Cancer rates are rising among young people. It's not clear why

Cancer rates are rising among young people. It's not clear why

Three years ago, Vanessa Chapoy was just 24 years old when she discovered a lump the size of a walnut in her breast. A series of medical tests followed, which ultimately led to a diagnosis of stage two breast cancer. Chapoy's world was turned upside down as she embarked on the tireless journey of cancer treatments, which included lumpectomy, fertility treatments, chemotherapy and a double mastectomy.

Now, at 27, she is still dealing with the after-effects of her treatments. As an unfortunate souvenir of her trip, she suffers from early menopausal symptoms due to hormone therapy and chemo-brain therapy, cognitive impairment following chemotherapy. Chapoy's story is far from unique; It is becoming increasingly common and symbolizes a worrying trend in our healthcare landscape: the increase in early-stage cancer.

The startling statistic: early-stage cancers are increasing

Cancer, a disease usually associated with older adults, has infiltrated the lives of younger people with alarming regularity. Nearly 60% of cancer patients in the United States are diagnosed at age 65 or older. However, in recent decades, the incidence of cancer in people under 50 (so-called early cancer) has seen a worrying upward trend.

Dubbed the “oncology tsunami,” this alarming increase in cancer rates has resulted in a nearly 18% increase in early-onset cases between 2000 and 2019 in the United States alone. This increase, reflected in data from the National Cancer Institute (NCI), has dwarfed a slight decline in cancer rates among older adults.

Among adolescents and young adults (AYAs), the demographic group defined by the age range of 15 to 39 years, the increase is even more pronounced, exceeding 20%. [1]. This growth trend is not limited by boundaries of gender, race, or organ specificity. It has penetrated various systems of the body, including the blood, bone marrow, gastrointestinal tract, and reproductive organs. Specifically, the incidence of breast cancer in the 15- to 39-year-old age group in America increased by over 17% over 19 years, while colon cancer rates increased by almost 45%.

The reasons behind the trend

What is behind this alarming increase? Cancer researchers are still trying to clarify the connections, but believe that increasing early detection and overdiagnosis due to improved screening techniques may explain some of the increase, particularly in thyroid and prostate cancer [2]. The reason, explains Archie Bleyer, professor of clinical research at the Knight Cancer Institute, is that screenings for cancer or other health problems have led to the detection of tumors and masses that would never have become problematic if left undetected, thus leading to a "misdiagnosis increase."

However, the rise in early cancer rates goes beyond the impact of advanced screening. Researchers suggest several environmental and lifestyle changes since the mid-20th century that may have contributed to the escalation.

Role of obesity and lifestyle changes

Among the several factors suggested, obesity stands out as a prime suspect. Obesity rates among children and adolescents have risen steadily since the 1960s. Numerous cancers, including breast cancer, uterine cancer, colon cancer, and others affecting the gastrointestinal tract, are associated with obesity. According to Tomotaka Ugai, a lecturer at Harvard Medical School, the dramatic increase in obesity-related cancers suggests that obesity is a significant contributor to early-stage cancers [3].

In addition to obesity, Western diet, sugar-sweetened beverages, processed meat, lack of exercise, reduced physical activity and metabolic diseases such as type 2 diabetes are also considered as triggering factors. Other risk factors that Bleyer points out include the increasing use of diagnostic imaging, which exposes patients to cancer-causing radiation, and the increasing use of cannabis, which is particularly relevant for testicular cancer.

Possible genetic and environmental triggers

Changes in body size, sleep patterns and the body's microbiome - the community of microorganisms that inhabit our bodies - could also contribute to the rise in early-stage cancer. Marios Giannakis, a researcher at the Dana-Farber Gastrointestinal Cancer Center, noted that changes in the microbiome, possibly due to dietary habits, lifestyle changes or surgical procedures such as cesarean sections, may play a role in early colorectal cancer [4].

