Even though Ajay Kohli had been experiencing debilitating abdominal discomfort for weeks in late 2021, such excruciating pain that he once had to pull over as he was driving his car, he wasn't sure if he needed a colonoscopy. He was 42, active and otherwise healthy.
Kohli, an Emergency Medicine Physician at Duke University Hospital, had a full panel of bloodwork and a CT scan done and everything came back normal. He continued with his life and plans and ran a half-marathon in the Bull City Race Fest on Oct. 17, 2021. The next day, when he was supposed to begin his prep for a colonoscopy, he turned to his wife with an idea.
"Let's go get some pizza," he said. "I don't need to do this."
She insisted, though, and Kohli kept the appointment and continued the prep that included a day of fasting.
He remembers waking up from the anesthetic for the procedure, still groggy and hearing the words "perforation" and "cancer."
The doctor found a mass in his colon that was eroding the colon wall. He was rushed to emergency surgery where the perforation was repaired, and the tumor was removed.
Both the surgery and the recovery were "brutal," Kohli said, but if he had waited, the consequences might have been devastating. Kohli had not yet reached the recommended age for his first colonoscopy screening, but Duke medical insurance plans fully cover all colonoscopies from in-network providers.
"All my labs and CT were clean, completely normal, despite having a decent-sized tumor," Kohli said. "Things can't really stop at labs and a CT scan. I'm not saying everyone should get a colonoscopy, but don't ignore these symptoms - especially with the rise of colorectal cancer."
Colonoscopies now recommended at age 45
In January 2024, the American Cancer Society published a report that said the rates of colorectal cancer are rising rapidly among people in their 20s, 30s and 40s. Colorectal cancer moved up from the fourth leading cause of cancer death in both younger men and women two decades ago to first in men and second in women. The reasons why are unclear, but the U.S. Preventive Services Task Force now says that people at average risk for colorectal cancer should start screening at age 45 rather than 50.
That means a baseline colonoscopy at age 45, a screening that is covered fully with in-network providers by Duke's medical insurance plans . In 2024, 72% of Aetna members and 77% of Blue Cross members covered by Duke received colonoscopy screenings, both of which exceed industry standards. Colorectal Cancer Awareness Month in March offers a timely reminder: research confirms that colonoscopies remain the most reliable method for detecting colorectal cancer.
Julius Wilder, a Duke Associate Professor of Medicine in Gastroenterology, has seen the rise in younger patients first-hand. Theories for what's driving the increase include alcohol consumption, diet and obesity. All those factors correlate with having polyps, Wilder said, and polyps can become cancerous.
One aspect not helping with early detection is misinformation spread around colorectal cancer on social media. Wilder studied TikTok users in 2023 who discussed colon cancer, and found that in 35 educational videos, 13 were misleading about causes and treatments - and those misleading videos were shared more often than useful ones.
"It's scary that people go into a public space and share that information," Wilder said. "It gets scary because of what that means in terms of people may begin to not get screened appropriately because of something so inaccurate."
Wilder encourages factual information from physicians, including relaying that the prep is the most difficult part of the colonoscopy.
"I am very transparent with my patients that yes, you're going to probably drink a lot of fluid and you're going to poop a lot," he said. "We might have a remote-control car on Mars right now with a helicopter on top of it, but that's still how we do colonoscopies."
Becoming a better patient
Kohli's recovery from colon cancer surgery and chemotherapy was slow and difficult, but one activity that helped throughout the process was walks with his wife and colleagues. When he felt better, those walks progressed to runs.
And that helped him keep a promise to himself: One year after he was diagnosed, he ran that same half marathon he'd participated in just before his 2021 colonoscopy.
"For me, it was important to do that race again, and I've done that race every year since," he said.
He's also been diligent about getting the tests and procedures recommended. That includes regular colonoscopies until he's five years cancer-free in 2027.
"I haven't always been great about taking my health as seriously as I should," Kohli said. "I know they say physicians don't make the best patients, so that's probably me - or used to be me."
Not anymore.
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