Three years ago, Vanessa Chapoy was only 24 when she discovered a lump in her breast as big as a walnut. What followed was a series of medical examinations that ultimately led to her diagnosis of stage two breast cancer. Chapoy’s world was turned upside down as she stepped into the relentless journey of cancer treatments which included lumpectomy, fertility treatments, chemotherapy, and a double mastectomy.
Now, at 27, she’s still battling the after-effects of her treatments. As an unfortunate souvenir of her journey, she suffers from early menopause-like symptoms due to hormone therapy and chemo brain, a cognitive impairment following chemotherapy. Chapoy’s story is far from unique; it’s becoming increasingly common, symbolizing a worrisome trend in our health landscape: the rise of early-onset cancer.
The Startling Statistics: Early-Onset Cancer on the Rise
Cancer, a disease usually associated with older adults, has been infiltrating the lives of younger individuals with alarming regularity. Nearly 60% of cancer patients in the United States are diagnosed at the age of 65 or older. However, in recent decades, the incidence of cancer among individuals under 50 (designated as early-onset cancer) has been on a disturbing upward trend.
Termed as an ‘oncological tsunami’, this alarming upswing in cancer rates has seen an increase of nearly 18% in early-onset cases between 2000 and 2019 in the U.S alone. This surge, as reflected by data from the National Cancer Institute (NCI), has eclipsed a slight decline in cancer rates among older adults.
For the adolescents and young adults (AYAs), the demographic group defined by the age range 15-39, the surge is even more pronounced, exceeding 20% [1]. This growth trend isn’t restricted by boundaries of gender, race, or organ specificity. It has permeated various systems of the body, including the blood, bone marrow, gastrointestinal tract, and reproductive organs. Specifically, the incidence of breast cancer among the 15-39 age group in America increased by over 17% in a span of 19 years, whereas colorectal cancer rates skyrocketed by nearly 45%.
The Causes Behind the Trend
What’s behind this alarming increase? Cancer researchers are still trying to connect the dots, though they suggest that increasing rates of early detection and overdiagnosis due to enhanced screening techniques could account for part of the increase, particularly in thyroid and prostate cancers [2]. The reason, explains Archie Bleyer, a clinical research professor at the Knight Cancer Institute, is that screenings for cancer or other health issues have led to the detection of tumors and masses that would never have become problematic if left undetected, hence creating a “false increase”.
However, the surge in early-onset cancer rates goes beyond the influence of advanced screenings. Researchers propose several environmental and lifestyle changes since the mid-20th century that have potentially contributed to the escalation.
Role of Obesity and Lifestyle Changes
Among the several proposed factors, obesity stands out as the primary suspect. Childhood and adolescent obesity rates have been steadily climbing since the 1960s. Numerous cancers including breast, uterine, colorectal and others affecting the gastrointestinal tract have been linked to obesity. As per Tomotaka Ugai, an instructor at Harvard Medical School, the dramatic increases in obesity-related cancers suggest obesity’s significant contribution to the early-onset cancer cases [3].
Beyond obesity, Westernized diets, sugar-sweetened beverages, processed meats, sedentary lifestyles, decreased physical activity, and metabolic conditions like type 2 diabetes have been implicated as contributing factors. Other risk factors pointed out by Bleyer include the increased use of diagnostic imaging exposing patients to carcinogenic radiation and the rising use of cannabis, particularly relevant for testicular cancer.
Potential Genetic and Environmental Triggers
Changes in height, sleep patterns, and the body’s microbiome — the community of microorganisms inhabiting our bodies — could also contribute to the rise in early-onset cancer. Marios Giannakis, a researcher at the Dana-Farber Gastrointestinal Cancer Center, noted that alterations in the microbiome, possibly due to dietary habits, lifestyle changes, or surgical procedures like C-sections, could play a part in early-onset colorectal cancer [4].
Giannakis emphasizes that we need more research to better comprehend the reasons behind the escalating rates, including longitudinal cohort studies that track participants over extensive periods. Understanding the ‘why’ could be key to prevention, he asserts.
