Editor’s Note: This story originally appeared in Volume 7 of B.H. Magazine, order your copy now.
The last video I ever saw of my mate Lachie, he was gaunt and hollow-eyed. A man being eaten from the inside. Speaking directly to camera, in tears, explaining that everything Australia's medical system had to offer had been exhausted. Only something experimental could save him now. If anyone knew of anything, could we help? He was dead within months.
Lachie's death prompted thousands of conversations about preventative health and probably the same number of colonoscopies in his network.
It’s how I found myself drinking Glycoprep – a bowel preparation solution that tastes like tea made from dirty gym gear – guts in open revolt, about to be $2,499 out of pocket for a procedure my private health wouldn't cover thanks to mandatory waiting periods.
Bowel cancer is now the deadliest cancer for Australians aged 25 to 44. Early-onset colorectal cancer rates have nearly tripled in the 30 to 39 age group since 2000. It's the disease we decided only happened to old people who hadn't looked after themselves.
Lachie looked after himself – a fit, thirty-seven-year-old, well-resourced husband and father surrounded by people who would have moved heaven and earth for him. None of it was enough, because by the time the system detected his cancer, there was nothing left to offer.
His wife Catherine now runs the Lachlan Kean Foundation with a mission to raise awareness and fund research and patient support for young adults with bowel cancer. I asked her where she thought the system had failed her husband.
"The national guidelines aren't just a step behind," she says. "They're years behind what's happening in the community." And she's clear – the doctors aren't the problem. "They're doing exactly what they've been told to do. The problem is, what they've been told to do was written for another time."
Australia runs a world-class sick care system – exceptional at crisis intervention and keeping people alive once something has gone catastrophically wrong. What we're less comfortable with is the period before that. The years when nothing hurts or announces itself. When the thing that could eventually kill you is still small enough to remove.
The National Bowel Cancer Screening Program sends free testing kits to Australians aged 45 to 74 every two years. The threshold was 50 until 2024. Lowering it was overdue, and whether 45 is actually sufficient is a question the data is beginning to answer grimly.
"I don't think we truly know what's driving the rise in younger Australians,” Associate Professor Suzanne Mahady, a gastroenterologist and clinical epidemiologist at Monash University, says plainly.
Younger patients tend to present at a more advanced stage, she says, because their symptoms – abdominal discomfort, low iron, and changes in bowel habits – are non-specific and mimic a dozen other conditions. A GP working within the National Health and Medical Research Council guidelines has limited grounds to refer a 34-year-old with bloating for a colonoscopy.
"The guidelines offer guidance on screening," explains Mahady, "but they are not a tool for working up patients with symptoms." In practice, that distinction costs lives.
Dr Steven Lu has spent sixteen years watching this unfold. As chief medical officer of Everlab, a Melbourne-based preventative health service, he works in the gap the public system can’t fill. "When I started medical school, it was pretty rare for someone in their 20s or 30s to get bowel cancer," he says. "Now I hear about it every week."
He's not generalising either – he's counting. If you were born in 1990, your risk of rectal cancer is four times that of your parents, and your overall bowel cancer risk is double. But those numbers haven't triggered a proportionate response from the system designed to protect us.
"Younger people often have more aggressive tumours," says Dr Lu, "and they're less likely to be referred for investigation because we're still operating on the cultural assumption that cancer is an older person's problem."
Shortly after Lachie's death, I ordered a ColoVantage home bowel screening test through the foundation. My result cleared me of blood in my stool, but blood tests can't detect polyps, the silent precursors that, when left untreated, can turn malignant. Plus, with an unrelated hereditary heart condition to investigate, I decided it was time for a more comprehensive look at my health. Everlab, a full-scale preventative health clinic in Melbourne, gave me that opportunity.
Following an initial consultation, I flew to Melbourne to undergo a DEXA scan, VO2 Max, and a physical assessment at Everlab HQ, and on Dr Lu's recommendation, I was booked for a CT Coronary Angiogram to check a floppy mitral valve, and a colonoscopy to investigate IBS.
"Everlab was designed to find blind spots in your health," explains Dr Lu. The polyp with no symptoms; the mitral valve irregularity that's never announced itself; or the arterial narrowing that becomes a heart attack in your fifties.
