Cancer rates among young people are rising. What you need to know

Cancer rates among young people are rising. What you need to know

By Karen E. Knudsen & Osman Laraki

Today, women in their 30s are more likely to be diagnosed with cancer than their grandmothers were two generations ago. According to data from the American Cancer Society (ACS), cancer incidence and death rates are rising among millennials and younger generations, while falling among older Americans. In July, a study found that Gen X and millennials face a higher risk than older generations for 17 types of cancer.

Cancer is inevitable for anyone. Not a month goes by without hearing the news of a celebrity, acquaintance, friend, or family member being told by a doctor, “You have cancer.” In March of this year, 42-year-old Catherine, Duchess of Cambridge, who is married to the heir to the British throne, announced the news of her cancer diagnosis, garnering worldwide attention.

According to the ACS’s Annual Cancer Statistics Report released in January, the only group in the U.S. that saw an overall increase in cancer incidence between 1995 and 2020 was the under-50 age group. For colorectal cancer, for example, incidence rates have risen 1-2% per year in those under 55 since the mid-1990s, while rates have declined in those over 65. Meanwhile, among people under 50, colorectal cancer has risen four spots to become the leading cause of cancer death in men and the second leading cause in women.

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As the rate of cancer diagnoses among younger Americans continues to rise, cancer is no longer considered an old person’s disease. What is going on?

No single cause for the increase has been found, but one thing is certain: it’s generational. The facts are stubborn, and this startling statistic demands answers. The over-50 population has benefited from efforts to reduce cancer deaths. What new strategies can deliver the same benefits to younger generations?

Let’s start with what we know. Evidence shows that catching cancer early can save lives because treatment is more effective, less intensive, and much less expensive. Regular guideline-based screening for the most common cancers, including breast, colon, and lung, offers the best chance of early detection. Cervical and colon cancer screening can detect warning signs before cancer progresses, helping to prevent disease. In developing screening guidelines, organizations such as the United States Preventive Services Task Force (USPSTF) and ACS conduct extensive scientific evidence reviews and consider the benefits, limitations, and harms of each test. Cancer screening also has downsides, such as some patients being called back for further evaluation based on abnormal signs that turn out not to be cancer, or being diagnosed with a cancer that is not life-threatening. However, the benefits of recommended cancer screenings significantly outweigh these harms. Therefore, it is important to pay attention to whether young people have risk factors that should lead to screening.

Raising awareness and discussing personal risk factors, such as unhealthy habits, environmental hazards, and especially family history of cancer, can guide screening and treatment recommendations and significantly improve outcomes. But the methods and systems to activate them are not reaching everyone under age 50. For colorectal cancer, only 20% of eligible people ages 45-49 reported getting up-to-date screening in 2021 (ACS guidelines recommend this screening begin at age 45), compared with 80% of people ages 65-74.

The benefits of following these guidelines go far beyond the screening appointment. An accurate diagnosis and a thoughtful decision on the appropriate course of treatment are two sides of the same coin, especially if the cancer is caught early. A diagnosis doesn’t necessarily mean curative surgery or expensive drugs. If a patient has indolent prostate cancer, the best care is watch and wait, medically known as “active surveillance.” Francis Collins, who led the sequencing of the human genome and was previously director of the National Institutes of Health, recently shared how he closely followed a case of indolent prostate cancer. The case eventually progressed, but it was caught in time, and it appears his life was saved. None of this would have happened without screening in the first place.

Those under 50 need to realize that they are not too young to develop cancer. Too often, people who have symptoms of cancer under the recommended screening age are reassured that because they are too young to have cancer, their symptoms must be related to something that is not of much concern. And too often, this delay in diagnosis has tragic consequences. Screening guidelines are written for people at average risk. A relatively small but significant proportion of adults have family histories and risk profiles that require earlier screening. Nearly one in three people who develop colorectal cancer under age 50 have a genetic mutation or a related family history. People who are found to have inherited risk factors through genetic testing should also begin screening earlier.

It’s not young people’s fault that compliance with testing guidelines is low. Guidance on cancer screening is not tailored to reach younger generations. Information needs to be found in places that are relevant to their lives, such as the websites and apps they use most frequently. As with media, evidence is emerging that younger generations use health care differently. Adults under 50 are less likely to have a primary care physician who understands their risk factors to determine where to begin screening and which test to use. Younger adults may face more barriers to accessing health care. They may be more likely to make trade-offs when seeking care, weighing out-of-pocket health care costs against paying for rent, student loans, and other financial priorities. And as the gig economy reshapes the workforce, traditional medical office hours are inconvenient for many workers. Physicians and their services need to be designed to meet your needs and convenience. Employer-based programs can also serve as additional touchpoints to engage workers early and often to fill screening gaps.

According to ACS researchers, nearly half (42%) of new cancer diagnoses in the United States could be avoided through a combination of preventive measures such as a healthy diet and maintaining a healthy weight. Cancer prevention measures such as reducing smoking combined with improved early detection and treatment have saved more than 4 million lives in the United States over the past 30 years. Armed with the right information about their cancer risks, knowledge of screening and prevention options, and a pathway to get the care they need, millennials can significantly reduce their risk of cancer. With cancer diagnoses expected to reach 2 million across all age groups in 2024, the highest number ever, it is more important than ever to reach younger Americans.