Colonoscopies now recommended starting at age 45. As colon cancer in young people increases, a young survivor urges others to act fast.

Sarah Wartell, a young, healthy-looking yoga teacher, was only 42 when strange digestive symptoms struck her. Her message to others: "Let's talk about poop. It just might save your life."
May 25, 2022
Colon cancer is increasing in younger people like Sarah Wartell. Here, Sarah Wartell poses with yoga beads.
Sarah Wartell is a yoga teacher who had a hard time getting a proper diagnosis of colon cancer because she looked young and healthy. Wartell is urging other young people to get screened for colon cancer. Photo by Cyrus McCrimmon for UCHealth.

Editor’s note: This story first appeared on Dec. 10, 2021.

The yoga teacher exudes health, wellness and serenity.

Before the pandemic, Sarah Wartell empowered women at transcendent yoga retreats.

She loves meditating, staying fit, juicing and sharing healthy recipes.

Then, debilitating gastrointestinal symptoms plagued Sarah at the beginning of this year.

On top of the physical distress, Sarah, 42, suffered unnecessarily as medical providers dismissed her concerns. She looked healthy. How could she be seriously ill?

The theories about Sarah’s maladies were as numerous as her trips to urgent care clinics and ERs.

Food poisoning. Giardia. Appendicitis. COVID-19.

None was correct.

“I was sick all the time. I had really bad abdominal pain. I couldn’t stop vomiting and I had diarrhea,” said Sarah. “I lost 22 pounds by the time a doctor would listen to me. It was devastating.”

Colon cancer in young people

Why are colon cancer cases increasing in young people?

Health experts are not certain why colon cancer cases are increasing in young people. Theories include the following:

  • Obesity.
  • Increased consumption of processed foods.
  • Poor diet.
  • Environmental factors.

What are the symptoms of colon cancer?

  • Abdominal pain/cramping.
  • Blood in the stool.
  • Bleeding from the rectum.
  • Changes in the shape/type of stool.
  • Constipation.
  • Diarrhea.
  • Decreased appetite.
  • Weight loss.

Finally, an answer came when Sarah switched to a new primary care doctor who was willing to suspend preconceived notions about the healthy-looking mother of two who was sitting in her exam room.

That doctor paid close attention to a telltale symptom that should have served as a red flag much sooner.

Sarah had blood in her stools.

Her doctor had a hunch: she might have colon cancer, an illness that has been striking younger and younger people in recent years.

Sarah’s doctor ordered a colonoscopy. And, when the results came back, Sarah learned more than two-and-a-half months after she started begging for help, that she did indeed have colon cancer.

While the diagnosis was crushing, Sarah soon found herself in the care of a top-notch team of women at UCHealth University of Colorado Hospital.

They helped her fight the biggest foe of her life. She is now cancer-free, using creativity to heal and urging other young, seemingly healthy people to be much more open about unpleasant, taboo topics.

“Let’s talk about poop,” says Sarah. “It just might save your life.”

Colon cancer in young people on the rise

Routine cancer screenings like pap smears, colonoscopies and mammograms are credited with saving countless lives.

But the tricky thing about colonoscopies is that they are not recommended until age 45. That’s sooner than the previous recommendation to start getting colonoscopies at age 50. (The guidance changed in May of 2021.)

Sarah Wartell poses with two members of her medical team, physician assistant, Whitney Herter, left, and her surgeon, Dr. Elisa Birnbaum. To deal with cancer, Sarah turned to art and created paintins for her doctors. Photo by Cyrus McCrimmon for UCHealth.
Sarah Wartell poses with two members of her medical team, physician assistant, Whitney Herter, left, and surgeon, Dr. Elisa Birnbaum, right. Sarah loved her all-women team. As she recovered from cancer, Sarah turned to art and created paintings for her doctors. Photo by Cyrus McCrimmon for UCHealth.

Still, a disease that used to be dangerous primarily for people in their 60s and 70s now is striking more young people like Sarah who are too young to have had their first colonoscopy. Experts don’t know exactly why colon cancer is becoming more common among younger people. Obesity, increased consumption of processed foods or environmental factors could be to blame.

Regardless, the toll is painful.

Last year, the world mourned the death of “Black Panther” star Chadwick Boseman from colon cancer when he was only 43.

Many younger people who have concerning symptoms that could be signs of colon cancer get ignored or misdiagnosed. That means critical time can be lost and cancers can spread.

According to the Colorectal Cancer Alliance and data from the National Cancer Institute, as many as one in five young people with symptoms of colon cancer suffers from delays in diagnosis and treatment.