My colonoscopy found a 10mm polyp, and it was removed. Of the 308 colonoscopies Everlab has referred to date, 52.6 per cent resulted in at least one polyp removed – more than double the national benchmark of 25 per cent. Several returned cancerous lesions, detected and treated early, and detection rates were higher in younger members.
The exact demographic the public system isn't screening. I asked him how much of preventative medicine was simply the relief of finding nothing. "It's not just relief," he says. "It's confidence. It gives people back bandwidth."
There's a version of health that isn't about discovering what's wrong with you – it's about knowing, with reasonable certainty, what isn't. The public system doesn't offer that.
After discussing my own colonoscopy results with Dr Lu, the first call I made was to my father – a man in his late sixties – suggesting he also undergo the procedure. He pushed back.
His generation was raised to believe medicine is a last resort. You see a doctor when something's wrong, not to find out whether something might be. “I feel fine, so I probably am fine,” is the most dangerous sentence in preventative health, and it's embedded so deeply in Australian culture it barely registers as a choice.
I paid $2,499 for a colonoscopy that discovered something real. If I couldn't afford the procedure, that polyp would still be there. I asked Dr Lu directly how he sits with the fact that his business saves lives the system can’t. "Health equity is always on my mind," he responds. "Everlab as of today can't help absolutely everyone. But technology is the only thing that scales quality, speed and cost simultaneously – otherwise you're always making trade-offs."
A recent Medicare and ABS analysis found that affluent Australians were having colonoscopies too frequently – contrary to clinical guidelines – while disadvantaged communities miss out. But the story is incomplete. The analysis focused almost entirely on over-50s and didn't ask what was happening to under-45s in either group. It didn't ask how a young, well-resourced man could still exhaust everything the system had to offer.
I put this to Mahady. I asked whether private preventative investigation was genuinely part of the problem, or whether conflating private and public demand was simply avoiding the harder conversation about chronic underfunding. She called it a difficult question, and left it there.
I asked Dr Lu a similar question: whether Everlab is a solution to a broken system or a symptom of it. "A bit of both," he says. "If the healthcare system functioned well, I wouldn't have quit my job to do this."
The answer to inequity isn't to restrict the choices of people who are paying attention. It's to lift the floor for everyone else.
After my colonoscopy, Everlab recommended specific dietary changes. I followed them for a month, and six months on I'd likely perform worse on the fitness assessment than when I first walked in. I'm not confessing – I'm making a point. The gap between knowing and doing is the central challenge of preventative health, and neither the public system nor a private clinic can close it for you. But I chose to take the option, and I could, because I was able to finance it.
The dietary picture is murky, but it matters. Research published in JAMA Oncology found that people consuming the highest levels of ultra-processed foods had a 45 per cent higher risk of developing the polyp precursors most associated with early-onset bowel cancer. Dr Lu goes further, pointing to pollution, heavy metals, microplastics, and sedentary behaviour as contributing factors. And, maybe surprisingly, the chemical environment of the womb.
"The bowel cancer rise we're seeing now may also be related to chemical exposure when you were still in your mother's belly," he says. Mahady is more cautious. Diet alone is unlikely to explain the full picture, she says. Science is still catching up.
Bowel cancer is more common in men than women, but more women complete the national screening kit. Younger men – the group most at risk of early-onset diagnosis – are the least likely to participate. They'll discuss bowel movements in detail among friends but won't spend five minutes on a test that could save their life. It's obviously not squeamishness. Perhaps something closer to denial – the same invincibility that makes men the last to see a doctor or admit something's wrong, before it becomes urgent.
The next generation is different. They track steps, sleep, HRV, and glucose. They've grown up watching parents defer and delay their health – plenty have watched those parents get sick, or die, as a result.
"People are usually driven by fear or by opportunity," says Dr Lu. "We want to empower people to be driven by opportunity – by taking away the fear."
That shift, from dread to agency, is the one that matters. But it takes time. And the guidelines, as Catherine Kean knows better than anyone, are still years behind where they need to be.
My polyp is gone, and my heart has been given the all-clear. I know, for now, what isn't wrong with me, and that knowledge is immensely relieving. Dr Lu calls it confidence. Catherine would call it what her husband never got.
The thing about a blind spot is that you can only confirm it was there after someone's looked. The system, as it stands, isn't looking early enough. By the time it does, it's already too late for too many people.
Lachie deserved better. So does everyone who comes after him.