Bowel cancer at 32 - Natalie's journey from patient to prevention

For the last two decades, a devastating trend has emerged: bowel cancer cases in young adults have risen by 65 per cent. It’s now the leading cause of cancer death in Victorians aged 25-44.

For neuro-medicine researcher and new mother, Natalie, a shock diagnosis at 32 sparked both a search for answers and a determination to help spare her baby daughter, Zoe, from bowel cancer in the future.

Natalie’s maternity leave was marked by exhaustion and persistently low energy; she couldn’t handle stairs without her head pounding and was collapsing on simple walks.

New to motherhood, she put much of this down to sleep deprivation and the usual challenges of caring for a baby. Blood tests revealed she was anaemic, but iron infusions failed to improve her condition. Then a colonoscopy found a five-centimetre tumour in her bowel.

Natalie says the diagnosis only felt ‘real’ when she shared it with her husband.

“When I said those words out loud to him, it hit home. Because he started crying. He’s not much of a crier.”

After a CT scan revealed abnormalities in her liver, Natalie was told to prepare for stage 4 bowel cancer, which carries a low 13 per cent five-year survival rate. The tragedy of early-onset bowel cancer is that so many young people are diagnosed at later stages. Age, symptoms being dismissed and lack of screening programs for younger age-groups all contribute to delayed intervention and poorer outcomes, costing the lives of people in the prime of their life.

Facing the possibility that she may not be around to see her daughter grow up, put everything into perspective for Natalie and she was resolved to be present for Zoe while she could be.

“I went to full mum mode,” she said. “Buying clothes for Zoe in the next size up, filling the freezer with lasagnes and booking family photos. I also recorded my voice reading Pride and Prejudice so Zoe could hear it when she was older.”

It was only after the surgery to remove the tumour that the surgeons were able to accurately diagnose her cancer as stage 2. It hadn’t spread to her lymph nodes or liver as first feared.

When an unexpected diagnosis becomes a family pattern

As a scientist, Natalie wasn’t content with simply surviving bowel cancer, she wanted to get involved in the research too. “My brain had already gone down that path of … I need to do something here.”

She signed up for a clinical trial looking at stage 2 recurrence by detecting circulating tumour DNA in the blood – a step that gave her greater peace of mind.

But when Natalie learned that years ago her grandfather had died from stage 4 bowel cancer that had spread to his liver, she began worrying about her genetics and Zoe’s risk.

“I went and saw a genetic counsellor who took some samples,” she said, but the results were inconclusive. Referred on to Associate Professor Daniel Buchanan to get more answers, Natalie became part of a consumer group for early onset bowel cancer. There she found not only a support network, but also a chance to be part of the research that could spare Zoe from a similar diagnosis one day.

“Early detection was critical for saving my life. But the prevention is really critical for saving Zoe,” she said.

When Natalie’s mother was later diagnosed with bowel cancer too, it was no longer a coincidence – it was a pattern. Three generations with bowel cancer and no clear genetic cause.

“I brought it to Dan and he was really interested. We started talking about other factors that may be transmissible through a family. It's not just genetics, there's lifestyle factors – things like the gut microbiome.”

Natalie became part of a roundtable discussion with researchers and others in the consumer group who had multiple generations of bowel cancer in a family with no known genetic link.

These insights have gone on to inform A/Prof. Buchanan’s latest research funded by Cancer Council Victoria.

His team has discovered a specific type of gut bacteria that releases a harmful toxin called ‘colibactin’, which can cause early-onset bowel cancer.

“We’re working to develop a simple test to detect this bacteria in young adults,” he said. “If found, we could use targeted therapies to eliminate it from the gut. This would allow us to stop the cancer before it ever begins.”

This research offers hope for so many families now impacted by bowel cancer with no genetic explanation. For Natalie, it signifies positive change.

“With three generations in our family, I feel it’s my duty of care to prepare Zoe for the screening that will come and I live in hope that there will be a blood test, rather than a colonoscopy, [in the future].”