Cancer rates are rising among younger people

Many were shocked when Catherine, Princess of Wales, announced recently that she had been diagnosed with cancer and was receiving chemotherapy – and for good reason. Her diagnosis is rare for a 42-year-old. (Only 12 percent of people with cancer are under 50.)

But while cancer risk increases with age, it’s also true that cancer is becoming more common among younger age groups – even as cancer rates are falling in older cohorts.

The numbers are startling. The American Cancer Society reported this year that every age group had a decrease in overall cancer incidence between 1995 and 2020 except for those under 50. For this group, the rate has been rising by 1 to 2 percent each year.

These trends are particularly pronounced for certain types of cancers. One study, published in JAMA Network Open, found that early-onset breast cancer rose by almost 4 percent among American women younger than 50 each year between 2016 and 2019. Another found a 2 percent annual increase in uterine cancer in younger women. The incidence of colorectal cancer in people under 50 has also risen rapidly since the 1990s.

These numbers are mirrored in global data. A sweeping investigation published in the British Medical Journal last year documented a nearly 80 percent increase in the number of people younger than 50 diagnosed with cancer since 1990. This was accompanied by a 27 percent increase in cancer deaths among adults in their 40s, 30s or younger.

These troubling statistics probably have multiple causes. A Lancet study links obesity with higher incidence of early-onset cancers; thus, as obesity rates have increased, so has cancer. Similarly, there are links between cancer and common lifestyle factors such as increased consumption of ultra-processed food, low levels of physical activity and high alcohol use.

Screening recommendations have been changing to account for the shifting demographics. In 2021, an influential federal task force changed its colorectal screening guidelines to recommend colonoscopies at 45 rather than 50. Last year, it proposed revising its breast cancer screening guidelines to start mammograms at 40 rather than 50.

These are moves in the right direction. Everyone should see their primary-care provider at least once a year and receive their recommended screenings. I often hear from patients that they don’t need these tests because they have no symptoms. But that’s why they are called screening exams – the tests are done among asymptomatic people to try to detect cancer in early stages before it spreads.

Younger people should also know their family history and whether it puts them in a higher-risk category. For instance, women with a sister or mother who had breast cancer have double the average risk of breast cancer. If they have two first-degree relatives who had breast cancer, their risk is five times the average. Their provider may recommend genetic testing, and they could begin screening exams earlier than those at average risk.

It’s also essential that people seek help for health concerns, no matter their age. People who consider themselves young and healthy often downplay certain symptoms that would raise red flags among older individuals. A breast lump, blood in the stool, abdominal cramping, irregular menstrual bleeding – all of these should prompt a visit to your health-care provider.

Health professionals, too, may not be thinking of cancer as a diagnostic possibility in younger patients. It’s true that when patients present a problem, chances are there is a more benign explanation than cancer. But patients should ask what that explanation is. Does that provisional diagnosis fully explain your symptoms? Are there additional tests that should be done, just in case?

The American Cancer Society estimates that an American woman has a 1 in 17 chance of being diagnosed with cancer before the age of 50. For men, it’s 1 in 29. That makes early-onset cancer uncommon but possible.

For many of us, these statistics are deeply personal. My mother was diagnosed with metastatic breast cancer in her 40s, when I was a young adult and my sister was only 8. As I approach my mother’s age at that time, I think back to the bewilderment, anger and sadness she must have experienced. My heart goes out to Catherine and to all the other people given a life-altering diagnosis of cancer. Tragically, it can happen to anyone – at any age.

– – Leana S. Wen is a professor at George Washington University’s Milken Institute School of Public Health and author of the book “Lifelines: A Doctor’s Journey in the Fight for Public Health.” Previously, she served as Baltimore’s health commissioner.