prevents them fromgetting that virus. And that
virus specifically is linked tocervical cancer and also
(11:59):
probably some head and neckcancers, especially in males. So
that's an easy thing to do, andit can make a huge difference.
So maybe at some point we willhave vaccines for other cancers
there. There certainly is a lotof research in that area, but
right now that's available, andit's not being taken advantage
of, as it as it should be okay.
Beth Brown (12:21):
So let's talk about - you two are definitely the
experts here. And I know Tiffanymentioned earlier that more
research needs to be done, but Iknow in a little the little bit
of reading that I did, there issome research being done based
on what is happening. Do youknow what those next steps need
to be in research? What are welearning now, and where is that
taking us?
Dr. Doug Kuntzweiler (12:40):
There are a lot of medical centers that
have developed special researchunits just to look at these
younger onset cancers, andthat's fairly new. So I would
say the research is still in itsinfancy. Trying to figure out
why this is happening is oneaspect of it. The other aspect
(13:03):
is that you have to realize thatif you have colorectal cancer
and you're 80 years old, itdoesn't have that huge an impact
on your life, because thoseextra years come at the end
anyway. But if you have that atage 40, you know you probably
have young children at home, youhave family planning that's
going on, you're at sort of thepeak of your productive years of
(13:25):
work, and it has a huge, hugeimpact. And also there's a
longer time when your cancermight recur, and so it has a
huge impact on your life. Andthese centers are realizing
that, and they're sort oftailoring their approach to this
new situation where the cancerhas much greater impact on a
person's life than we were usedto seeing
Dr. Tiffany Kniepkamp (13:49):
And I would say that, yeah, some of
the key areas of research iswhat we talked about and what
they're looking at right now isenvironmental toxins, like
pollution and the chemicals weused in our food lifestyle
factors, which we talked about,you know, sleep devices, diet,
exercise and then the geneticmutations. There's also this
(14:12):
growing interest, when I waslooking through all of this
research in just the molecularbiology of early onset cancers,
and I alluded to it earlier,where it was talking about,
we're aging biologically fasterthan we historically had, and so
they're looking at, why is that?
But honestly, we just we needbetter ways to predict who is at
risk, so even researchingscreening options so that we
(14:36):
have earlier recognition anddiagnosis. And then we need more
research on targeted therapies,because they do act differently
in early onset cancer thanolder. They're, you know, more
rapidly dividing. There's morecell growth, and the cancers are
more aggressive. So how do wehit those harder, early, but
also knowing that chemoradiation, those tree. Moments
(14:58):
affect your life long term. Andso how can we minimize your
lifestyle effects and your justlife effects after the fact, but
also be aggressive in treatingit, since they are more rapidly
dividing. So I think just largescale studies and clinical
trials are critical. They'restarting to get done. There's
this amazing researcher atMemorial, Sloan Kettering, who
(15:21):
recently published in JAMA, andthey're doing some really
interesting work onimmunotherapy. And so it's it's
recognized, and they're workingon it, but we're kind of in the
infancy of really figuring outhow to move forward.
Beth Brown (15:38):
So some hope there, but it might be a ways down the
road. So if there is one or twomain things that you want to
make sure our listeners takeaway with them today about this
topic of early onset cancer,what do you want to make sure we
all hear?
Dr. Doug Kuntzweiler (15:53):
Well, I'm going to sound like my mother on
some of these.
Beth Brown (15:57):
That's okay. Moms are smart.
Dr. Doug Kuntzweiler (15:59):
So know your family history, get the
screening that you need, andthen the usual things that I
harp on, exercise, healthy diet,eat your fruits and vegetables,
your whole grains, the ranchershate me, minimize your red meat
consumption. Stop smoking.
That's probably the single mostimportant thing you could do,
(16:20):
drink less than I do so,minimize your alcohol intake,
get to get an adequate amount ofgood rest, you know, make your
bedroom dark, put your phoneaway. So these are all things
that we know are generallyhelpful, whether or not they are
specific to this early onsetcancer is yet to be really
(16:42):
determined, but, but these aregood things to do anyway, and it
may it may help. Certainly won'thurt. And get your HPV vaccine.
Keep up on all of your othervaccinations. I'm done.
