Cancer is no longer viewed as a disease that only affects the elderly. In the G20 industrialised nations group, an analysis conducted last year revealed that rates of cancer among young people are increasing faster than those among older adults.
Scientists at the American Cancer Society confirmed this trend in a broader range of cancers. Statistics suggest that a Gen Xer or Millennial has a higher risk of developing certain types of cancer than their Baby-boomer parent. The “birth cohort effect” was evident in half of the 34 cancer types that were studied, meaning they became more common with each successively younger cohort. The incidence of pancreatic cancer and kidney carcinoma, for instance, was twice or three times higher among those born between 1990 and 1955.
According to the academics, “generational changes in cancer risk” are being observed. These shifts have profound implications. The influx of younger cancer patients will challenge future cancer treatment, whether that means rethinking the screening programme or finding ways to maintain fertility during treatment. The dream of eradicating cancer as it transforms into an unfamiliar disease becomes more difficult.
Hyuna Sung is an epidemiologist with the ACS based in Atlanta. She teamed up to analyze data from American cancer registries on over 23mn patients who were diagnosed between 2000 and 2019 with 34 different types of cancer. Researchers also used registries that recorded over 7mn cancer-related deaths over the same time period.
The data were sorted by birth year. Patients were grouped into five-year intervals between 1920 and 1990. The ACS, as well as other groups, have conducted research that has shown an increase in cancers such colorectal, pancreatic (or bowel), kidney, gallbladder, and testicular among those under 50. Sung and his colleagues observed the same pattern across the board.
Cancers of the small intestinal tract, liver cancer among women and anal carcinoma in men are all conditions that are on the rise in the younger generation. Death rates have risen in some cases along with the incidence of certain cancers, such as colorectal (in women), liver and testicular. “These results are sobering, as they show that the increased cancer risks in younger generations are not just an artifact of more frequent cancer diagnosis and detection,” Sung said. It indicates a real increase in cancer risks at the population-level, where the increase in incidence is substantial enough to overshadow improvements in cancer survival.
The fact that many cancers in younger patients are gastrointestinal, including colorectal and bile-duct cancer, liver, gall bladder, or liver, could provide clues. Jeffrey Meyerhardt is chief clinical researcher at Harvard University’s Dana-Farber Cancer Institute. The institute recently opened a clinic for under-50s diagnosed with colorectal carcinoma. Meyerhardt says that there may be unknown risk factors as well as known ones, such as sedentary behavior, changes in diet and rising rates of diabetes and obesity.
These same factors may disrupt the gut microbiome – the balance of bacteria that is thought to affect health and immunity. Meyerhardt stated that it is not clear what the changes in microbiome are, or how they can be reversed or improved.
Unbelievable, many of the young patients at this clinic are in great shape. They exercise regularly and eat healthy. This has prompted a search for environmental carcinogens that can affect entire generations. Researchers in New Zealand showed last year that microplastics – now everywhere and consumed from childhood onwards – could disrupt the gut lining. Microplastic pollution has been prevalent since the 1960s. The tiny plastic particles are a result of consumer products or industrial waste. This timeline is correct and could explain the compounding effects between generations. However, further research is needed.
Screening programmes are evolving. In the US, the task force recommended that breast cancer screening begin a decade earlier, at age 40. However, experts have been hesitant to do the same for colorectal screening, as it would miss people in their 20s and 30s.
These are delicate calls. The downsides of a wider screening are cost, radiation exposure and false-positives. 90% of cancer cases still occur in people over 50. The shifting burden of disease requires more attention.
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