Spotlight on… bowel cancer

Bowel cancer isn’t a topic many people talk about—but that needs to change. As the second deadliest cancer in Australia, it claims more than 5,000 lives each year—including around 300 people under 50. But while these statistics are confronting, bowel cancer is also one of the most treatable cancers if it is detected early.

So, what can you do to protect your wellbeing? We spoke to Bowel Cancer Australia’s Medical Director, Associate Professor Graham Newstead AM, to uncover key risk factors, prevention strategies and why early screening is critical—especially as cases rise among younger Australians.

Who is at risk of bowel cancer?

Bowel cancer can affect anyone, but if you have a family history, your risk is significantly higher.

“If a parent, sibling, or multiple close relatives have had bowel cancer, you need to be especially vigilant,” says Graham. “That’s why knowing your family medical history is not a privilege, it’s a right.”

People with certain digestive conditions, such as ulcerative colitis, are also at a higher risk, because “the chronic inflammation causes continuous cell regeneration, which can lead to abnormal changes over time,” he adds.

Unfortunately, younger people are not immune from bowel cancer. In fact, people aged 15–24 have experienced a 266 percent increase in bowel cancer diagnoses over the past 30 years, and the risk of being diagnosed with bowel cancer before age 40 has more than doubled since 2000.

“We’ve seen a definite rise in bowel cancers among young people over the last two decades, with one in nine cases now occurring in Australians under 50,” says Graham. “That’s over 1,700 diagnoses a year—which might not seem like many in a country of 26 million, but it’s a hell of a lot of people in the families of whom it’s affected.”

While the medical profession can’t say with 100 percent certainty why this is happening, they do have their suspicions.

“We don’t fully understand why cases in people under 50 are increasing, but it’s likely a combination of genetic and environmental factors,” says Graham.

“For one thing, our food production has changed dramatically—many people now consume processed and genetically modified foods, as well as processed meats with nitrates added as preservatives, and antibiotic-fed meats. One or all of these factors may be contributing to the trend.”

Prevention and early detection

While some risk factors—like genetics—are out of your control, there are steps you can take to lower your risk of developing bowel cancer:

1. Start screening early—even if you feel fine

If bowel cancer spreads, it often moves to nearby lymph nodes first, before potentially reaching other organs. Early detection is therefore critical—and the good news is that, when caught early, almost 99 percent of bowel cancer cases can be successfully treated.

Australia has one of the best bowel cancer screening programs in the world, says Graham, and yet “only 40 percent of eligible people take part, which is crazy.

Thanks to Bowel Cancer Australia’s tireless advocacy work:

• If you’re 50-plus, you’ll automatically receive a free, at-home screening kit every two years.
• If you’re 45 to 49, you can now opt-in to have a free at-home screening kit mailed to you every two years.
• If you’re 40 to 44, you can request a kit to be bulk-billed from your GP.

“These simple, non-invasive tests detect microscopic amounts of blood in your stool—an early warning sign of bowel cancer,” explains Graham. “It’s easy, it’s free, has no side effects and it could save your life.”

2. Eat for bowel health

A fibre-rich diet—whole grains, fruits, vegetables and legumes—supports gut health and plays a key role in a healthy digestive system, lowering your risk of bowel cancer. Limit processed meats like bacon, sausages and salami, and if you eat red meat, choose grass-fed over grain-fed.

“Most cattle today are grain-fed in feedlots and given antibiotics to prevent bloat,” explains Graham. “When we consume this meat—especially when it’s rare—we may also be ingesting residual antibiotics, which can alter gut bacteria.

“Since gut bacteria play a role in digestion and cell regeneration, this may be one reason bowel cancer rates are rising.”

3. Stay active and maintain a healthy weight

Regular exercise and maintaining a healthy weight can help lower your risk of bowel cancer.

“A sedentary lifestyle is linked to higher cancer rates,” says Graham. “Even a brisk 30-minute walk a day can make a difference.

4. Quit smoking and limit alcohol

Smoking and heavy alcohol consumption both increase your risk of bowel cancer.

“You can eat a Big Mac, but don’t have that as your main diet,” says Graham. “Don’t smoke at all—that’s a no-brainer. And have a mild amount of alcohol, sensibly, socially.”

On the other hand, he adds, you can have no family history, lead a very healthy lifestyle, and still get bowel cancer. That’s why regular screening is so critical.

Recognising the signs of bowel cancer

The symptoms of bowel cancer can be subtle or mistaken for other digestive issues, so it’s essential to know the red flag signs and symptoms, and seek medical advice early if something feels off.

For example, “if you’re experiencing extreme tiredness or unexplained weight loss, your doctor may recommend a blood test to check for anaemia, which can sometimes indicate bowel cancer,” says Graham.

A helpful way to remember the key symptoms is the “BOWEL” acronym, developed by Bowel Cancer Australia:

• B – bleeding (blood in your stool or on toilet paper)
• O – obvious changes in bowel habits (diarrhoea, constipation or narrow stools)
• W – weight loss that is unexplained
• E – extreme tiredness (ongoing fatigue or anaemia)
• L – lumps or abdominal pain

“If you have any of these symptoms—especially bleeding or changes in bowel habits that persist beyond a couple of weeks—see your GP immediately,” urges Graham.

We need to talk about it more often, and more openly

One major issue in the fight against bowel cancer is that younger people presenting with red flag signs and symptoms of bowel cancer are often dismissed by their doctors.

Indeed, age bias is a major barrier, with many younger patients making 10 visits to doctors before receiving a diagnosis. The lack of awareness that young people can get bowel cancer contributes to delays of between three months and five years before treatment can begin.

While early-stage bowel cancer has high survival rates, advanced cases may require more intensive treatment, including surgery, chemotherapy, and in some cases, palliative care to manage symptoms and improve quality of life.

But Graham and his team are working hard to make sure GPs are on alert via the Never2Young campaign.

“We hear so many cases where a young person with rectal bleeding is told it’s just haemorrhoids, only for them to be diagnosed with advanced bowel cancer months later,” he says.

While this advocacy work continues, the rest of us have a job to do too—and that is to avoid pooh-poohing the subject of bowel cancer. We all need to get comfortable discussing it openly with our friends and family, says Graham, even if it initially feels awkward or embarrassing.

“We all go to the toilet, so let’s make bowel cancer a dinner-table conversation,” he urges. “Get to know the symptoms, encourage your friends and family to do the screening, and don’t be afraid to push for a second opinion if something feels off.”

All statistics and information courtesy Bowel Cancer Australia