Beth Brown (16:56):
I was gonna say that was more than one or two things
but all really good. Would youhave anything to add to that big
old list that Dr K just gave us?
Dr. Tiffany Kniepkamp (17:05):
Yes, yeah, I would say I agree with
everything Doug said, but, andit's just never too early to
start thinking about preventionand early detection. If you're
concerned about your risk, makesure you get that physician
early. Talk to your health careprovider. Just take control of
your health, and just know thatthe things that are unhealthy,
(17:26):
that you know are unhealthy, areunhealthy, and do affect your
health long term. And so yes,and I would say one other
comment that I feel like wedidn't touch on that is very
important in early onset cancerand could play a role. Is
smoking, so which alsocorrelates to vaping or E
(17:46):
cigarettes. There is still a lotof research being done in this
field, but it does look like itis linked to cell damage. And so
I think there's a big thought inour younger generation that I'm
not smoking, because that hasall the bad cancer causing
stuff, but I'm vaping, which ishealthier. It's actually not. It
(18:08):
does damage the cells. It's justit hasn't been around long
enough for us to have all of thedata we have behind smoking
cigarettes, but all of the earlydata does suggest that it does
damage the cells at an alarmingrate and can contribute to early
onset cancer. So just keep thatin mind, sometimes it can be too
(18:31):
good to be true.
Dr. Doug Kuntzweiler (18:34):
And I will add, sometimes people say the
screening is is souncomfortable, like referring
specifically to colonoscopy,they've heard horror stories
about it, and they don't want todo it, just because it doesn't
sound like very much fun. I'vegone through it, and it's not
that bad. I'm not saying it'sfun, but it's really not that
(18:55):
bad. And the valuable thingabout colonoscopy is they can
find polyps that 10 years fromnow, could turn into cancer, and
they can remove them. And soit's it's more than just
screening, it's actually alsoprevention and treatment. So
don't be afraid of thecolonoscopy. You know, they
sedate you, so you're not reallyeven aware of what's going on.
(19:17):
The prep, I was told the prepwas going to be awful, and it
really wasn't bad at all, sodon't be afraid of the
screening. It may prolong yourlife.
Beth Brown (19:27):
Perfect. Thank you.
And for those people who areconcerned, maybe they do have
cancer in their family history,what are the resources that you
would advise that they can takeadvantage of if they want more
information?
Dr. Doug Kuntzweiler (19:39):
The American Cancer Society has good
information, the National CancerInstitute. And then the usual
things we talk about, like JohnsHopkins' website, Yale's
website, Tiffany mentionedMemorial Sloan Kettering, they
have a really good website.
Dr. Tiffany Kniepkamp (19:55):
And I would say the typical website
that Montanans love is the MayoClinic. Which also has a lot of
really good data and informationfor people looking into that.
And then just another plug foryour health care provider, they
tend to stay up on all of thisand know the recommendations and
can help you through that familyhistory and whether you need
(20:16):
early screening.
Dr. Doug Kuntzweiler (20:17):
Tiffany, I'm interested in having a
discussion with you. I in mylast well, maybe 10 years or so
of er medicine, I felt like Iwas seeing more brain cancers.
Not to say I didn't find oneoccasionally earlier in my
career, but it got to the pointwhere I was finding two or three
a year, and I knew if I wereseeing that, my partners were
(20:39):
probably seeing that. Do youfeel like you're seeing any
cancer more frequently than inthe past?
Dr. Tiffany Kniepkamp (20:45):
Yes, Doug, I would say the brain
cancer has been alarming to me,but more so the colorectal
cancer we have been finding onCAT scan in the ER whether it's
a bowel blockage or a tumor thatwe actually see on the CAT scan.
We're finding some of these lateand that is the one that has
(21:06):
surprised me that I didn't seeearly in my career, and I've
only been in practice for 13years. 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'sreally shocked me, but yes,
brain cancer as well, but I feellike now that it doesn't shock
me as much anymore, because weare seeing it more, and it has
(21:27):
been an increased rate. But thecolorectal has really been a
surprise to me in the youngerpeople. It's shocking.
