“He had experienced tiredness, but he brushed that off as just having a toddler while working a corporate job. There were no other symptoms until much further down the line. It wasn’t until he was experiencing consistent pain after going to the bathroom that he felt like something was amiss,” states Catherine Kean, board member of the Lachlan Kean Foundation. After two surgeries, eight rounds of chemotherapy and four radiation sessions, Lachlan Kean passed away from stage three colorectal cancer at just 37 years old.
As described by his widow, Catherine explains that any early indications of illness presented as fairly innocuous—bowel cancer was the last thing on their minds. At the time of Lachlan’s diagnosis, which was only 15 months prior to his death, the couple knew very little about the disease; they subscribed to the commonly held view that it only affected the elderly. Unfortunately, the data now indicates otherwise.
The changing face of colorectal cancer
Far from just a “senior’s disease,” a 2025 paper, Trends in Early-Onset Colorectal Cancer in Singapore: Epidemiological Study of a Multiethnic Population, revealed that between 1968 and 2019, approximately 11.7% of the roughly 53,000 cases identified, were classified as early-onset (patients aged 20 to 49). The study also found that while “colorectal cancer incidence and mortality in those aged 50 years and above have decreased over the past 2 decades”, the younger age bracket is facing a climbing risk that was far less prevalent fifty years ago.
Historical data also shows that early-onset cases have roughly doubled over the last half-century, and that these patients typically are diagnosed at an advanced stage. And this trend is affecting men significantly more than women: the rate for younger men is increasing by about 1.5 percent every year, while for younger women, the increase is much slower at 0.4 percent. As evidenced in the latest Singapore Cancer Registry Annual Report, colorectal cancer is the second most commonly diagnosed cancer in both men and women.
Overcoming the “too young” myth
Dr. Chew Min Hoe, Senior Consultant, General & Colorectal Surgeon at The Surgeons, has observed that “many people assume they’re “too young to worry,” which leads to delayed diagnosis.” He adds, “one of the biggest misconceptions about colorectal cancer is that it only affects older people. While risk does increase with age, cases in younger adults (under 50) have been rising globally.” This type of cancer that starts in the large intestine is also widely known as “bowel cancer”—a colloquial term which is often used interchangeably with colorectal cancer, the scientific one.
Although stool-based screening markers—such as the faecal occult blood test (FOBT) which detects hidden blood, the faecal immunochemical test (FIT) which is more specific for human blood and stool DNA tests (for example, detecting mutated genes shed by tumors)—are useful for early detection, a colonoscopy is considered the exemplary option or “gold standard” for screening. This procedure allows for more thorough investigation by an endoscopist who can pinpoint and remove suspicious polyps on the spot. Despite this potentially life-saving intervention being readily available, many young adults don’t test until the situation is more dire. Currently, Singapore’s Ministry of Health guidance is that people at an average risk begin colorectal screening at age 50.
Breaking the taboo
Alarmingly, younger patients are frequently diagnosed with late-stage or even metastatic disease. This deferment in testing could potentially stem from the “stigma” or embarrassment around colonoscopies. Dr. Chew is working to change that narrative by demystifying the experience. He believes “a lot of fear comes from imagining the procedure when in reality you’re usually sedated so you won’t feel or remember much, the procedure itself is short—usually around 20–30 minutes and that the biggest “inconvenience” is actually the prep the day before. Overall, it’s far less dramatic than people think.”
And if we explore why it appears to be more prevailing amongst men, perhaps they are more reluctant to get checked than females when it comes to health concerns. Dr. Chew postulates that “generally, men are more likely to downplay symptoms, hoping it resolves on its own. Women tend to be more proactive because they are used to routine health checks like for example gynae visits and monitoring their bodies regularly, so preventive care feels more “normal” to them.” There are also biological and lifestyle differences and one of the strongest hypotheses involves hormones. “Oestrogen appears to have a protective effect on the colon; it reduces inflammation and may slow polyp formation. Men don’t get this hormonal protection, so their risk accumulates earlier. Risk in women rises after menopause, narrowing the gap.” Then there’s diet. Broadly speaking, men tend to consume more red and processed meat, eat larger portions, have lower fibre intake and a higher exposure to alcohol and smoking—the last two of which are established risk factors for colorectal cancer.
Colorectal cancer is often called a “silent” disease. When it came to Lachlan, he was incognisant of the disease growing in his body and was even misdiagnosed by a General Practitioner. By the time the incredibly hard news was delivered, the situation was near irremediable. “It can sit in the body for years with no symptoms, which is exactly what happened to Lachie. When he was diagnosed he was already at stage three.” For Catherine, the frustrating reality is that “if caught early, it can be one of the most curable diseases. However, conversely, if left too late, it can be one of the most aggressive and deadliest diseases. If it was identified sooner, there may have been a chance of survival and the treatment plan may have been far less extensive and intensive for Lachie.”
A legacy of awareness
Now residing in Australia, Catherine, with the help of his friends, is fulfilling Lachlan’s wishes to help others. The mission of the Lachlan Kean Foundation is to build greater awareness, support patients and fund research for bowel cancer in young adults. She finds the most rewarding part is when she receives messages from people saying that they have been tested because of the work the foundation has been doing. Some have even mentioned that they located and addressed pre-cancerous conditions which were detected early—conceivably saving their lives. To her, a colonoscopy is “nothing to be embarrassed about. It’s a straightforward procedure that is over in 30 mins. Sure the prep isn’t pleasant, but it’s a small price to pay for your health and peace of mind.”
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Similarly, Dr. Chew urges people to take symptoms seriously and reiterates that any delay in treatment is the real risk. “Any persistent change in your bowel lasting more than two to three weeks should get checked early, especially if there is blood in stool and even if it looks like hemorrhoids. Plus, any unexplained fatigue or weight loss.” According to him, asymptomatic persons can begin with the FIT stool test and if you’re at a higher risk, earlier screening is recommended. Additionally, we shouldn’t overlook the power of dietary choices. It’s been evidenced that from large studies and meta-analyses, the risk of colorectal cancer is 15-25 percent lower in people with a high fibre intake. The good news? Despite the incidence of the disease increasing, overall the number of deaths have, in the last decade, decreased.
While statistics tell a sobering story, having bodily awareness and taking agency when it comes to your health could be pivotal in the long run.
