When Inherited Condition Leads to Two Cancers, Young Survivor Finds Hope at Prevention Center

As one of three family members with the same first and last name, John E. Duggan found individuality through initials while growing up — becoming universally known as “Jed.” Having survived both stage III colon cancer and thyroid cancer before age 30, he is refusing to let another familial tie get him down.

Duggan has MUTYH-associated polyposis (or MAP), a genetic condition that increases one’s risk of developing gastrointestinal polyps, colorectal cancer, and, to a lesser degree, other cancers. MAP is caused by an alteration in both copies of the MUTYH gene, one inherited from each parent. Jed’s parents are both carriers, and he and older sister, Caitlin, inherited it from them.

The Duggans learned their status because Jed’s oncologists in his native Worcester, Mass., and at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) referred them for genetic testing at Dana-Farber’s Gastrointestinal Cancer Genetics and Prevention Program. The family’s medical history, which includes multiple cancers going back several generations on both sides, was one red flag for doctors.

Jed Duggan.

MAP carriers should be watched carefully. Most individuals with the condition will develop ten to a few hundred colon polyps by age 50, and although all polyps start benign, some can become cancerous and spread throughout the body. Both Jed and Caitlin, who has not developed cancer, have frequent colonoscopies to catch polyps as early as possible.

Jed admits that the challenges he’s faced in his twenties — including surgery and treatment for both colon and thyroid cancer in a two-year span — have been tough. But thanks to the support of his family, a tight network of fellow survivors, and a medical team at DF/BWCC led by Kimmie Ng, MD, MPH, he is looking forward with hope.  

“Dr. Ng is great, encouraging me to keep my life as normal as possible,” says Duggan, 29, a construction engineer who still lives in Worcester. “I play softball twice a week, go to the gym every day, and focus on eating healthier meals with less red meat and more vegetables.”

Meanwhile, Ng and other physician-scientists at Dana-Farber continue to seek the causes of MAP through basic and clinical research, including clinical trials. 

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Duggan receiving treatment.

From a cold to cancer

Duggan was feeling anything but healthy in early 2016, but did his best to ignore the various medical maladies he was experiencing as a student at Fitchburg State University.

“I just thought I had a bad cold,” he recalls. “I was trying to finish up my last year of college and didn’t realize my symptoms — lots of coughing, cramping, fatigue, some bloody stool — were all signs of cancer. I tried to work my way through it.”

By the time he went to the doctor several months later, Duggan’s blood count was off the charts. His colon had perforated, and doctors at first thought he had inflammatory bowel disease. He was readying for further treatment when the cramping got so bad he needed emergency surgery in July.

“I went in for surgery on a Monday afternoon in July,” Duggan remembers. “They thought it was an oversized polyp, and when they took it out expected everything to be fine. Then on Tuesday they told me I had stage III colon cancer.”

He had started chemotherapy, but then a PET scan revealed a lesion growing in his liver, along with two more spots in his pelvis. It was at this point that Duggan was referred to Dana-Farber and Ng.

Another challenge

Several months of biweekly chemotherapy eliminated the spots in his liver and pelvis, and controlled the colon cancer, but then in February 2017 a lesion was found in Duggan’s thyroid. It was also cancerous, requiring surgery at DF/BWCC that April by Matthew Nehs, MD.

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Duggan with his family.

“That was not the greatest news,” says Duggan, “but Dr. Nehs really made me feel better. They told me how glad they were that we caught it early.”

Better news was to come. He had his ostomy reversed, one year to the day of his first colon surgery. Then, after his initial chemotherapy regimen was completed, he was given the choice of continuing with the same protocol or starting maintenance chemotherapy. He could also stop altogether.

“I decided I wanted to stop, because it was so physically draining,” says Duggan, “Now it’s three years later, and both of my cancers are in remission. I check in at Dana-Farber every few months and try to be as active as I can.

“Why worry about what you can’t control? That’s my new mantra.”