Giannakis emphasizes that we need more research to better understand the reasons for the rising rates, including longitudinal cohort studies that follow participants over longer periods of time. Understanding the “why” could be the key to prevention, he claims.

The Consequences: From Diagnosis to Survival and Beyond

As research continues, the number of cancer diagnoses among adolescents and young adults in the United States alone exceeds 85,000 each year. Unfortunately, these patients are often only diagnosed in advanced stages, when the cancer has already spread throughout their body. This late detection is often due to infrequent medical exams, lack of insurance, and a general lack of awareness about cancer in this age group.

The Financial Impact of Cancer

While the disease itself can be challenging, its financial impact is also worth discussing. Because cancer often requires long-term treatment, it can place a significant financial burden on those affected and their families. According to the American Society of Clinical Oncology, the total annual cost of cancer treatment in the United States is expected to rise to $173 billion by 2020, highlighting the financial difficulties young adults may face following their diagnosis.

In the case of Tatyana Ridgeway, who was diagnosed with stage one breast cancer at the age of 26, she had to stop working as she underwent four cycles of chemotherapy and proton radiation. Like Chapoy, Ridgeway also chose fertility treatments. This journey made her reevaluate her perspective on life, including her plans around parenthood and expectations of how life should unfold in her twenties. Although she managed to preserve some embryos, the costs involved were significant. Her in vitro fertilization treatments were covered by insurance, but she had to take out a loan to cover the cost of cryopreservation.

Each of Ridgeway's four cycles of chemotherapy cost $15,000, and her proton radiation therapy totaled over $100,000. “This is without insurance,” she said. Chun Chao of the Kaiser Permanente Southern California Department of Research & Evaluation states that a significant proportion of young adult survivors report financial difficulties related to cancer, including taking out loans, taking on debt, or even filing for bankruptcy.

Racial disparities and cancer

Additionally, the lack of diverse representation in cancer research is worth noting. When Ridgeway, a Black woman, sought cold cap therapy to reduce hair loss caused by chemotherapy, she discovered that no one with her hair texture or age group had been included in trials for this therapy. This experience highlights the continued need for cancer research and clinical trials to cover the full spectrum of age, racial and ethnic groups affected by cancer.

Alison Silberman, CEO of Stupid Cancer, a nonprofit that advocates for young adults affected by cancer, recognizes that this age group is “underserved and underrepresented” in cancer research. “Over the last few decades, awareness has increased as cases increase,” Silberman notes. However, she emphasizes the need for further research and awareness, particularly in smaller communities that may lack the resources of larger academic institutions.

Future directions in cancer research

In the future, the researchers are keen to raise awareness of cancer among young people and their doctors and to further investigate these cases in order to find better treatment methods. Danielle Carnival, the White House Cancer Moonshot Coordinator, expresses that the administration is focused on closing the gap in cancer care for young adults. This includes understanding the underlying science and improving patient care.

The government is also committed to “reducing the impact of preventable cancers” through efforts to reduce smoking rates and studying the impact of diet and lifestyle on cancer incidence. Bleyer points out that declining rates of lung cancer and melanoma among young people are an encouraging example of how preventative strategies can be effective in curbing cancer incidence.

Summary

In summary, the increasing incidence of cancer in young adults is a complex problem with multiple potential causes, including lifestyle changes, obesity, and possibly increased exposure to diagnostic radiation. This trend highlights not only the need for further research into the causes and prevention of early cancer, but also the need for strategies to support young adults during and after cancer treatment, from medical to financial support. The impact of a cancer diagnosis at such a crucial time in life can extend well beyond the medical field, disrupting educational, career and family plans and requiring a reassessment of the life course.

Advances in understanding and treating early cancer are promising, but there is still a long way to go. Young adults deserve access to the best care and treatment options and an integrative research approach that recognizes the unique challenges they face. The fight against cancer in young adults is far from over, but with more awareness, research and support, steps can be taken to turn the tide in their favor.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345192/