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Editor’s Note: Dr. Jalal Baig is a Chicago-based physician and author whose work has appeared in The Washington Post, NBC News, The Atlantic, Foreign Policy, and other publications. The views expressed in this comment are his own. Read more opinions on CNN.
(CNN) — The recent revelation of the cancer diagnosis of 42-year-old Catherine, Princess of Wales, has shocked many observers. As a medical oncologist, I am saddened, but not surprised.
Early cancer, defined as occurring in adults under the age of 50, has no abnormalities. In fact, it is part of a growing global trend in which newly diagnosed cancer patients are becoming younger. Additionally, it also debunks the myth that cancer occurs only in older people.
Just last week, I saw a 37-year-old woman with breast cancer that had already metastasized to her lymph nodes, bones, lungs, and liver. In the next room was a 45-year-old man who had colon cancer, which had spread throughout his liver to the point where it was full and large with tumors. Both patients had stage IV cancer that could potentially be controlled for a limited time but is no longer curable.
According to a 2023 study published in the journal BMJ Oncology, the global incidence of early-onset cancer increased by 79.1% between 1990 and 2019 and deaths from early-onset cancer increased by 27.7%. More detailed data on this increase, published last year in the Journal of the American Medical Association, showed that from 2010 to 2019 in the United States, this young population had the highest number of breast cancer cases, while cancer rates were rising along with gastrointestinal infections. increased from throughout the year.
This disproportionate increase in gastrointestinal cancers reflects the implications and risks associated with a person’s year of birth alone. As Dr. Kimmy Ng, a medical oncologist at the Dana-Farber Cancer Institute, told the Boston Globe last year, “People born in 1990 have more than double the risk of colon cancer compared with people born in 1950. And the risk of contracting The danger is fourfold.” rectal cancer.
As the incidence of early cancer continues to rise, it is more important to identify why this increase in cancer is occurring in young people and who is most at risk. At least part of the answer appears to lie in changes in nutrition and lifestyle in the middle of the last century.
Notably, there has been no change in the population’s underlying genetic risks in recent decades, lending credence to the argument that environment and lifestyle play a larger role in these cancers than our genes. Culprits may include ultra-processed foods, sugary drinks, red meat, smoking, alcohol, sleep disruption, obesity and physical inactivity. Alone, and especially together, these factors can alter our body’s internal processes by altering metabolism and increasing inflammation.
More research efforts are underway to investigate whether changes in the gut microbiota, the billions of microbes that live within us, are increasing our body’s susceptibility to cancer. This community of microbes contributes significantly to health and influences the digestive and immune systems. Poor diet, overuse of antibiotics, and certain medications can cause changes in this microbiota, which may contribute to cancer promotion.
Oncologist Jalal Baig says primary care doctors should be educated about the increased presence of cancer in people under the age of 50. Bongkarnthanyakij/iStockphoto/Getty Images/Archive
Because cancer is thought to develop over decades as changes in DNA accumulate and cause tumors, a person diagnosed at a young age may have been exposed to risk factors as a child or in the womb. . Research is also currently focused here, including studies into women at increased risk with cesarean delivery and using a synthetic form of progesterone to prevent premature birth.
But as I see regularly in my oncology clinic, obesity and lifestyle alone cannot explain all of the young patients who are diagnosed. Many of the people I treat are healthy, eat wisely and exercise regularly. And that is why the cause of their diseases is still beyond the reach of science.
As Dr. Sunil Kamath, a gastrointestinal medical oncologist at Cleveland Clinic’s Taussig Cancer Institute and a member of Cleveland Clinic’s newly opened Young Onset Colorectal Cancer Center, told me: “The short answer is that we really don’t know.”
However, the only certainty at this time is that underdiagnosis of these early cancers is prevalent and has consequences. Primary care physicians should be educated about the increased presence of cancer in people under the age of 50 and why age should not be used to discount the symptoms present in a patient.
On the other hand, people should not ignore any persistent symptoms and should be aware of family history of cancer. Young patients will often have to advocate aggressively, as multiple appointments may be required before the cancer is diagnosed.
And because early cancers are often diagnosed at advanced stages, they were once considered biologically different and more dangerous than their older counterparts. They are often diagnosed late and may metastasize due to delay in diagnosis and any particular aggressive quality.
Once treatment begins, the risks also differ for people in their 20s, 30s, and 40s. Anticancer drugs can cause heart problems and secondary cancers years after treatment. Young patients may become pregnant at the beginning of treatment or may be concerned about effects on fertility. Additionally, there are concerns about long-term cognitive damage after chemotherapy, especially when people return to work.
“It’s frustrating to talk to people about missing classes because of college and parenting responsibilities during chemotherapy,” Kamath said. “These people shouldn’t have to deal with this.”
This troubling phenomenon in cancer care will require a doubling of funding, more research, educational campaigns, and our collective efforts to revise screening guidelines.
Most of this is already underway. In a remarkable move, a voluntary panel of disease prevention experts, including the U.S. The Preventive Services Task Force now recommends that colorectal cancer screening begin at age 45 for people at risk.
Although much progress has been made in cancer outcomes, true progress cannot be declared if certain age groups are worryingly lagging behind. The Princess of Wales’s public disclosure of her cancer is a reminder of the work that still remains to be done.
