Ask Dr. Mike: Why Are More People Under 50 Getting Cancer?

Meet internal medicine physician Michael Cirigliano, affectionately known as “Dr. Mike” to not only his 2,000 patients, who love his unfussy brilliance, tenacity, humor, and warmth (he’s a hugger!), but also to viewers of FOX 29’s Good Day Philadelphia, where he’s been a long-time contributor. For 32 years, he’s been on the faculty at Penn, where he trained, and he’s been named a Philadelphia magazine Top Doc every year since 2008. Starting today, he’s our in-house doc for the questions you’ve been itching (perhaps literally) to ask a medical expert who’ll answer in words you actually understand. Got a doozy for him? Ask Dr. Mike at lbrzyski@phillymag.com.

Listen to the audio edition here:

Actor James Van Der Beek’s passing from colorectal cancer at age 48 has gotten more people talking about the unfortunate fact that more younger adults are being diagnosed with cancer. Why are the numbers going up?
That’s the million-dollar question — and if I could answer it, I might win a Nobel Prize. In all seriousness, though, it’s very disconcerting, especially because the numbers are going down for older folks. It’s why we’ve changed our cancer-screening tactics. In this case, for example, we now recommend an initial colonoscopy at age 45 instead of 50.

Certainly, smoking and drinking alcohol are big causes of cancer in general, but younger people tend to not drink and smoke as much as past generations did, so we don’t know if we can attribute those behaviors to the rising rates. More likely potential contributors are obesity, sedentary behavior, microplastics, and chemicals in the environment. Genetics are at play, too, so it’s important to know your family history. Also, consuming highly processed foods, and more red meat, refined grains, and sugary drinks — all of which can negatively impact the microbiome — could potentially lead to pre-cancerous polyps.

Ah, the gut microbiome — that mysterious, “invisible” organ that’s so important to gut health. What’s its potential link to cancer?
The bacteria in your gut helps with things like digestion and regulation of your immune system. But eating highly processed food and constantly taking antibiotics could damage and change the natural flora of bacteria in the intestines. GI doctors also have a theory about the impact of emulsifiers, which are food additives that essentially allow oil and water to cohabitate. They may be damaging that fine layer of intestinal cells that protects your gut from toxic stuff like carcinogens.

But you can be a healthy eater and still get cancer …
No food is going to give you immunity from disease. My rule of thumb is: If it looks the same after a year, it’s probably not the best thing to put in your body. If it doesn’t degrade, what’s in there? Foods that are packaged and processed to have a long shelf life might not be the best to consume — they are thought to cause inflammation and changes in the gut microbiome. But they’re tough to avoid if you live in an area with limited access to fresh produce, or if you’re working like a maniac and rely on microwavable dinners, which are full of sugar, salt, and other additives. I have a strong hunch that those last things are a big part of why there’s obesity and early-onset of cancer.

A healthy diet won’t prevent you from getting cancer, but it might reduce your risk. We should be eating vegetables — especially cruciferous ones like broccoli, cabbage, and radishes due to their documented cancer-fighting compounds — and fiber-rich foods. Every night for dessert, I skip the ice cream and eat about a half cup of frozen wild blueberries. I love them because they have more polyphenols — those are plant-based antioxidants and anti-inflammatories — than cultivated blueberries. They’re like natural M&Ms with really good stuff in ‘em!

Not to make this all about James Van Der Beek, but he noted that, when he was diagnosed, he’d felt like he was in the best shape of his life and doing all the stuff we’re told benefits our health, like working out, eating well, and even doing cold plunges. And he still got cancer and died from it. He also admitted he had ignored significant changes in his bowel habits, which is a major warning sign of colorectal cancer. What’s the takeaway here?
When you’re young, you tend to feel invincible. A lot of young people, historically men, haven’t gone to the doctor. People need to remember to listen to your body — symptoms are your body’s way of telling you something isn’t right. A lot of times, people assume they can’t be sick if they look or seem healthy, but that’s far from the truth. Disease can be very stealthy. If something doesn’t seem right, you have to get checked out and get lab work done — and get a second opinion if the healthcare provider shrugs off your symptoms. Knowledge is power.

You need a medical quarterback in your corner — the person who is checking your labs on a regular basis to make sure, for example, that your hemoglobin and iron levels are where they should be. I have my patients undergo digital rectal exams, which can detect blood in the stool, a possible symptom of cancer. There’s also a test called FIT, which stands for Fecal Immunochemical Test, which can detect blood in the stool. If blood is found, then the next step is a colonoscopy.

Think of it this way: If you don’t get your car inspected and you get pulled over, you’re going to get a ticket. We need to start thinking about our bodies that way — they need to be checked on, at least once a year, and might need some maintenance.

If there’s one thing people should prioritize when it comes to reducing their cancer risk, it’s …
You’ve got to start investing in your health 401(k), as early as possible. Until science catches up and we figure out exactly what’s causing cancer, especially early-onset, you have to do things in your power that’ll help reduce your risk, like limiting alcohol (it’s a toxin!) and sugary drinks, exercising, keeping up with your labs and screenings, and knowing your family history for any genetic predispositions.