And, those delays can be very dangerous. Why? According to the Colorectal Cancer Alliance:

  • Colon cancer is the third most common cancer to be diagnosed in men and women in the U.S.
  • Colon cancer is the second leading cause of cancer deaths for men and women combined.
  • By 2030, researchers expect colon cancer to be the No. 1 cause of death among people ages 20 to 49.
  • People of color are at especially high risk. African Americans have the highest rates of getting colon cancer and dying from it. Colorectal cancer deaths are 40% higher in the U.S. for African Americans than for people of other races.

Colonoscopies are absolutely critical for saving lives. Everyone ages 45 and older should get them regularly. And, the U.S. Centers for Disease Control and Prevention (CDC) recommends that anyone who has a history of colon cancer in their family should get screened by age 40, or 10 years younger than the age when their family member was diagnosed. Learn more about CDC recommendations related to colon cancer screenings.

While colon cancer can be very dangerous, Sarah’s doctors love their work because they can save so many lives.

“It’s incredibly gratifying. Colon cancer is a highly treatable cancer,” said Dr. Elisa Birnbaum, Sarah’s surgeon and an expert on colorectal diseases. “If caught in the early stages, some people don’t even need chemotherapy.”

Increased screening and better chemotherapy options both have boosted survival rates for people with colon cancer. That’s why screenings are so critical.

“If you have no symptoms, but are of screening age, you should get a colonoscopy. If you have symptoms and are not old enough to have had a colonoscopy, please bring your symptoms to a doctor’s attention,” said Birnbaum, who is a professor of surgery at the University of Colorado School of Medicine on the Anschutz Medical Campus in Aurora. (Learn more about concerning symptoms that may be related to colon cancer.)

Multidisciplinary team works together to help patients, including young people with colon cancer

Once Sarah finally learned she had colon cancer, she quickly connected with providers at University of Colorado Hospital.

A team approach speeded up Sarah’s treatments and recovery.

Her first point of contact was Whitney Herter, a physician assistant who coordinates the hospital’s colorectal cancer multidisciplinary clinic.

Each week, experts ranging from surgeons to medical oncologists to radiologists gather to discuss and map out treatment plans for each new patient.

“It’s collegial, but it’s also thoughtful. There’s a team of 20 providers from all of these different disciplines. We think about what’s best for each individual,” Herter said.

Sarah Waller, a young colon cancer survivor, hugs her surgeon, Dr. Elisa Birnbaum
Sarah hugs her surgeon, Dr. Elisa Birnbaum. Photo by Cyrus McCrimmon for UCHealth.

That same afternoon, patients see the doctors who will oversee their care. And treatments begin immediately.

“That’s one of our values. We get people in as soon as we can,” Herter said.

The multidisciplinary approach — which is much more common at academic medical centers — brings all of the experts together on the same day in the same room to give patients the highest quality care on a fast timeline.

Colon cancer in young people is on the rise. An all-female team loves healing young cancer survivors and older patients too.

For Sarah, finally being heard, taken seriously and given a path to healing was a tremendous relief.

“They were so thoughtful. They knew my story. They knew how sick I had been,” Sarah said.

She also liked the fact that doctors with diverse expertise and approaches had weighed in on the best course of treatment for her. Long ago, President Abraham Lincoln famously filled his cabinet with experts who might disagree with him and each other, his so called “team of rivals.”

Sarah knew that she would receive better care if her cancer experts similarly brought unique perspectives as they mapped out treatments for her.

“I wanted different voices in the room. I wanted a team approach. That’s why we picked UCHealth,” she said.

Colon cancer is getting more common in young people. To cope with cancer, Sarah Wartell started painting. Here, she shows two of her paintings.
To cope with colon cancer, Sarah started doing colorful, abstract paintings on canvass that showed a transverse colon and dots to represent her team members. Photo by Cyrus McCrimmon for UCHealth.

The icing on the cake was that Sarah’s providers turned out to be “an all-female team of rock stars,” as Sarah calls them.

During her surgery, everyone from the nurses to Birnbaum to the doctors training with her happened to be female. Sarah loved the way all the women collaborated.

Back in college, Sarah earned dual degrees in Women’s Studies and Peace and Conflict Studies at Indiana University. And through her work, she has focused intently on women’s health and well-being.

Sarah, a young colon cancer survivor, with her husband, Justin Waller.
Sarah, with her husband, Justin Wartell. Sarah’s husband, children and medical team supported her after she received a devastating colon cancer diagnosis. Photo courtesy of Sarah Wartell.

For Birnbaum, Sarah’s appreciation for female experts meant a great deal.