Dr. Doug Kuntzweiler (21:37):
One thing I've read about colorectal
cancer in particular is that asyou look at each cohort every 10
years or so, the rate ofcolorectal developing increases.
So if, if you look at the 40 to50 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% eachtime you look at a younger
(22:01):
cohort, which means whatever ishappening is sort of
accelerating, and I find thatpretty disturbing. Yeah, get
your screening.
Dr. Tiffany Kniepkamp (22:10):
Yes, absolutely.
Beth Brown (22:12):
I was gonna say that goes back to talk with your
primary care provider and andget screened. Definitely,
whatever your provider says,Because of your risks, you need
to be paying attention so thatwe can catch those things early.
Okay, perfect. Thank you so muchboth of you, both Dr. Ks, for
being with us today. This is aserious topic, but it's one that
(22:35):
doesn't have to scare us if wetake the right steps to protect
our own health.
Dr. Doug Kuntzweile (22:39):
Absolutely.
Beth Brown (22:40):
And thank you so much for listening. We'll put
some resources for you with thisepisode, as always, if you would
like more information about thistopic, and if you have a
question for Dr K. or Dr K., wecan, we can do this again and
invite both Dr Ks to be on anepisode. Please email us, and
that email address isQandAwithDrK@mpqhf.org, and that
(23:03):
email address will be with thisepisode as well. Thank you so
much and be well.
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 healthquestions answered, because on Q
and A with Dr K, the doctor isalways in.
(00:34):
Hello, everyone. This is BethBrown, your host, and we are so
excited to have Dr. K squared.
Today we have two Dr. Ks joiningus for this episode of Q and A
with Dr. K, and so as usual,we're joined by Dr. Doug
Kuntzweiler, our chief medicalofficer at Mountain Pacific. And
today we also have Dr. TiffanyKniepkamp. So welcome both Dr
(00:57):
Ks!
Dr. Doug Kuntzweiler (01:00):
Thank you.
Dr. Tiffany Kniepkamp (01:01):
Thank you. Happy to be here.
Beth Brown (01:02):
Yeah, it's great to have you. So we are going to
talk about early onset cancertoday. That is what we're going
to tackle a little bit. Andpeople paying attention to the
latest in health news, maybehave started noticing concerns
about cancer cases in youngerpeople are sharply on the rise.
And so we want to talk todayabout why is this happening? Why
(01:25):
should we be concerned? And canwe do anything to get those
numbers to either even out or godown, so that they aren't on the
rise anymore? So let's breakdown those questions and take
them one at a time. So let'sfirst start with what is early
onset cancer? Because we knowkids can get cancer.
(01:45):
Unfortunately, you know cancerstrikes at any age. So what the
heck do we mean when we sayearly onset cancer?
Dr. Doug Kuntzweiler (01:53):
Well, to some extent, it's semantics, but
what we're talking about isseeing cancers that typically we
used to see in people when theywere in their 60s and 70s. Now
we're seeing them show up ingreater numbers when people are
in their 30s, 40s, even 50s.
That's my understanding.
(02:14):
Tiffany, do you agree?
Dr. Tiffany Kniepkamp (02:16):
Yeah, I would. I would say we're even
talking about people in their20s at this stage. And I think
it's important to note that somecancers, which we traditionally
associate with olderpopulations, they're now
increasing in that youngerpopulation. So we historically
hadn't seen them in the youngerand now we are, for example,
(02:36):
like colorectal cancer, breastcancer, melanoma, they're
showing up frequently in youngerpeople, but childhood cancer is
tragic and real, but early onsetis just a little bit different.
It's more that 20s, 30s, 40s and50s,
Beth Brown (02:54):
And you already started to answer what my next
question was, which is, arethere specific cancers that are
on the rise among these youngeradults.
Dr. Doug Kuntzweiler (03:03):
There are, but it's actually a pretty broad
range. Colorectal is probablythe leading one, and I've read
that that is now the leadingcancer death in males under the
age of 50, which used to be, youknow, lung cancer and prostate
cancer. Now it's colorectalcancer, but colorectal and as
Tiffany mentioned, breast,prostate, uterine, gastric
(03:27):
cancer, pancreatic cancer,myelomas, it's a fairly broad
range.
