No Fooling: Cancer in Young Adults — Pandemic-Driven or Long-Term Trend?
Setting the scene for further investigation
Holy Week and Easter pushed this off a bit, but this is time to return to the subject.
Recent Cancer-Related Posts
Let us look at recent posts and key graphs:
4 Feb 2024: World Cancer Day 2024: History of Mammography, Recent Research, and Some Trends
This is a graph on new cancer incidence rates — has been rising for ages 15-39 for over 25 years as a general trend. Note the specific types - this will return.
8 Feb 2024: Top Cancer Types: By Crude Death Rate, 1968-2023
10 Feb 2024: Cancer Death Rates by Age and Gender for the U.S., 1968-2023
These are death rates, not incidence rates, and not split out by cancer type.
16 Feb 2024: Cancer Death Rates by Race/Ethnicity, U.S. 1968-2023
Again, not differentiated by cancer type. The death rates are age-adjusted, but still not showing sex or age groups. There can be different trends by disaggregation.
21 March 2024: Colorectal Cancer: Top Cancer With Concerning Trend in Younger Ages
23 Mar 2024: The Princess Announces Cancer Diagnosis
Here the results are a mix, with overall cancer death rates for younger adults increasing for some age groups (30-34, 40-44) and decreasing for others (35-39, under age 30). No distinction for type of cancer is made.
Additional News: Increasing Incidence
CNN opinion piece: Oncologist: Kate’s diagnosis is part of a troubling trend
The recent revelation of the cancer diagnosis of Catherine, Princess of Wales, who is 42, has left many observers shocked. As a medical oncologist, I am heartbroken — but hardly surprised.
Early-onset cancer, which is defined as happening in adults under 50 years of age, is no anomaly. In fact, it is part of a rising global trend in which newly diagnosed cancer patients are getting younger. Further, it deflates the myth that cancer is the preserve of older people.
During the past week alone, I saw a 37-year-old with breast cancer that had already metastasized to her lymph nodes, bones, lung and liver. In the room next door was a 45-year-old with colon cancer that had spread so diffusely throughout the liver that it had become packed and enlarged with the tumors. Both patients had stage IV cancers that can potentially be controlled for a finite time but are no longer curable.
The global incidence of early-onset cancer increased by 79.1% and early-onset cancer deaths rose by 27.7% from 1990 to 2019, a 2023 study in the journal BMJ Oncology found. More granular data on this uptick published last year in the Journal of the American Medical Association showed that from 2010 to 2019 in the United States, breast cancer accounted for the highest number of cases in this younger population, while rates of gastrointestinal cancers were rising the fastest.
This jarring increase in gastrointestinal cancers alone captures the implications and risks associated with a person’s birth year. As Dr. Kimmie Ng, a medical oncologist at Dana-Farber Cancer Institute, told The Boston Globe last year, “People born in 1990 have over double the risk of getting colon cancer compared to those born in 1950. And quadruple the risk of getting rectal cancer.”
The author of the piece, Dr. Jalal Baig, posits multiple sources of the increasing incidence of these cancers, such as changes in diet, uses in certain types of drugs, increased obesity (though many of the people with the early onset cancer are far from obese), and more.
Historical Interlude
One thing that came to my mind, though I don’t have good statistics, was a certain spate of type of fatal conditions in the Gilded Age:
One aspect of Arthur that I’d like to look into a bit more was his death at age 57 from stroke. He had been in poor health before then as well.
I had noticed a bunch of the Gilded Age nabobs having all sorts of health problems, and I’d like to do a little investigation into their causes of death (high levels of oral cancer, liver cancer, cirrhosis, stroke, gout, etc.?)
Maybe somebody has already looked into it — deaths of the Rich and Famous of the Gilded Age.
The obvious ones were the various oral and throat cancers from tobacco use, but there were various complaints of the gastrointestinal system… adulterated food? Too rich a diet? Lacking in micronutrients? Something off in the gut biome in some way?
Perhaps we’ve got Gilded Age 2: Electric Bugaloo in the current era?
Quick Stats of the Pandemic
For reasons (those reasons being that the CDC's death stats databases in WONDER are separated into groups, and it’s work for me to stitch results together), so far, I’ve only pulled out age group results for cancer types for 2018-2023:
By Count of Deaths:
Change of rate:
As you can see, some are negative (they go down) and some are positive (increase in deaths) — but as with my longer look at colon cancer (colorectal), this is a much longer trend than just during the pandemic.
Also, some of these are very small numbers of deaths, so may just be noise in one year.
This sets me up for my next post tomorrow, in which I’ll look at the longer-term mortality trends for the major cancer types among younger adults. Are these effects short-term or long-term, as with colorectal cancer?