Back when Birnbaum was in medical school in the 1980s, she was one of just two women out of a class of 300 who chose to become a surgeon.

“A lot of people discouraged us,” Birnbaum said.

One older male doctor told her she’d never succeed because she liked wearing dangly earrings.

Of course, Birnbaum’s gender — and taste in jewelry — had nothing to do with her skills as a doctor and surgeon. Birnbaum loves preventing and treating cancer. Rapport with patients like Sarah is an added bonus.

“Ours is a field that is incredibly rewarding. We have really good outcomes. We don’t take our success for granted. There’s a lot of work that goes into it by both the women and the men on our team,” Birnbaum said.

Early detection of colon cancer dramatically improves outcomes

The team classified Sarah’s cancer as Stage III, meaning it had spread beyond the initial site to some nearby lymph nodes. Fortunately, however, the cancer had not spread widely throughout Sarah’s body. Birnbaum would first do surgery, a colectomy to remove about 19 inches of what’s known as the transverse colon, part of the large intestine, which passes horizontally across the belly.

Next, Sarah’s medical oncologist, Dr. Lindsey Davis oversaw a challenging course of chemotherapy to rid the cancer from Sarah’s body.  Sarah needed an infusion one week, followed by a week of taking eight chemotherapy pills a day followed by a week of rest before starting over again. The side effects were extensive and Sarah had to endure this grueling schedule over four cycles for a total of 12 weeks.

Still, Sarah’s determination to get help when her gastrointestinal symptoms worsened had made a big difference.

“The positive aspect of her cancer is it was found early enough that she was in a better risk group, so we were able to do chemotherapy for three months instead of six,” said Davis, who is also an associate professor of medical oncology at the University of Colorado School of Medicine.

Leery of addiction, Sarah avoided narcotics during and after her colon cancer surgery

In addition to benefiting from her doctors, Sarah appreciated the sensitivity to an issue that’s important to her. Her family has a history of addiction and Sarah wanted to avoid opioid medications during her surgery and as she recovered.

Birnbaum eagerly worked with Sarah and used non-addictive, non-narcotic medications.

Sarah’s preferences synched with priorities at University of Colorado Hospital.

“Everyone is trying to minimize the use of narcotics,” Birnbaum said. “The fewer narcotics we use, the faster the patients get out of the hospital and the better they feel.”

For Sarah’s surgery — a colectomy or the removal of part of her colon —  Birnbaum used a drip of lidocaine that continued for 24 hours after surgery. Combined with Toradol, which is like a stronger version of ibuprofen — Sarah was able to deal with both the surgery and her recovery without addictive painkillers.

“We’re trying to do this for everyone,” Birnbaum said.

It’s especially helpful when patients, like Sarah, support the concept of eliminating or using fewer pain medications.

“It really helps to have a highly motivated patient. That’s huge,” Birnbaum said.

How yoga and meditation helped young woman recover from surgery and cope with challenging side effects from chemotherapy

Sarah’s immediate goal after surgery was to get back home as soon as possible to her husband, Justin Wartell, and their daughter, Sophia, 13.

Due to COVID-19 restrictions in the hospital at the time, Sarah could only have minimal visits with her husband and their daughter couldn’t come to the hospital at all.

Their older child, Degan, 22, now lives in Maryland where he’s works as a campaign coordinator.

Many years ago, Sarah had worked as a nursing assistant in an Ohio hospital, so she knew well what it would take to recuperate from surgery.

Sarah Wartell with her husband and children.
Sarah Wartell has received excellent support from her husband, Justin, son, Degan, and daughter Sophia. Photo courtesy of Sarah Wartell.

Her yoga practice helped tremendously as Sarah endured post-surgical pain, and later, when she suffered severe side effects from chemotherapy.

Sarah has extensive yoga experience, having worked as an instructor for 10 years. She’s a Reiki Master and has earned a Thai Yoga certification. She also has devoted 800 hours to becoming a certified yoga therapist and is back in school earning her credentials as an addiction counselor.

Yoga therapists use the principles and practices of yoga — like breathing, movement and mindfulness — to support clients who are coping with physical, mental and emotional challenges.

Sarah calmed herself with simple movements. Before she could stand up after surgery — and later when side effects from chemotherapy felt overwhelming — Sarah used breathing exercises and practiced gentle yoga techniques like daily joint rotation from head to toe.

(Listen to details about how Sarah navigated her cancer journey in the podcast, “This is Yoga Therapy” with Michele Lawrence.)

Sarah made it home two days after her colon surgery, then recovered for one month before starting on the chemotherapy regimen.

The medication hit her hard.

