'This disease is happening younger and younger'

The first time Briana Mezuk Ratliff visited a doctor about her gastrointestinal issues, she already had a hunch it might be cancer.

For a while, things just hadn't been right when she went to the bathroom. She wasn't experiencing pain. She hadn't lost weight. But there was blood in her stool, and Mezuk Ratliff had done enough research to know that could be a cancer symptom.

And Mezuk Ratliff was good at research. After all, she was a professor in the Department of Epidemiology at Virginia Commonwealth University School of Medicine.

But when Mezuk Ratliff, then 35, asked her original doctor in Virginia if she could get a colonoscopy to rule out the possibility of colon cancer, the reaction she received was completely unexpected.

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"He literally laughed at me and said, 'You're far too young to have colon cancer,'" Mezuk Ratliff said. Instead, the doctor suggested, her symptoms were most likely irritable bowel syndrome or hemorrhoids and not a cause for alarm.

Forty years ago, that reaction might have been common, but not anymore.

In recent decades, colorectal cancer rates have been increasing among adults under age 50 at a clip of over 2% every year. The incidence is rising particularly quickly in people ages 20-39 - Mezuk Ratliff's age group.

'You need better'

After her dismissive visit, Mezuk Ratliff went home feeling a mixture of "embarrassment and relief." She was embarrassed to have to make an appointment to discuss her bowel symptoms but also relieved to hear her doctor say she didn't need to worry.

Nine months later, though, Mezuk Ratliff was still experiencing symptoms. She returned to another doctor in August 2016 and demanded a colonoscopy. Yet again, as she was preparing for her procedure, her worries were dismissed.

"Looking at my chart, the doctor turns around to me and he says, 'I'm 99% certain you just have hemorrhoids,'" Mezuk Ratliff said.

He was wrong.

During the colonoscopy, the doctors removed a 2-inch polyp from her lower intestine, which turned out to be cancerous. After apologizing for dismissing Mezuk Ratliff's concerns, the doctor informed her that she needed treatment elsewhere, since the hospital had never treated someone her age for colon cancer.

"He said to me, 'You need to go to a top place,'" Mezuk Ratliff said. "'You need better.'"

For Mezuk Ratliff, "better" meant University of Michigan Health and not just for its cancer center.

Just two weeks before receiving her cancer diagnosis, Mezuk Ratliff had accepted a job as an associate professor in the epidemiology department at U-M's School of Public Health.

She was able to connect with Samantha Hendren, M.D., surgical director of the Multidisciplinary Colorectal Cancer Clinic at the Rogel Cancer Center. Hendren agreed to take on Mezuk Ratliff's case within 24 hours of learning her story. Despite Mezuk Ratliff's young age, Hendren wasn't surprised to learn about the diagnosis.

"Both the proportion of colorectal cancers that are occurring in people under 50 and the absolute number of colorectal cancers being diagnosed in those younger people are increasing," Hendren said. "We need to all be aware that this disease is happening younger and younger, and when people come with these symptoms, we have to take them very seriously."

Mezuk Ratliff's multi-step journey to receive an accurate diagnosis as a younger patient wasn't uncommon, either. According to a 2020 survey of 884 colorectal patients and cancer survivors conducted by the Colorectal Cancer Alliance, 75% saw at least two doctors before their diagnosis was confirmed. Additionally, 40% said their providers dismissed their symptoms and concerns.

Hendren wanted to ensure that Mezuk Ratliff's treatment plan was right before proceeding with her care. So when Mezuk Ratliff arrived in Ann Arbor with her husband, Scott, and 4-year-old son, Max, she ordered a new set of tests. The results suggested that the cancer was fairly advanced: Stage 3C.

Because of Mezuk Ratliff's age and symptoms, Hendren met with members of her tumor board team to discuss the case. Hendren suggested that instead of treating the cancer with a combination of chemotherapy and radiation prior to surgery - as is typical of advanced colorectal cancer cases - they begin with an aggressive surgery.

"Briana had one set of tests from Virginia that told one story and a different set of tests from U- M that told another," Hendren said. "It was a judgment call. We talked about her preferences and my advice, and we put it all together. Ultimately, I think we made the right decision."

Hendren performed the surgery on Sept. 30, 2016, and removed the remaining cancer cells. According to the final pathology report from the surgery, results showed that the cancer hadn't spread to Mezuk Ratliff's lymph nodes, making it stage 1, not stage 3C as they'd initially thought. The end result? Chemo and radiation treatment post-surgery wouldn't be necessary.

For Mezuk Ratliff, the only remaining surgical step was a procedure to reverse her ostomy (an external bag to collect waste) a few months later. Much to her relief, the year-long process from symptoms to treatment was over. She couldn't thank Hendren enough.

"She saved me from unnecessary treatment," Mezuk Ratliff said. "She saved my life. Period."

Lessons learned

Today, more than five years out from her surgery, Mezuk Ratliff continues to teach epidemiology at U-M. She's also taken up running (when she can find time between research, teaching and being a wife and mom). Despite not being a runner before her diagnosis, she's completed two half marathons over the past three years.

In all, Mezuk Ratliff says she's a stronger person today because of her experience, and she has advice on how to strengthen future colon cancer treatment for both physicians and patients.

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"Doctors who haven't been with you the whole way [in your cancer care] don't necessarily understand how some comments can come across," Mezuk Ratliff said. "I can't tell you how many times I've heard, 'Colon cancer? But you're so young!' While that may be true, hearing it isn't comforting to me - instead, it makes me feel like a novelty or like I'm a bizarre case to be studied."

Ultimately, Mezuk Ratliff says, she wants doctors to remember that people are only patients when they're in the clinic.

"The remaining 99% of the time they're just people," Mezuk Ratliff said. "Dr. Hendren and her team at U-M always made me feel like a human being, and that is so important when you are in such a vulnerable, literally life-threatening situation."

And for patients who may be facing a cancer diagnosis at a young age, Mezuk Ratliff advises them to be their own advocates, ask questions and, if a physician isn't listening, find one who will.

"If something doesn't feel right and your doctor says, 'Don't worry about it,'" Mezuk Ratliff said, "get a new doctor."