During my first meeting with my oncologist, in August 2021, she told me that people like me (52, physically fit, no relevant family history) rarely used to get bowel cancer, but there had been a huge spike in the number of ‘young’ people being diagnosed. My next question, naturally, was: ‘Why?’ She shrugged. ‘We don’t have the data.’
There is now a study underway, though it is a five-year project. But you don’t need to be a scientist to make the connection between a tumour in your digestive system and the food you put into your body each day.
In those early days, I kept asking myself if I was to blame for my cancer. I mentally divided my lifestyle into ‘good’ and ‘bad’ lists. Before my diagnosis I did exercise most days: 5k or 10k runs, weights in the gym, Pilates, football. I ate oily fish and a large salad of lettuce, peppers and tomatoes three nights a week. I consumed very little red meat (Bethan is vegetarian). As for the bacon sandwiches, I probably ate one a year.
Admittedly, I had my vices – a weakness for crisps, for example, and alcohol, which had been a near-daily occurrence for most of my 30s and early 40s. A decade earlier I’d resolved never to drink during the week. Over the weekend, however, I tended to binge 20 to 25 units – a drop in the ocean compared with most of my friends.
Even some of my healthy habits turned out to be questionable. Shortly after my diagnosis I opened a newspaper and was confronted with a list of the worst fruits and vegetables for pesticides. I became convinced that these had contributed to my cancer; I’ve since read that there isn’t necessarily a link, but at the time it just fuelled my emotional turmoil. Many things I ate all the time were up there: lettuce, oranges, grapes, carrots. I washed things, of course – but sometimes, in a rush, a quick dunk under the tap seems to suffice.
My oncologist was adamant that there is no way of knowing what makes an individual’s cells mutate. Genes, lifestyle, environmental exposures and diet are all factors, but unlike lung cancers – of which 85 per cent of cases are believed to be caused by smoking worldwide – with bowel cancer it’s impossible to pinpoint what caused your illness.
Nonetheless, the more I found out about the rise in bowel cancer cases among younger people, the angrier I got. I lurched between guilt (‘I did this to myself’) and rage (‘Big Food did this to me’). In the end, guilt won. In darker moments, when I asked myself, ‘What have I done to deserve this?’ I thought knew the answer.
I had always eaten too much sugar. I mentally scrolled back to my 1970s childhood, when I drank orange squash almost exclusively. Later, throughout most of the 1990s, I smoked cigarettes – only giving up aged 30 – and drank too many cocktails. Could I really expect to avoid cancer just because I’d become a model of clean living in my late 40s?
The truth is that I felt embarrassment – yes, embarrassment – telling people that I had a life-threatening illness that is linked to poor diet. And the more I thought about it, the more the true meaning of my friend Simon’s comment revealed itself to me: ‘Everyone’s going to assume you ate a lot of bacon sandwiches… so you might as well have eaten them.’
Of course, the idea of one person being more ‘deserving’ of a major illness than another person is obscene. And yet it was hard to avoid a sense of shame. And once I’d convinced myself that I was to blame, that’s when the self-loathing really kicked in.