Dr. Lindsey Davis, left, with Sarah Wartell, a young person who dealt with colon cancer.
Dr. Linsdsey Davis with Sarah Wartell. Photo courtesy of Sarah Wartell.

She had to take about eight chemotherapy pills per day.

“For a person who doesn’t take pills, that was a lot,” Sarah said.

While the medication was killing Sarah’s cancer, it also blasted her with painful side effects from blurred vision to nausea, vomiting, brain fatigue, hair thinning, skin rashes and inflamed, sensitive hands and feet. Neuropathy in Sarah’s extremities made her feel like lightning was crackling right through her body.

To cope with pain, Sarah used what is known as “stair-step breathing.”

“It’s a mini version of hyperventilating,” Sarah said. “You take short sips of breath in and visualize something soothing at the top of the breath. Then, you exhale deeply and slowly to bring your central nervous system back to a state of ease.”

On days when she felt too sick to get out of bed, she focused on her joints from her toes to her face, gently moving each part of her body.

“You can do this from bed in an unwell state or sitting or standing,” Sarah said. “That’s huge for cancer patients and anyone who experiences pain.”

Sarah’s oncologist, Dr. Davis, said Sarah’s strength and coping skills were remarkable.

“She had quite a few side effects, but she had the perseverance to get through it,” Davis said. “She already had to deal with a shocking diagnosis. For someone who is used to being super healthy, that’s tough. Then, she had to have a big operation. She did an amazing job. It’s speaks to her strength.

“Sarah is the most important member of the team,” Davis said.

And, there’s no doubt that Sarah’s healthy practices supported her recovery.

“Yoga helps with resiliency,” Davis said.

While the chemotherapy was brutal, Sarah and her family celebrated at the end when her doctors gave her the official declaration that every cancer patient craves: “NED,” which stands for “no evidence of disease.”

“My husband has been my rock. He fed me. He held my hand. He wiped my tears. He listened. He advocated. And, he connected me with people,” Sarah said.

The kids have been a great support too. Degan likes to tease his mom and make her laugh. Sophia is an old soul, who cleaned, cooked and soothed her mom.

“She’s 13 going on 40. She’s very independent and empathetic. She made me pancakes, waffles and chocolate chip cookies.”

Painting proved therapeutic as Sarah recovered from colon cancer

Along with yoga and her family, Sarah found comfort in creativity.

She connected with a support group called Twist Out Cancer that links cancer survivors and caregivers to artistic mentors.

Sarah worked with an Arvada painter who encouraged her to try expressing her creativity through visual arts, a new medium for her. Sarah started doing colorful, abstract paintings on canvass that showed a transverse colon and dots to represent her team members.

She gave original paintings to both Drs. Davis and Birnbaum, who have hung the mementos of healing on their office walls.

“I was very impressed. She’s such a thoughtful person. Her art helped her take her feelings about her cancer and translate them into something beautiful,” Davis said.

As colon cancer in young people increases, Sarah urges other young people to get screened: “Colonoscopies are not easy,” but cancer is worse

Sarah was in her 20s when she had the tree of life tattooed on her left shoulder.

That tree has taken on new meaning now. It has new branches and surviving cancer has changed Sarah’s perspective about life and yoga.

“The whole goal is love and connection,” Sarah said.

Sarah Wartell is a young colon cancer survivor. Here she poses in yoga gear showing her "tree of life" tattoo.
Sarah Wartell has had her “tree of life” tattoo for many years. Now, it’s more significant than ever. Photo by Cyrus McCrimmon for UCHealth.

She’s also forging a new mission: encouraging other young people to learn about colon cancer and to protect themselves.

If people under age 45 have strange gastrointestinal symptoms, Sarah urges them to fight for help and to get screened if warranted.

“Colonoscopies are not easy. But, the stress of not knowing is going to kill you. If you have a family history and symptoms, don’t wait.

“I want to be vocal about the things that aren’t talked about,” Sarah said. “I’m trying to figure out how I can use this cancer journey to do good.”

About the author

Katie Kerwin McCrimmon is a proud Coloradan. She attended Colorado College thanks to a merit scholarship from the Boettcher Foundation and worked as a park ranger in Rocky Mountain National Park during summers in college.

Katie is a dedicated storyteller who loves getting to know UCHealth patients and providers and sharing their inspiring stories.

Katie spent years working as an award-winning journalist at the Rocky Mountain News and at an online health policy news site before joining UCHealth in 2017.

Katie and her husband, Cyrus — a Pulitzer Prize-winning photographer — have three adult children and love spending time in the Colorado mountains and traveling around the world.