Beth Brown (03:33):
Yikes. Okay, and so before we just start honing in
on how terrible America is whenit comes with the way we eat and
how much we weigh and all ofthat stuff. I think it's also
important to note that this isnot just a US. Problem. Is that
correct? This is something thatwe are seeing worldwide. And one
story that comes to mind is KateMiddleton. Everyone was paying
(03:53):
attention. She's in her 40s. Shewas diagnosed with cancer and
has been getting cancertreatment. So what are we seeing
worldwide, as far as statisticsgo?
Dr. Tiffany Kniepkamp (04:02):
So I would say yes. So it's
absolutely a global issue. It'snot just us. We might think of
these trends as limited to theUS, but they're not like
colorectal cancer, as we talkedabout earlier, it's been
increasing in countries like theUK, Canada, Australia, and even
parts of Europe and Asia. It'snot just one part of the world.
It's all over, and especiallyhigh profile cases like Kate
(04:25):
Middleton. What that does is itreally just brings attention to
this issue, like when someone intheir 40s, especially someone in
the public eye, goes through acancer diagnosis, it's a
reminder that anyone, regardlessof their lifestyle, their
status, they can face thischallenge, and it's kind of a
wake up call for all of us to beaware of this rising rate of
(04:46):
cancer in younger people and theimportance of early detection.
Dr. Doug Kuntzweiler (04:49):
And I think it probably goes to help
us see, or help us find out whatis behind all of this. Because
if it were, let's say, just. Indeveloped nations, then you
would look at, well, maybe it'srelated to diet, or maybe it's
related somehow to theirindustrial pollution or that
sort of thing. But we're seeingit even in underdeveloped
(05:12):
countries, East Asians, PacificIslanders, South America. So
there's something going on thatis affecting us worldwide. It's
not limited just to thewealthier developed countries.
Beth Brown (05:24):
I had made the joke about, you know, diet and
weight, because those are thethings that we hear all the time
when it comes to just about anyhealth issue that's out there.
We usually can, you know, pointthe arrow towards our lifestyle.
So it's not clear cut with thisthat we don't really know why
we're seeing these rates go up.
Dr. Doug Kuntzweiler (05:44):
No, I would say, in my reading, most
people are still in the stage offorming hypotheses. And so you
would think about sedentarylifestyle, you would think about
processed food. Some people feelit's related to an increase in
just general inflammation,related to diet and who knows
what, maybe some environmentalpollutant. There are people who
(06:07):
are saying that, well, this issomething that has been
discovered, is that if you lookat younger people, their biome,
that is the bacteria in theirgut, has gotten simpler and
simpler compared to oldergenerations, and that is that
the number of bacteria and thedifferent species of bacteria
has shrunk. And so some peoplethink maybe that's related, at
(06:30):
least to colorectal cancer, andmaybe to others as well. So
there are lots of theories, butI don't, I don't know. Tiffany,
what do you think from yourreading?
Unknown (06:39):
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 belike. We talked about poor diet
and obesity definitely play arole, especially in the
colorectal cancer, I think too,just lack of exercise. We're an
amazing country who hastechnologically advanced
(07:02):
tremendously, but what that hasalso done is we sit in front of
a computer, we have less socialinteraction. We're on our
devices more. And one of theinteresting topics I found was
how it affects your sleep. Justhaving that light at night when
you're looking at your phone, itaffects your circadian rhythm,
(07:22):
it affects your socialinteractions, which increases
your stress, causes you to bemore sedentary. So I think with
all of the technology advanceswe have, we do need to be
careful that we're still gettingout, we're still exercising,
we're getting off of thosescreens before bed, because it
definitely, from what I wasseeing, that's some of the big
(07:43):
new research that they're doing,which is really interesting to
me, just affecting your sleep.
So that was one of the mostimportant things I looked at.
And then we do just age, youknow, they're saying we age
differently, and we're agingmore rapidly than we have in the
past. And that's linked to a lotof different factors as well,
including, just when you get anearly onset cancer, your cells
(08:05):
are more rapidly dividing, andso those cancers become more
aggressive faster. And so it'sit's a very interesting topic,
but I do think there's a lot ofresearch that still needs to
happen.
