Stage 4 diagnosis at 29: Are more young people getting cancer?
Aimee-Rose Yates never expected to hear that she had metastatic bowel cancer at just 29.
The Auckland woman had spells of diarrhoea prior to her diagnosis in July 2022, but said she didn’t have any other obvious signs pointing to cancer. Instead, her disease was discovered almost by chance.
A family member had been diagnosed with a medical condition associated with an increased risk of colorectal cancer, so it was recommended Yates undergo a colonoscopy.
When they found a “suspicious area”, Yates said she just knew it was cancer.Then a full-time primary school teacher, Yates had a 6.5cm tumour, diagnosed as adenocarcinoma. “I was told it was terminal.”
The incidence of a range of cancers in adults under the age of 50 - often referred to as early-onset - has been rising in many parts of the world since the 1990s.
Last month, the Princess of Wales, announced she had an unspecified form of cancer at age 42, shortly after 43-yearold actress Olivia Munn posted on social media that she had been diagnosed with breast cancer. Increased use of screening programmes had contributed in part, but a “genuine increase” in the incidence of several types of early-onset cancers also seems to have emerged, a journal article stated.
Consultant medical oncologist Professor Chris Jackson said there’s been an “emerging trend” of incidence rates of cancer in people under 50 slowly increasing over roughly the past 30 years.
As the population goes up, you’d expect to see more cancers, and therefore more cancers in younger people, he said. And while the increase in incidence rates in young people was “statistically meaningful, and highlights important trends we need to understand”, Jackson noted it was from a low baseline. “The burden of cancer still primarily falls to those over 60.”
Known risk factors for cancer would account for some, but not all, of the changes being seen in young people, he said.
Things like tobacco and alcohol use, sun exposure, increasing physical inactivity, sedentary lifestyles and obesity were risk factors for cancer, Jackson said.
There were other possible factors that remain areas of active study, and were “speculative rather than certain”, he said, such as whether changes in the gut microbiome, linked to ultra-processed foods and excess antibiotic use, may be playing a role.
Te Aho o Te Kahu (the Cancer Control Agency) deputy chief executive Nicola Hill said while there were concerns that cancer incidence under 50 was increasing globally, “the current available data for New Zealand does not reflect this for cancer overall”. Health New Zealand data from 2012-21 showed that the rate of cancer registrations (across all disease types) in those aged 0-24 and 25-44 remained relatively stable.
“We continue to monitor trends in cancer incidence to ensure any changes – such as an increase in younger people being diagnosed – is noticed early.”
However, similar to other countries, New Zealand is seeing an increase in colorectal cancer in younger age groups, Hill said.
“It is not clear what is causing this increase, and we will continue to monitor and review both local and international research to better understand this pattern and look for preventable factors.”
Despite overall rates of bowel cancer decreasing in many countries, incidence in under-50s has been reported to be on the rise. Bowel cancer can affect the small bowel, or large bowel (colon and rectum). Cancer of the large bowel is also known as colon or colorectal cancer, and was more common than small bowel cancer.
Early-onset colorectal cancer had been rising at “significant” rates in Aotearoa over 20-30 years, general surgical trainee Dr Oliver Waddell, a PhD candidate completing his thesis on studies into early-onset colorectal cancer, said.
Soon to be published research by the University of Otago (Christchurch) found that in 2000, the incidence rate of colorectal cancer in Kiwis under 50 was 4.4. per 100,000 people.
By 2020, it was 8 per 100,000 - nearly double, said Waddell, who was involved in the research. In 2020, 270 New Zealanders under 50 were diagnosed with bowel cancer, up from 124 in 2000, he said.
Over those 20 years, incidence of colorectal cancer overall in those under the age of 50 was increasing 26% per decade in the total population, and 36% per decade in Māori, Waddell said.
If rates continue as they are, it’s predicted that 524 under-50-year-olds will be diagnosed with bowel cancer annually by 2040. It’s a change colorectal surgeon and Bowel Cancer Foundation medical adviser Professor Frank Frizelle has noticed over time, and one that experts say is consistent with other studies in Australia, the United States, Canada, United Kingdom, France and Asia.
A 2023 American Cancer Society report stated that in 2019, 20% of colorectal cancers were in people aged 54 or younger, up from 11% in 1995.
However, it’s not completely clear yet why this is happening, Frizelle said.
An international review article suggested early-onset colorectal cancer appears to represent a “unique disease process, with different clinical, pathological and molecular characteristics” compared with late-onset colorectal cancer.
Many early-onset colorectal cancers were diagnosed due to symptoms such as changes in bowel habits, rectal bleeding, fatigue, and weight loss, Frizelle said.
It’s important to note that people over 50 make up 90% of bowel cancer cases in Aotearoa.
“Bowel cancer is still largely a disease of older adults, but is becoming much more common in younger people,” Waddell said.
Aimee-Rose’s story
Yates, 30, said having stage 4 cancer so young “definitely made me appreciate the little time that I do have”.
Having lost her mum to GIST (gastrointestinal stromal tumour) cancer just after her 48th birthday, Yates expected she may need to be mindful of symptoms earlier or access screening younger, but thought she’d have more time.
With the support of her “amazing” medical oncologist - whose name she even had tattooed on her leg - she has undergone extensive chemotherapy, including a sixmonth clinical trial, and targeted radiation.
She’s currently having a break from treatment, with plans to work, travel and spend time with her husband, Aaron, and friends, and would have another scan in June to determine the next steps.
Yates encouraged other young people to see their doctor if things don’t feel right, and to push for tests or investigations. “I don’t think most young adults would run to the doctor over having diarrhoea, [but] if I had, maybe it could have saved my life.”
She is passionate about seeing the bowel cancer screening age lowered, to help detect cancers sooner and prevent others suffering a similar fate.
Yates featured at a leaders debate last year, asking Chris Hipkins and Christopher Luxon if they would commit to reducing the screening age if elected.
Health Minister Dr Shane Reti requested advice on this matter, and was considering it. “As was the case with the announcement to raise the age of breast screening, any decision to adjust eligibility for screening has significant clinical, workforce and funding implications to consider,” Reti told Stuff.
Looking ahead
Hill, at Te Aho o Te Kahu, said cancer does not discriminate and can occur at any age, so it’s important anyone with concerning symptoms speaks to their GP.
Aotearoa has evidence-based prevention measures in place to help decrease the incidence of cancer, Hill said, such as the HPV vaccine - a “vital pillar” in reducing cervical cancer incidence.
In 2022, the agency released the Cancer Prevention Report, which looked at six areas where cancer prevention could be strengthened. Focusing on decreasing the number of people smoking, ensuring people were drinking in moderation and maintaining a healthy diet and weight were all things that will help to ensure fewer people develop cancer, Hill said.
Health New Zealand interim national chief medical officer Dr Nick Baker said routine tests and checks in primary care settings, and people taking advantage of publicly funded screening services, would help to support early cancer diagnoses.
This, combined with “greater practitioner awareness of the evolving picture of the cancer age distribution” and how presentations may vary with age, would also improve detection of cancers in younger people, Baker said. Health NZ has also indicated an intention to improve access to community referred diagnostic services, to reduce variations in access across the country.