SIOUX CITY | Holli Skuza cried for five minutes when she learned she had a tumor on the right side of her colon.
Then she dried her tears and told herself everything was going to be OK. She would persevere.
"I didn't know if I would live through the surgery -- that part really bothered me," the 45-year-old Dakota Dunes woman said. "I'd never had a major surgery like that. They had to remove part of my colon."
For decades, colorectal cancer rates have been declining among Americans born between 1890 and 1950, but the disease is surging among Americans younger than 50, according to an American Cancer Society study released last month.
Colon cancer incidence rates have increased 1 to 2.4 percent annually since the mid-1980s in adults 20 to 39 and by 0.5 to 1.3 percent annually since the mid-1990s in adults 40 to 54. Rectal cancer incidence rates have been climbing longer and faster, increasing 3.2 percent annually from 1974 to 2013 in adults 20 to 29.
The study's authors say adults born around 1990 now have double the risk of colon cancer and quadruple the risk of rectal cancer than those born around 1950.
Gokul Subhas, a colorectal surgeon who practices with Tri-State Specialists in Sioux City, said Skuza, who was diagnosed with stage 3 colon cancer at age 44, is the youngest patient he has treated for the disease.
Unfortunately, he said younger people are usually diagnosed with colorectal cancer at a later stage. Colonoscopy, the main screening tool for colorectal cancer, isn't recommended for a person at average risk until age 50.
"It's kind of hard to imagine somebody in their 30s or 40s having a colon or rectal cancer," he said. "They are picked up a little later compared to say a 60-year-old or 70-year-old, where many times it's just caught so early as a part of routine screening."
Subhas believes diets high in red and processed meats, sedentary lifestyles and climbing obesity rates are likely to blame for the colorectal cancer surge among younger people.
"We see plenty of that with the newer generation -- like not that much walking, eating junk food and not eating a lot of fruits and vegetables, which have natural antioxidants in them," he said.
Allison Rossow, a registered dietitian at UnityPoint Health-St. Luke's, said we are what we eat.
She said studies have shown that people who adhere to diets that are high in fruits, vegetables and whole grains and low in red and processed meats have a reduced risk of developing colorectal cancer.
Fruits and vegetables contain fiber, which helps keep the digestive tract strong, according to Rossow. She said people should strive to eat five servings of fruits and vegetables a day and make half of the grains they consume whole grains. She suggests topping a salad with beans or a bowl of oatmeal with nuts to add fiber.
"The goal for fiber consumption is 25 to 35 grams a day," she said. "Most Americans probably get half that or less on average in a day."
Genetic link to cancer
A bout with the flu in February 2016 brought Skuza, who was experiencing tiredness and dizziness, to her family doctor's office.
Medical testing revealed the mother and grandmother was anemic, which led her doctor to order more tests. One of those tests was a colonoscopy.
"They found a tumor in my right colon," Skuza said. "At the time, we didn't have a family history (of colon cancer). Now we have a huge family history."
Subhas encouraged Skuza to undergo genetic testing -- a blood or saliva test -- which traced her cancer to Lynch syndrome, a genetic disorder also called hereditary nonpolyposis colorectal cancer.
Individuals with Lynch syndrome have up to an 85 percent lifetime risk of colorectal cancer and an above average risk of endometrial, ovarian, stomach and other types of cancer. Due to the risk, Skuza will have a hysterectomy.
"In Lynch syndrome those genes which play a role in the repair of DNA damage get mutated," Subhas explained. "A cancer starts out with some mutation or some damage to DNA and then if the genes that normally repair the damage aren't there, it turns into cancer."
Although Lynch syndrome affects 1 out of every 279 people, few know they have it until they're diagnosed with cancer. Subhas said anyone under age 50 who develops colorectal cancer should have genetic testing, as well as those with a family history of the disease.
Skuza said she's glad she knows she has Lynch syndrome because now she can focus on living a happier, healthier life. She finished chemotherapy in December and was declared cancer-free.
Today, she spends a great deal of time raising awareness about the hereditary disorder through Lynch Syndrome International, an organization founded and governed by survivors, their families and health care professionals. At her request, South Dakota Gov. Dennis Daugaard declared March 22 Lynch Syndrome Hereditary Cancer Awareness Day.
In addition to her volunteer work, Skuza leads a healthy lifestyle by meditating and squashing negative thoughts. Fruits and vegetables are a major part of her diet, which is completely free of processed meats.
"That's really hard because I really like bacon. But I like to live more than I like bacon," she said with a chuckle. "I'm grateful for every single day."