Beth Brown (08:18):
What advice can we give people at this point, then?
We should be screening earlierand more? Or? Get more sleep,
I'm hearing that. Make sure thatyou're getting off those devices
and that, you know, same advicewe always give, eat, right,
exercise, be active,specifically towards cancer. Can
we talk about the screeningthing?
Dr. Doug Kuntzweiler (08:39):
I think one thing that's important is to
find out about your familyhistory, because some of this is
definitely genetically related,and if you have a family
history, and primarily closerelatives, parents, siblings, if
you have a family history, yourrisk goes up, and your screening
(09:00):
should probably start earlier.
So I think that's one thing thatthat we can tell people. The
other is to see your primarycare and make sure that you are
getting the screening that youshould especially for things
like colorectal cancer andbreast cancer. We know that we
have fairly good earlydetection, but you have to take
(09:20):
advantage of that, and therecommendations from
organizations like the AmericanCancer Society have changed. We
were recommending colorectalscreening at age 50, and now
that's been lowered to age 45breast cancer mammograms was
recommended at age 45 and nowthat's lowered to age 40 and
I've read advice that if youhave a parent who, for instance,
(09:41):
maybe had a cancer at, let'ssay, age 45 then you should
start your screening 10 yearsyounger than that. So you should
start your screening at age 35and that's, I mean, this is
somewhat based on yourindividual risk factors, and the
best way to know that is to talkto your family and then talk to
(10:03):
your primary care person.
Dr. Tiffany Kniepkamp (10:07):
We are typically not getting a primary
physician until later in life. Alot of young people use our
urgent cares and our ERs asbecause they just don't have,
you know, you have yourpediatrician up until 18, and
then you have this age gap from18 to 30 or 40 where you just
don't feel like you need aprimary doctor if you're fairly
(10:27):
healthy or haven't had anymedical problems. And I think
it's important that we do getinto primary care and establish
care with a physician earlierthan we historically have, so
that when issues come up, we canhave those discussions. Or if
there are risk factors thatrequire you to get screening
early, you're aware of that, andyou recognize that, and the
(10:50):
doctors can help you with that.
And also, there's geneticcounseling, which is, I think, a
big key in all of this thatpeople don't realize, because
there are some genetic testingthat can be done to see if you
have that increased risk, whichsome people want to know and
some people don't. And there's awhole field that specializes in
(11:11):
this to help you through that,but if we don't have those
primary providers early, youdon't even recognize this, and
before you know it it's toolate. So I think that's one
important point in the youngergeneration, is get get your
doctors sooner, not just whenyou have a problem.
Beth Brown (11:28):
That's great advice.
Anything else that we need to betalking about to help folks
reduce their risk?
Dr. Doug Kuntzweiler (11:36):
Well, one thing we haven't mentioned yet
is the HPV vaccine, the HumanPapilloma Virus. There is a very
good vaccine for this now youget it in younger age children,
and it prevents them fromgetting that virus. And that
virus specifically is linked tocervical cancer and also
(11:59):
probably some head and neckcancers, especially in males. So
that's an easy thing to do, andit can make a huge difference.
So maybe at some point we willhave vaccines for other cancers
there. There certainly is a lotof research in that area, but
right now that's available, andit's not being taken advantage
of, as it as it should be okay.
Beth Brown (12:21):
So let's talk about - you two are definitely the
experts here. And I know Tiffanymentioned earlier that more
research needs to be done, but Iknow in a little the little bit
of reading that I did, there issome research being done based
on what is happening. Do youknow what those next steps need
to be in research? What are welearning now, and where is that
taking us?
