Cedars-Sinai Blog
Cancer in Younger Patients Spurs an Expected Record-High Case Total
The U.S. is on track to hit a painful cancer milestone: 2024 is the first year that new cancer cases are expected to cross the 2 million mark, according to the American Cancer Society.
What is especially troubling for healthcare providers and researchers is the rise in cancer diagnoses among younger people. According to an American Cancer Society report in January, people under the age of 50 were the only broad age group among the three it tracked that posted an overall rise in cancer from 1995 to 2020. Particularly notable were the increases in cervical cancer in women ages 30 to 44 and in colorectal cancer among people younger than 55.
What adds to the frustration among healthcare experts is that while there is no screening available for most cancers, that’s not the case for cervical and colorectal cancer.
"Cancer is occurring more often in younger people, who are less likely to be screened, and they tend to have more aggressive tumors."
"These diseases have screenings that can even prevent cancers by removing precancerous polyps and lesions," said Jane Figueiredo, director of Community and Population Health Research and professor of Medicine at Cedars-Sinai Cancer. "Cancer is occurring more often in younger people, who are less likely to be screened, and they tend to have more aggressive tumors."
Overall, the American Cancer society estimates that U.S. women have a one in 17 chance of being diagnosed with an invasive cancer before the age of 50. For men, it’s one in 29.
Not all of the cancer news is gloomy. For 30 years, cancer deaths have steadily declined due to advances in treatments, early detection of cancers through screening and lifestyle changes, such as fewer people smoking. But at the same time, diagnoses are increasing, particularly among six of the 10 most common cancers: breast, prostate, endometrial, pancreatic, kidney and melanoma. The upturn in cases of cervical and colorectal cancers among younger patients is yet another setback.
Cervical Cancer: A Matter of Using the Available Tools
Socioeconomic factors appear to play a large role in explaining the uptick in cervical cancer.
A recent study in the International Journal of Cancer found women living in low-income areas face increased cervical cancer incidence and mortality rates.
Yet PAP screening can prevent cancer. When an abnormal test result occurs, doctors can perform procedures that remove the pre-cancerous cells to maintain a healthy uterus and cervix while eliminating the risk of cancer.
Vaccine access and compliance also are important. Human papillomavirus, or HPV, causes nearly all cases of cervical cancer. The Centers for Disease Control and Prevention (CDC) recommends 11- to 12-year-olds receive two doses of the vaccine six to 12 months apart. Even so, as of 2022, only 56.9% of teens ages 15 to 17 had received at least one dose of the vaccine, according to the CDC’s most recent statistics.
"We’ve had PAP testing since the 1950s and a vaccine for prevention since 2006, so really this is a disease that should have a continuous downward trajectory and incidence," said B.J. Rimel, MD, medical director of the Cancer Clinical Trials Office at Cedars-Sinai and a gynecologic oncologist. “When that doesn’t happen, that doesn’t necessarily mean cervical cancer is worse than it used to be. It says something about how we’re implementing these tools and whether people have access to them.
"Cervical cancer could be virtually eliminated with widespread vaccine use," Rimel added.
"There’s a lot of misinformation about vaccines," she said. "Because HPV is sexually transmitted, there was a lot of pushback against young people getting the vaccine—but the point of the vaccination is to establish immunity long before becoming sexually active and when the immune system is most adept at mounting a strong response."
Read: Should I Freeze My Eggs?
Colorectal Cancer: An Elusive Why
For people under 50 years old, colorectal cancer is now the leading cause of cancer death in men and the second in women, according to the American Cancer Society.
Early detection remains crucial in treating colorectal cancers, and not enough people are screened. Among adults ages 40 to 49, an age range associated with the uptick in colorectal cancer incidence, 80% are not being screened.
One major reason for that is that screening for people in their early 40s is not being promoted. When the U.S. Preventive Services Task Force last took up the issue in 2021, it lowered the recommended age for starting colorectal cancer screening by only five years—from 50 to 45.
Why more people in this age group are developing colorectal cancer is a hot topic in cancer research—but so far, there are no clear answers.
Use of antibiotics, changes in obesity rates, the gut microbiome, alcohol use and a whole range of behaviors are being studied for how they might be contributing to colorectal cancer.
"There is no one single answer," Figueiredo said.
Colonoscopy can help prevent cancer by removing polyps, potentially pre-cancerous growths. Keeping up with these screenings, as well as healthy lifestyle changes known to reduce overall risk of cancer and heart disease, can help.
"We studied smoking for a long time—over 50 years before we were all convinced that smoking causes cancer," Figueiredo said. "We know that people are dying from this disease now and it’s affecting people in the prime of their lives. We can’t wait 50 years before we fully understand what’s driving early-onset disease—we need to do something now."
Read: Living with Colon Cancer