The Consequences: From Diagnosis to Survival and Beyond
As the research continues, the number of cancer diagnoses in adolescents and young adults exceeds 85,000 each year in the U.S alone. These patients, unfortunately, are often diagnosed at advanced stages when the cancer has already proliferated in their bodies. This late detection is often due to infrequent medical check-ups, lack of insurance, and a general lack of awareness about cancer in this age group.
The Financial Implications of Cancer
While the disease itself can be quite challenging, its financial implications also merit discussion. As cancer often requires long-term treatment, it can impose a significant financial burden on the affected individual and their family. According to the American Society of Clinical Oncology, the total annual cost of cancer care in the U.S. was projected to rise to $173 billion by 2020, which highlights the financial struggles that young adults might face in the wake of their diagnosis.
In the case of Tatyana Ridgeway, who was diagnosed with stage one breast cancer at the age of 26, she had to step away from her work as she underwent four cycles of chemotherapy and proton radiation. Like Chapoy, Ridgeway also opted for fertility treatments. This journey made her reassess her perspective on life, including her plans around parenthood and the expectation of how life should unfold in one’s 20s. Although she managed to preserve some embryos, the associated costs were substantial. Her in vitro fertilization treatments were covered by insurance, but she had to take a loan to cover the cost of cryopreservation.
Each of Ridgeway’s four cycles of chemotherapy cost $15,000, and her proton radiation totaled over $100,000. “That’s without insurance,” she stated. Chun Chao of the Kaiser Permanente Southern California Department of Research & Evaluation indicates that a significant proportion of young adult survivors report financial hardships related to cancer, including resorting to borrowing money, incurring debt, or even filing for bankruptcy.
Racial Disparities and Cancer
Moreover, the lack of diverse representation in cancer research is worth noting. As Ridgeway, who is Black, sought out cold cap therapy to help reduce hair loss brought on 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 ongoing need for cancer research and clinical trials to encompass the full range of age, racial, and ethnic groups that cancer affects.
Alison Silberman, the CEO of Stupid Cancer, a non-profit organization advocating for young adults impacted by cancer, recognizes this age group as “underserved and underrepresented” in cancer research. “There has been a growing awareness over the last couple of decades amid the increase in cases,” Silberman observes. However, she emphasizes the need for further research and awareness, particularly in smaller community settings that might lack the resources of larger academic institutions.
Future Directions in Cancer Research
Looking forward, researchers are keen to raise further awareness about cancer among young people and their doctors and to continue studying these cases for better treatment methods. Danielle Carnival, the White House cancer moonshot coordinator, expresses the administration’s focus on bridging the gap in cancer care for young adults. This includes understanding the underlying science and improving patient care services.
The administration is also committed to “decreasing the impact of preventable cancers,” by implementing efforts to reduce smoking rates, and looking into the impact of nutrition and lifestyle on cancer incidence. Bleyer points out that the declining rates of lung cancer and melanoma among young people serve as encouraging examples of how preventive strategies can be effective in curbing cancer incidence.
Wrapping Up
In conclusion, the rising incidence of cancer among young adults is a complex issue with multiple potential causes including lifestyle changes, obesity, and potentially, increased exposure to diagnostic radiation. This trend not only underscores the need for further research into the causes and prevention of early-onset cancer, but also the need for strategies to support young adults during and after cancer treatment, from medical to financial assistance. The impacts of a cancer diagnosis during such a pivotal life phase can reverberate far beyond the medical sphere, disrupting plans for education, career, and family, and necessitating a reevaluation of life’s trajectory.
The progress in understanding and treating early-onset cancer is promising, but there’s still a long way to go. Young adults deserve access to the best care and treatment options, and an inclusive research approach that acknowledges the unique challenges they face. The fight against cancer in young adults is far from over, but with increased awareness, research, and support, strides can be made to turn the tide in their favor.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345192/