Dr. Doug Kuntzweiler (12:40):
There are a lot of medical centers that
have developed special researchunits just to look at these
younger onset cancers, andthat's fairly new. So I would
say the research is still in itsinfancy. Trying to figure out
why this is happening is oneaspect of it. The other aspect
(13:03):
is that you have to realize thatif you have colorectal cancer
and you're 80 years old, itdoesn't have that huge an impact
on your life, because thoseextra years come at the end
anyway. But if you have that atage 40, you know you probably
have young children at home, youhave family planning that's
going on, you're at sort of thepeak of your productive years of
(13:25):
work, and it has a huge, hugeimpact. And also there's a
longer time when your cancermight recur, and so it has a
huge impact on your life. Andthese centers are realizing
that, and they're sort oftailoring their approach to this
new situation where the cancerhas much greater impact on a
person's life than we were usedto seeing
Dr. Tiffany Kniepkamp (13:49):
And I would say that, yeah, some of
the key areas of research iswhat we talked about and what
they're looking at right now isenvironmental toxins, like
pollution and the chemicals weused in our food lifestyle
factors, which we talked about,you know, sleep devices, diet,
exercise and then the geneticmutations. There's also this
(14:12):
growing interest, when I waslooking through all of this
research in just the molecularbiology of early onset cancers,
and I alluded to it earlier,where it was talking about,
we're aging biologically fasterthan we historically had, and so
they're looking at, why is that?
But honestly, we just we needbetter ways to predict who is at
risk, so even researchingscreening options so that we
(14:36):
have earlier recognition anddiagnosis. And then we need more
research on targeted therapies,because they do act differently
in early onset cancer thanolder. They're, you know, more
rapidly dividing. There's morecell growth, and the cancers are
more aggressive. So how do wehit those harder, early, but
also knowing that chemoradiation, those tree. Moments
(14:58):
affect your life long term. Andso how can we minimize your
lifestyle effects and your justlife effects after the fact, but
also be aggressive in treatingit, since they are more rapidly
dividing. So I think just largescale studies and clinical
trials are critical. They'restarting to get done. There's
this amazing researcher atMemorial, Sloan Kettering, who
(15:21):
recently published in JAMA, andthey're doing some really
interesting work onimmunotherapy. And so it's it's
recognized, and they're workingon it, but we're kind of in the
infancy of really figuring outhow to move forward.
Beth Brown (15:38):
So some hope there, but it might be a ways down the
road. So if there is one or twomain things that you want to
make sure our listeners takeaway with them today about this
topic of early onset cancer,what do you want to make sure we
all hear?
Dr. Doug Kuntzweiler (15:53):
Well, I'm going to sound like my mother on
some of these.
Beth Brown (15:57):
That's okay. Moms are smart.
Dr. Doug Kuntzweiler (15:59):
So know your family history, get the
screening that you need, andthen the usual things that I
harp on, exercise, healthy diet,eat your fruits and vegetables,
your whole grains, the ranchershate me, minimize your red meat
consumption. Stop smoking.
That's probably the single mostimportant thing you could do,
(16:20):
drink less than I do so,minimize your alcohol intake,
get to get an adequate amount ofgood rest, you know, make your
bedroom dark, put your phoneaway. So these are all things
that we know are generallyhelpful, whether or not they are
specific to this early onsetcancer is yet to be really
(16:42):
determined, but, but these aregood things to do anyway, and it
may it may help. Certainly won'thurt. And get your HPV vaccine.
Keep up on all of your othervaccinations. I'm done.
Beth Brown (16:56):
I was gonna say that was more than one or two things
but all really good. Would youhave anything to add to that big
old list that Dr K just gave us?
Dr. Tiffany Kniepkamp (17:05):
Yes, yeah, I would say I agree with
everything Doug said, but, andit's just never too early to
start thinking about preventionand early detection. If you're
concerned about your risk, makesure you get that physician
early. Talk to your health careprovider. Just take control of
your health, and just know thatthe things that are unhealthy,
(17:26):
that you know are unhealthy, areunhealthy, and do affect your
health long term. And so yes,and I would say one other
comment that I feel like wedidn't touch on that is very
important in early onset cancerand could play a role. Is
smoking, so which alsocorrelates to vaping or E
(17:46):
cigarettes. There is still a lotof research being done in this
field, but it does look like itis linked to cell damage. And so
I think there's a big thought inour younger generation that I'm
not smoking, because that hasall the bad cancer causing
stuff, but I'm vaping, which ishealthier. It's actually not. It
(18:08):
does damage the cells. It's justit hasn't been around long
enough for us to have all of thedata we have behind smoking
cigarettes, but all of the earlydata does suggest that it does
damage the cells at an alarmingrate and can contribute to early
onset cancer. So just keep thatin mind, sometimes it can be too
(18:31):
good to be true.
