A recent study published in JAMA Network Open reveals an increasing trend in cancer rates among individuals under 50 years old.
Notably, breast cancer accounted for the highest number of cases in this age group, while gastrointestinal cancers, including colon cancer, exhibited the most significant percentage increase among all cancer types.
Conversely, the study found a decrease in cancer rates among individuals aged 50 and older during the same period from 2010 to 2019.
The findings not only emphasize the importance of raising awareness to prevent missed diagnoses but the study authors also wrote that “investigations for possible tumors need to be considered when clinically appropriate, even in patients younger than 50 years.”
Hematologist, medical oncologist, and assistant professor of medicine at Cleveland Clinic in Ohio, Suneel Kamath, MD, agrees.
“Many of the people I see told me that they saw several different doctors for many months for the same symptoms, and nobody thought of cancer. The thought was, ‘You’re too young to have cancer, so it can’t be that,’” explains Dr. Kamath, who was not involved in the research.
Dr. Kamath reiterates that while the study isn’t only important to help build awareness so that diagnoses will not be missed, it may also lead to bigger funding for research to “get to the bottom of why this is happening.”
Early-Onset Cancer Higher in Women But Lower in Men
Utilizing data spanning from 2010 to 2019 obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program, the study scrutinized the occurrence of early-onset cancers across various organ systems. It also examined patterns concerning sex, age group, and race and ethnicity. The SEER database serves as a comprehensive repository, collating cancer-related data from diverse locations and sources across the United States.
Throughout the 10 years, the study identified 562,145 cases of early-onset cancer (in individuals under 50). Of these cases, 62.5 percent were female. Overall, there was a 0.74 percent increase in early-onset cancers during the study period, with a notable rise of 4.4 percent in women but a decline of 4.9 percent in men. The increase in younger women was largely attributed to breast and uterine cancers, explained the study authors.
In 2019, breast cancer constituted the highest number of early-onset cases, with 12,649 instances, followed by thyroid cancer at 5,869 cases.
Fastest-Rising Early-Onset Cancers are GI Cancers
The study highlighted gastrointestinal cancers as the fastest-growing among all early-onset cancers, increasing by almost 15 percent from 2010 to 2019. Alongside colon cancer, cancers of the appendix, bile ducts in the liver, and pancreas exhibited the most rapid growth rates, particularly in individuals aged 30 to 39.
Certain ethnic backgrounds, experienced notable variations, with early-onset cases rising by 32 percent among individuals of Asian or Pacific Island descent and nearly 28 percent among Hispanic individuals. In contrast, rates fell by nearly 12 percent among white individuals and 5 percent among Black Americans, though potential underreporting or underdiagnosis in underserved populations is acknowledged.
“I think this is a really important article in a growing literature really showing that cancer is increasingly in the young. There just seems to be this rise in a number of different cancers and people even in their twenties and thirties,” says Dr. Kamath.
Dr. Kamath adds that not only will these findings build a greater awareness that cancer in younger people is on the rise, but it could also help identify groups at higher risk.
“For example, people of Asian descent or Hispanic descent where there was the biggest spike may benefit from increased screening,” he says.
Early Onset Cancer Is Harder to Treat, Say Experts
Dr. Kamath also shares that in people below 50, cancer tends to be harder to treat. A large part of that is due to these cancers being diagnosed at very late stages already, making the outcomes usually worse.
Ning Jin, MD, a gastrointestinal medical oncologist with the Ohio State University Comprehensive Cancer Center in Columbus, who was not involved in the research, explains, “The cancer diagnosis in a young adult is more devastating, when life is supposed to be full of great excitement and expectations, such as career goals and family life.”
Moreover, Dr. Jin says that people under 50 may have more financial stress and difficulty in balancing work, life, and medical treatment.
“They often need to deal with acute and long-term side effects from treatment, including the pain and bowel dysfunction. If patients require radiation treatment for their rectal cancer, there will be concerns for fertility,sexual dysfunction, and colostomy management,” she adds.
Dr. Kamath adds that in several cases, younger people have delayed diagnosis, resulting in delayed treatment, which then increases the likelihood of poorer outcomes.
The Role of Lifestyle and Early Antibiotic Exposure in Cancer Development Among Young Adults
According to the authors, more research is needed to understand why cancer in younger adults and in certain groups is on the rise.
As per Dr. Lin, the reasons could be due to lifestyle changes, such as the typical Western diet, which includes more red meat and less fiber, as well as food additives.
Dr. Kamath adds that there is data to suggest that antibiotic use, especially early in life, could play a role.
“There does seem to be this birth cohort effect, where people born in a certain time frame — the 1980s until the early 2000s — may be the most impacted,” says Dr. Kamath.
He further explains that during this period, the over prescription of antibiotics could have had long-term impacts on the microbiome, which could be related to more cancer onset later in life.
Why the Decrease in Cancer Rates in Older Adults?
According to Dr. Kamath, screenings such as mammograms or colonoscopies could be what’s helping reduce cancer incidence in some cases.
“If you think about mammograms for example, if you detect a precancerous lump before it turns into cancer and it gets removed, you can stop a cancer from happening. In a colonoscopy, if polyps are identified and removed, you’re actually stopping people from ever developing colon cancer,” he says.
Dr. Kamath adds that although screening is certainly making a dent in reducing the number of older adults with cancer, some of the reduction is caused by the people who would have developed cancer in their fifties and sixties getting it earlier.
“Someone that may have gotten cancer later, at age 65, is getting it at age 45,” he adds.
Seeking a Second Opinion Can Be Beneficial for Younger Individuals with Unexplained Symptoms
According to Dr. Kamath, there is research showing that people in their twenties and thirties who are eventually diagnosed with cancer saw several doctors over the 6 to 12 months prior to their diagnosis.
“And it wasn’t as if their symptoms really changed during that time. They were basically the same, but it ultimately took a different doctor coming across them to realize that something more serious was going on,” he says.
Moreover, Dr. Kamath adds that getting a second opinion and going to a hospital where there is more specialization and more awareness is important.
“I think it takes a doctor really being educated on this to take that next step in terms of doing more testing to get to the bottom of what’s going on,” he says.
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