James Van Der Beek/Wikimedia/Super Festival

For fans of the late 90s TV series Dawson’s Creek, the passing of cast member James Van Der Beek, who played the teenage aspiring filmmaker Dawson Leery, was a shock. It has also brought into the spotlight the fact that colorectal cancer is no longer a disease only affecting older adults. More personalities, regardless of ethnicity, who have been diagnosed with, undergone treatment for, or succumbed to this type of cancer are often not even in their 50s.

According to the Globocan 2020 report from the World Health Organization (WHO), colorectal cancer is the third most common cancer among men worldwide, accounting for 10.6% of all male cancers, and the second most common among women at 9.4%. In Malaysia, the latest National Cancer Registry Report (2017–2021) shows that colorectal cancer accounts for 14.1% of all cancer cases, making it one of the most prevalent cancers nationwide. It remains the most common cancer among men at 18.8% and the second most common among women at 13.7%.

Despite its high prevalence, screening rates remain low, especially among younger adults, largely due to fear, misunderstanding, and the belief that colorectal cancer only affects the elderly.

Rising number of young colorectal cancer patients

Dr Premjeet Singh of Ara Damansara Medical Centre

In Malaysia, once considered a disease of older adults, colorectal cancer is increasingly being diagnosed in much younger people. Doctors are now seeing patients in their 20s, 30s, and even teens presenting with the disease, often at a more advanced stage, when treatment becomes more complex and outcomes less certain.

Dr Premjeet Singh, Consultant General Surgeon, Endoscopist, and Minimal Access Surgeon at Ara Damansara Medical Centre, commented, “In my practice, I am increasingly seeing colorectal cancer in patients in their 30s and 40s. The youngest patient I have treated was only 13 years old. Age alone does not protect anyone from colorectal cancer.”

Why younger people are not immune

One reason colorectal cancer is frequently detected late in younger individuals is that early symptoms are often mild and easy to dismiss.

“Many young patients experience symptoms such as constipation, rectal bleeding, or mild abdominal discomfort, but they tend to brush these off,” Dr Premjeet explains. “Rectal bleeding is commonly assumed to be piles, while changes in bowel habits are often blamed on stress or a busy lifestyle.”

Cultural discomfort around bowel health also plays a role, with many patients delaying consultation due to embarrassment or fear of invasive tests.

Diet and lifestyle habits also contribute. “We are seeing younger adults consuming more processed foods and less fibre. Over time, this affects gut health and increases colorectal cancer risk,” Dr Premjeet says. Diets high in red and processed meats, combined with low intake of fruits, vegetables, and whole grains, are known to affect bowel health and, over time, increase colorectal cancer risk.

Because these symptoms do not significantly disrupt daily life, many delay seeking medical attention. By the time they consult a doctor, the disease may already be at an advanced stage, requiring more complex treatment.

No early symptoms

Colorectal cancer is particularly dangerous because it can develop quietly. In its early stages, many patients feel completely well and have no obvious warning signs.

“Colorectal cancer can remain silent for a long time. When symptoms appear, it usually means the cancer has already grown significantly,” says Dr Premjeet. This is why waiting for symptoms can be risky. Screening allows doctors to detect problems before cancer fully develops or while it is still highly treatable, even in people who feel perfectly healthy.

Early detection and screening make the difference

When the disease is found early, treatment is often simpler and less invasive. Surgery can frequently be performed laparoscopically using a thin tube with a camera inserted through small incisions, which allows faster recovery and fewer complications.

Some patients may even avoid chemotherapy. In contrast, those diagnosed at a later stage often face major surgery, chemotherapy, longer recovery periods, and a greater impact on quality of life. Dr Premjeet said that patients whose cancer is detected through screening generally have more treatment options and a stronger chance of long-term survival.

He recalls a woman in her early 40s who underwent a colonoscopy due to family history despite having no symptoms. A one-centimeter polyp was found and completely removed during the procedure, and laboratory tests later revealed cancerous cells within it. Because it was detected and removed early, she did not require surgery or chemotherapy, and follow up scans with a repeat colonoscopy confirmed that the cancer was gone, giving her an excellent prognosis. This case shows how early screening can detect cancer at an early stage and, in some cases, prevent it from progressing further.

Colonoscopy: more than just a diagnostic test

For many, the word “colonoscopy” can make people feel uneasy. Common fears include pain, embarrassment, or safety concerns, which often discourage individuals from getting screened.

“In reality, colonoscopy today is a very safe and routine procedure,” Dr Premjeet explains. “Patients are sedated, so most do not feel pain or even remember the procedure. The risks are very low, especially when compared to the danger of undetected cancer.”

Beyond diagnosis, colonoscopy also plays a preventive role. During the procedure, doctors can detect and remove polyps, small growths in the colon that may turn cancerous if left untreated. “Removing a polyp early is essentially stopping cancer before it starts,” he says.

Don’t wait till you’re in your 50s

While routine colorectal cancer screening is generally recommended from age 50, preventive action should begin much earlier, with priorities varying at each life stage.

For children and teenagers, the focus should be on healthy habits. A high fiber diet, maintaining a healthy weight, regular physical activity, and limiting processed foods can reduce long term risk.

Colonoscopy is usually unnecessary unless symptoms persist or there is a strong family history. In rare cases, inherited conditions such as Familial Adenomatous Polyposis, Lynch syndrome, Juvenile polyposis, or Peutz–Jeghers syndrome may require screening as early as 10 to 20 years old under specialist care.

Adults in their 20s and early 30s generally do not need routine screening without symptoms or family history, but should stay alert to bowel health. Persistent constipation, rectal bleeding, or changes in bowel habits should not be ignored, and medical advice should be sought if symptoms appear.

