A new study adds to a small body of research, through which a picture is emerging: colorectal cancer, commonly known as colon cancer, strikes younger people in Egypt far more frequently than it does in Europe or the US, making it much more lethal and socially destructive.
Colon cancer in Egypt is more deadly and destructive than elsewhere, yet less understood.
Yet, while colorectal cancer in European and North American contexts is well-studied, researchers have uncovered far less about the causes of the abnormally high rates of early-onset colorectal cancer in Egypt.
Ahmed Morsi started suffering from rectal bleeding three years ago, at age 37. When he saw doctors, they told him it was related to piles, commonly known as haemorrhoids, but the bleeding did not stop. It took six months and visits to five different doctors before he was correctly diagnosed with colorectal cancer.
And it was another two months before he told his wife.
“I was afraid of the situation for her, and I wanted to do everything by myself,” he said.
Over the course of five months, Morsi underwent a colostomy, radiotherapy and chemotherapy.
A father of two, Morsi is the sole breadwinner of the family, and had to quit his job as a server at a Cairo coffee shop for the duration of the treatment. At first, his brothers were able to support his family, but his wife eventually had to sell all their gold to make ends meet.
Morsi is one of 412 patients diagnosed by Egyptian colorectal cancer specialist Ahmed Gado between 2000 to 2012. Gado found that one quarter of his patients were less than 40 years old, a far higher percentage than in Europe or North America, where incidence of the disease is much higher, but only 2-6 percent of patients are that young. According to the American Cancer Society, 90 percent of new cases of colorectal cancer in the US and 94 percent of deaths occur in individuals 50 and older.
Young patients have families to support, which compounds the effects the disease has on the general population.
“It’s a catastrophe for families,” Gado told IRIN.
What makes this trend more alarming, he said, is that the prognosis is worse for younger patients. In general, those who acquire the disease below the age of 30 are three times as likely to die within five years than those who acquire it past 50, according to European studies. The five-year survival rate drops from 75 to 25 percent for the younger patients.
Gado published the results of his research, conducted at his unit at Giza’s Bolak el-Dakror Hospital, a few kilometres from downtown Cairo, in the Alexandria Journal of Medicine in April. The study was peer-reviewed by the Faculty of Medicine at Alexandria University and confirms findings of early onset colorectal cancer in Egypt by other researchers.
A study published in the International Journal of Cancer in 1997 found that 35 percent of more than 1,600 colorectal cancer patients in four Egyptian hospitals were under 40.
According to the Middle East Cancer Consortium, based on data collected between 1999 and 2001, colorectal cancer constituted 4.4 percent of cancer cases in Egypt, affecting six in every 100,000 Egyptians, compared to 32 in every 100,000 Americans.
But in Egypt, colorectal cancer is often not diagnosed quickly, which Gado attributes to a combination of cultural issues and lack of awareness, even among practitioners.
He routinely sees patients who have had rectal bleeding for a year before seeing doctors, and there are rarely follow-ups on a patient’s condition. Colonoscopy is an invasive procedure, and few patients with a family history of cancer agree to undertake it as a preventive measure.
General practitioners will also often misdiagnose bleeding as piles, he said, and they will not always refer patients to specialists. Few specialists have adequate competency to perform colonoscopies, even in the Cairo region.
Egypt is thought to have among the highest rates of early onset colorectal cancer in the world, and only a few studies have attempted to better understand the disease here.
In general, comprehensive data on cancer in Egypt is limited, according to Randa Abou El Naga, a researcher on non-infectious diseases at the World Health Organization (WHO), which, itself, does not have research about colorectal cancer in Egypt.
The Egyptian government has a national cancer registry, but research is not representative of the entire country. It compiles data annually, but on a rotation basis between different governorates, Abou El Naga said. For example, the registry’s 2008 data covers only Aswan Governorate on the Sudanese border, and its latest report, published in 2010, covers only Damietta Governorate in the Delta region.
WHO is assessing the quality of Egypt’s national cancer registry, with the goal of providing recommendations to the Egyptian government on how it can be improved to provide a complete overview of cancer occurrence in the country.
Causes and correlations
In general, higher risks of colorectal cancer appear to be related to a number of dietary and lifestyle habits, including higher intakes of alcohol and red and processed meats; lower intakes of fibre, fruits and vegetables; micronutrient deficiencies, especially selenium, iron and vitamin D; lack of physical activity and increased obesity.
One theory is that these factors combine to create an excess of calories, resulting in obesity, insulin resistance, hyperglycaemia, inflammation and oxidative stress, which could cause cellular damage in the colon and lead to cancer over the long term.
Egyptians’ diet has been changing as junk food becomes increasingly accessible and most restaurants take Internet orders.
A busier lifestyle and lack of parks and sports infrastructure means that urban Egyptian waists are taking a hit. Statistics from 2010 aggregated by the National Nutrition Institute show that 20 percent of teenagers, 55 percent of adult males, and 75 percent of adult females in Egypt are either overweight or obese.
But the reasons behind early onset of colorectal cancer, specifically, remain unclear. Researchers are looking at the roles played by genetic predisposition or environmental exposure, such as the use of pesticides. Early life exposure could also be a factor.