Dr. Doug Kuntzweiler (18:34):
And I will add, sometimes people say the
screening is is souncomfortable, like referring
specifically to colonoscopy,they've heard horror stories
about it, and they don't want todo it, just because it doesn't
sound like very much fun. I'vegone through it, and it's not
that bad. I'm not saying it'sfun, but it's really not that
(18:55):
bad. And the valuable thingabout colonoscopy is they can
find polyps that 10 years fromnow, could turn into cancer, and
they can remove them. And soit's it's more than just
screening, it's actually alsoprevention and treatment. So
don't be afraid of thecolonoscopy. You know, they
sedate you, so you're not reallyeven aware of what's going on.
(19:17):
The prep, I was told the prepwas going to be awful, and it
really wasn't bad at all, sodon't be afraid of the
screening. It may prolong yourlife.
Beth Brown (19:27):
Perfect. Thank you.
And for those people who areconcerned, maybe they do have
cancer in their family history,what are the resources that you
would advise that they can takeadvantage of if they want more
information?
Dr. Doug Kuntzweiler (19:39):
The American Cancer Society has good
information, the National CancerInstitute. And then the usual
things we talk about, like JohnsHopkins' website, Yale's
website, Tiffany mentionedMemorial Sloan Kettering, they
have a really good website.
Dr. Tiffany Kniepkamp (19:55):
And I would say the typical website
that Montanans love is the MayoClinic. Which also has a lot of
really good data and informationfor people looking into that.
And then just another plug foryour health care provider, they
tend to stay up on all of thisand know the recommendations and
can help you through that familyhistory and whether you need
(20:16):
early screening.
Dr. Doug Kuntzweiler (20:17):
Tiffany, I'm interested in having a
discussion with you. I in mylast well, maybe 10 years or so
of er medicine, I felt like Iwas seeing more brain cancers.
Not to say I didn't find oneoccasionally earlier in my
career, but it got to the pointwhere I was finding two or three
a year, and I knew if I wereseeing that, my partners were
(20:39):
probably seeing that. Do youfeel like you're seeing any
cancer more frequently than inthe past?
Dr. Tiffany Kniepkamp (20:45):
Yes, Doug, I would say the brain
cancer has been alarming to me,but more so the colorectal
cancer we have been finding onCAT scan in the ER whether it's
a bowel blockage or a tumor thatwe actually see on the CAT scan.
We're finding some of these lateand that is the one that has
(21:06):
surprised me that I didn't seeearly in my career, and I've
only been in practice for 13years. 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'sreally shocked me, but yes,
brain cancer as well, but I feellike now that it doesn't shock
me as much anymore, because weare seeing it more, and it has
(21:27):
been an increased rate. But thecolorectal has really been a
surprise to me in the youngerpeople. It's shocking.
Dr. Doug Kuntzweiler (21:37):
One thing I've read about colorectal
cancer in particular is that asyou look at each cohort every 10
years or so, the rate ofcolorectal developing increases.
So if, if you look at the 40 to50 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% eachtime you look at a younger
(22:01):
cohort, which means whatever ishappening is sort of
accelerating, and I find thatpretty disturbing. Yeah, get
your screening.
Dr. Tiffany Kniepkamp (22:10):
Yes, absolutely.
Beth Brown (22:12):
I was gonna say that goes back to talk with your
primary care provider and andget screened. Definitely,
whatever your provider says,Because of your risks, you need
to be paying attention so thatwe can catch those things early.
Okay, perfect. Thank you so muchboth of you, both Dr. Ks, for
being with us today. This is aserious topic, but it's one that
(22:35):
doesn't have to scare us if wetake the right steps to protect
our own health.
Dr. Doug Kuntzweile (22:39):
Absolutely.
Beth Brown (22:40):
And thank you so much for listening. We'll put
some resources for you with thisepisode, as always, if you would
like more information about thistopic, and if you have a
question for Dr K. or Dr K., wecan, we can do this again and
invite both Dr Ks to be on anepisode. Please email us, and
that email address isQandAwithDrK@mpqhf.org, and that
(23:03):
email address will be with thisepisode as well. Thank you so
much and be well.
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