For those in their mid to late 30s and 40s, especially with family history or ongoing symptoms, earlier screening may be recommended. “In higher risk individuals, a colonoscopy may be advised every three to five years, depending on individual risk and findings,” says Dr Premjeet. He adds that screening should begin at least 10 years earlier than the age at which an immediate family member was diagnosed. Those without risk factors should still discuss colon health during routine check-ups, with screening possibly deferred until their 50s unless symptoms arise.

“Colorectal cancer is one of the few cancers that we can prevent or cure early through screening,” Dr Premjeet says. “Being proactive can save you from major treatment later and, more importantly, save your life.” Early screening is about taking control of your health, and being “too young” should never be a reason to delay care.

By Dr Lim Su Yin, Consultant Neurologist and Senior Lecturer in Internal Medicine, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University

Dr Yau Weng Keong, Associate Professor of Geriatrics and Internal Medicine, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University

Dr Lee Chung Wah, Consultant and Senior Lecturer in Psychiatry, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University

Understanding dementia

Dementia is not a single disease but a syndrome that can result directly from specific conditions such as Alzheimer’s disease or develop due to other underlying medical conditions. Many forms of dementia are linked to treatable conditions. Early diagnosis is crucial because while dementia itself is irreversible, addressing underlying conditions early can prevent or slow cognitive decline.

Cognitive function includes memory, attention, problem-solving, language, and planning abilities. Dementia is a significant decline in these cognitive functions, impacting daily life. It is common for both the public and healthcare providers to dismiss mild cognitive impairment as a normal part of aging. However, when cognitive decline interferes with daily activities like self-care, financial management, and social interactions, it is crucial to take it seriously. Dementia progression can lead to changes in speech, personality, and behaviour, often accompanied by hallucinations and delusions.

The 2018 National Health and Morbidity Survey (NHMS) of older adults in Malaysia revealed that 8.5% of the population aged 60 years or more, or about 260,000 people, have dementia ¹. In 2023, 7% of Malaysians reported memory and cognitive issues, yet only 6% sought help, largely due to a lack of awareness, stigma, and discrimination associated with the disease.

Globally, awareness of dementia remains low, making it difficult for families to recognise early signs and to intervene. Undiagnosed dementia often leads to avoidable social, financial, and medical issues such as getting lost, getting into accidents, falling victim to scams, or experiencing medical complications. Caregivers face significant challenges when a loved one is diagnosed with dementia as they often lack the necessary knowledge and skills to navigate complex legal, financial, and medical systems.

Prevention and early intervention are vital

This year’s World Alzheimer’s Day theme “Time to Act on Dementia, Time to Act on Alzheimer’s “underscores the urgency of addressing dementia. The Lancet Commission on Dementia Prevention, Intervention, and Care have so far identified 14 modifiable risk factors contributing to dementia. By focusing on these modifiable risk factors, individuals can take proactive steps to prevent or delay the onset of dementia. Early intervention through regular check-ups and cognitive assessments allow for timely management of these risks. Dementia prevention is a collective responsibility that requires awareness, education, and action from the individual, community, health policymakers, and the government.

14 modifiable risk factors for dementia

Hearing Loss – Untreated hearing loss can lead to social isolation and cognitive decline. Having regular hearing assessments and using hearing aids can minimise this risk.
Smoking – Smoking is linked to vascular damage which can increase the risk of dementia. Quitting smoking at any age can reduce this risk.

Hypertension – High blood pressure is a significant risk factor for dementia. Managing blood pressure through diet, exercise, and medication can protect against dementia.
Obesity – Mid-life obesity increases the risk of dementia. Maintaining a healthy weight through a balanced diet and regular physical activity is essential for cognitive health.

Physical inactivity – Regular physical activity enhances blood flow and reduces inflammation in the brain, improving cognitive function. Aim for at least 150 minutes of moderate-intensity exercise per week.

Diabetes mellitus – Type 2 diabetes mellitus increases the risk of dementia. Managing blood sugar levels through diet, exercise, and medication is crucial for reducing this risk.

Excessive alcohol consumption – Heavy drinking is associated with brain damage and dementia. Limiting alcohol intake to recommended levels can help preserve cognitive function.

Air pollution – Long-term exposure to airborne pollution, especially PM2.5, has been linked to dementia. Advocacy for cleaner air and personal measures like using air filtration systemsand wearing a N95 mask when outdoor air quality is poor can help reduce this risk.

Traumatic brain injury – Repeated head injuries increase the risk of dementia. Wearing a helmetand taking precautions in high-risk activities can prevent these injuries.
Limited educational opportunities for youth – A lower level of education is associated with a higher risk of dementia. Promoting lifelong learning and cognitive activities can build cognitive reserve and delay the onset of dementia.

Depression – Depression in mid-life and later life is linked to an increased risk of dementia. Seeking treatment for depression such as therapy and medicationis vital for mental and cognitive health.

Social isolation – Loneliness and social isolation can accelerate cognitive decline. Staying socially active and connected with others can protect against dementia.

High LDL cholesterol – Elevated levels of low-density lipoprotein (LDL) cholesterol have been associated with an increased risk of dementia. Managing cholesterol through a healthy diet, regular exercise, and medication can help reduce this risk.

Untreated vision impairment in later life – Vision impairment in older adults, if left untreated, can lead to social isolation and cognitive decline. Regular eye check-ups and timely correction of vision problems could help minimise this risk.

¹https://iku.nih.gov.my/images/IKU/Document/REPORT/