Cancer incidence continues to rise among younger patients in US
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Key takeaways:
- Breast cancer was responsible for the highest number of early-onset cancers, but gastrointestinal cancers had the fastest growing incidence rates.
- Cancer incidence declined among people aged 50 years and older.
The incidence rate of early-onset cancer significantly increased in the United States from 2010 to 2019, particularly gastrointestinal cancers, according to researchers.
Although cancer “has traditionally been considered a disease of older individuals,” recent data have indicated “a marked increase” in the incidence of cancers diagnosed among those aged younger than 50 years, which are known as early-onset cancers, Benjamin Koh, a student at the National University of Singapore’s Yong Loo Lin School of Medicine, and colleagues wrote.
“These cancers affect a variety of organ systems, including the breast, colon and/or rectum, pancreas, head and neck, kidney and reproductive organs,” they wrote. “The increase in early-onset cancers is likely associated with the increasing incidence of obesity, as well as changes in environmental exposures, such as smoke and gasoline, sleep patterns, physical activity, microbiota and transient exposure to carcinogenic compounds.”
Previous studies have assessed incidence patterns of certain types of early-onset cancers; however, the researchers wrote that an updated comprehensive overview has not yet been reported. So, they conducted a population-based cohort study to characterize patterns in early-onset cancer incidence in the U.S. from 2010 to 2019 and to learn more about the cancers with the most rapidly growing incidence rates.
The researchers analyzed data from 562,145 patients with early-onset cancer from 17 National Cancer Institute Surveillance, Epidemiology and End Results registries. They extracted age-standardized incidence rates per 100,000 people for early-onset cancers with rates that were adjusted by age to the general U.S. population.
Koh and colleagues found that the incidence rates of early-onset cancer increased overall during the study period, with an annual percentage change (APC) of 0.28% (95% CI, 0.09-0.47). They also reported an increase among women (APC = 0.67%; 95% CI, 0.39-0.94) but a decrease in men (APC = 0.37%; 95% CI, 0.51 to 0.22).
The researchers additionally found that breast cancer was responsible for the highest number of incident cases in 2019 (n = 12,649) and gastrointestinal cancers were responsible for the fastest growing incidence rates from 2010 to 2019 (APC = 2.16%; 95% CI, 1.66-2.67).
Among gastrointestinal cancers, those with the fastest growing incidence rates were in the:
- pancreas (APC = 2.53%; 95% CI, 1.69-3.38);
- intrahepatic bile duct (APC = 8.12%; 95% CI, 4.94-11.39); and
- appendix (APC = 15.61%; 95% CI, 9.21-22.38).
In contrast, the cancer incidence rate among individuals aged 50 years and older significantly decreased during the study period (APC = 0.87%; 95% CI, 1.06 to 0.67), according to Koh and colleagues.
Along with the disparity between men and women, the researchers noted several others: the increase in early-onset cancer disproportionately occurred among individuals aged 30 to 39 years, those who are American Indian or Alaska Native and those who are Asian or Pacific Islander.
The study’s overall findings, Koh and colleagues wrote, “may have implications for the development of surveillance strategies and funding priorities.”
“There is a need to inform health care professionals about the increasing incidence of early-onset cancer, and investigations for possible tumors need to be considered when clinically appropriate, even in patients younger than 50 years,” they wrote. “These data will be useful for public health specialists and health care policymakers and serve as a call to action for further research into the various environmental factors that may be associated with this concerning pattern.”
Perspective
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“Beware the tyranny of the anecdote” was wisdom given to me by a clinical mentor. However, this study confirms the anecdote. A topic of conversation that I have with my medical and surgical colleagues is that patients are presenting with cancer at a younger age. This study noted early-onset cancer is often associated with increased morbidity and mortality. The review and revision of surveillance and screening guidelines are imperative. The delayed routine screenings during the pandemic and the recognized early-onset pattern may result in a tsunami of new cancers in the near future.
Perspective
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It is not surprising that the risk factors associated with increased cancer incidence are largely preventable. Obesity, tobacco and alcohol intake, sedentary lifestyle, as well as decreased quality, lack of adequate rest — sadly, all these were exacerbated during the pandemic, and future studies will be very telling with respect to the impact that COVID-19 has had upon these preventable risk factors in younger populations. Additionally, it is important to examine the underlying root cause for all of these with a focus on mental health and diet, as well as social determinants of health that influence these risk factors. The story is likely complex and multifactorial, but all roads point to a renewed focus on wellness in individuals and across the population. Beyond investigating the underlying genetic and epigenetic biomarkers of disease, it is wise to explore solutions focusing on reduction of chronic and preventable illness to reverse the trend of climbing rates of malignancy in a population that has a longer life expectancy.
The study is further evidence of a disturbing trend that physicians have more than anecdotally known to be true, which is that cancer rates are increasing in younger individuals. Breast and gynecological cancers continue to have the highest incidence in 30- to 39-year-olds, and this should prompt a close examination of the screening, best practices, guidelines and risk-reducing strategies for individuals within this age group, especially those with family history and other nonpreventable risk factors.
Perspective
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The overall age-adjusted incidence rates for new cases of cancer located at any site in the U.S. declined each year during the period between 2010 and 2019, according to the National Cancer Institute. However, this study reported that the incidence rates for new cancer cases at any site differed by age group for the same period. These findings are significant in that cancer found in people aged younger than 50 years are at an increased risk for long-term side effects or late effects of cancer treatment and overall morbidity and mortality.
In the past 5 years in my clinical practice, I have seen a greater number of breast and thyroid cancer cases in people aged younger than 50 years. Given the findings and other similar studies, there is a definitive urgent need to update the current guidelines for cancer surveillance and for funding of research studies on preventive measures for early-onset cancers.
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