The latest episode of The Excerpt podcast, which aired on Sunday, discussed the issue of early-onset cancer being a worldwide health emergency. While there has been a decrease in the occurrence of gastrointestinal cancer in individuals aged 65 and above, there has been a sharp rise in colorectal cancer as the leading cause of cancer-related deaths in men under 50 and the second leading cause in women of the same age. The question that arises is why? To shed light on this concerning trend, Dr. Kimmie Ng, the founding director of the Young-Onset Colorectal Cancer Center at the Dana-Farber Cancer Institute, joins The Excerpt to share how the medical and research communities are addressing this issue.
Dana Taylor is the author of this text.
Greetings and thank you for joining us at The Excerpt. My name is Dana Taylor and today is Sunday, May 19th, 2024.
The global health crisis of early onset cancer has become a major concern. Researchers are puzzled by the increasing number of young and healthy individuals under the age of 50 who are developing and succumbing to aggressive forms of cancer at a faster rate than ever before. While there is a decline in rates of gastrointestinal cancer among those aged 65 and above, the younger population is experiencing a significant rise, with colorectal cancer being the leading cause of cancer-related deaths in men and the second leading cause in women under 50. To gain more insights into how the medical and research community is addressing this alarming trend, we have with us Dr. Kimmie Ng, who is the founding director of the Young-Onset Colorectal Cancer Center and co-director of the Colon and Rectal Cancer Center at Dana-Farber. Thank you for joining us, Kimmie.
According to Dr. Kimmie Ng: I am grateful for the invitation.
Dana Taylor:
The National Cancer Institute has reported a 51% rise in cases of colorectal cancer among young individuals since 1994. The reason for this increase in cancer rates among younger individuals and specifically in the colon remains unclear.
Dr. Kimmie Ng:
The question that many scientists and researchers are striving to answer is the one worth a million dollars. It has been observed that the occurrence and death rates of colorectal cancer are decreasing overall, taking into account individuals of all age groups. This positive trend can be attributed to the effectiveness of screening programs, increased adherence to screening, and advancements in treatments. However, there has not been a similar improvement in people under the age of 50. It is believed that an environmental exposure, risk factor, or a combination of both is responsible for the rise of this disease in younger individuals.
Dana Taylor:
Is there a significant rise in cancer cases among the younger population for other types of cancer as well?
Dr. Kimmie Ng:
Indeed, there are occurrences of breast cancer in young women on the rise. Other types of cancer, including ovarian and endometrial, have also seen an increase. However, the most significant increase has been seen in cancers of the digestive system, specifically in the gastrointestinal tract. This includes pancreatic cancer, appendix cancer, and bile duct cancers, which have all been on the rise in individuals under the age of 50. As with colorectal cancer, the underlying causes of these increases are not yet fully understood.
The person being discussed is Dana Taylor.
Dr. Kimmie Ng:
It is often assumed that a young and healthy individual who develops cancer must have a genetic predisposition or a family history of the disease. However, this is not the case in our clinics. Surprisingly, these young individuals are typically in good health, with an active lifestyle, regular exercise, and a nutritious diet. They also do not have a family history of cancer or any known genetic syndromes. This raises concerns about why these otherwise healthy individuals in the prime of their lives are developing cancer, often in advanced stages. It is likely that a recent environmental change is contributing to this trend.
Dana Taylor:
Could you provide further information regarding the demographic of those affected by this, and whether there are any discrepancies among different communities or regions globally?
Dr. Kimmie Ng:
Regrettably, this is a widespread issue. The incidence of early onset colorectal cancer is increasing in various regions across the globe. Interestingly, the sharpest and highest increases have been observed in countries with a higher socioeconomic status and those with a more westernized way of life. However, there have also been documented increases in Mediterranean countries, sub-Saharan Africa, and East Asian countries, where diets and lifestyles differ significantly from those in the United States. Therefore, this is truly a global occurrence.
It has long been recognized that there are significant and concerning discrepancies in the occurrence and death rates of colorectal cancer across different races and ethnicities. Specifically, individuals in the Black community have a 20% higher chance of being diagnosed with colorectal cancer, usually at a younger age, and a 40% higher likelihood of dying from it. However, it is interesting to note that the incidence of early-onset colorectal cancer is increasing at a faster rate among non-Hispanic white individuals, resulting in a narrowing of the disparities. This trend is evident in all states of the United States where data is available, with a documented rise in cases of early-onset colorectal cancer.
Dana Taylor:
The influence of the “birth cohort effect” on cancer rates is a topic of interest among researchers. Can you elaborate on this concept and how it relates to factors such as the environment and lifestyle that may contribute to the increase in cancer cases?
The individual known as Dr. Kimmie Ng:
The mentioned birth cohort effect suggests that there may be a recent environmental change causing the increase in young onset colorectal cancer. This question raises a strong possibility for further investigation.
The birth cohort effect refers to the fluctuation and progression of colorectal cancer among younger individuals based on their generation. Research indicates that individuals born in 1990 have a significantly higher risk of developing rectal cancer and double the risk of colon cancer compared to those born in 1949. This trend suggests that a recent environmental factor or change in lifestyle and dietary habits may be responsible for this increase in risk as it is seen to impact multiple generations as they age. Therefore, it is likely that an environmental factor, rather than genetics, is the main cause of this rising rate.
Dana Taylor:
According to a study, being breastfed during infancy may result in a 23% higher chance of developing colorectal cancer in the future. However, should this information discourage mothers from breastfeeding, or are there other biological factors that should be considered?
The individual referred to as Dr. Kimmie Ng:
Absolutely not. This study should not be used to discourage breastfeeding, as we are aware of its numerous protective and beneficial effects on health. It is important to note that this finding, which we came across, has also been observed in other cohort studies. Therefore, the consistency of the finding should be acknowledged, but it is crucial to emphasize that it is currently only an association and not a cause and effect relationship. The underlying mechanism for why being breastfed as an infant may increase the risk of developing colorectal cancer in adulthood is not yet fully understood.
In the nurses’ health study, a considerable group of young female nurses have been monitored for many years. When questioned, these women revealed that being breastfed as infants led to a 23% increase in their likelihood of developing colorectal cancer later in life. Moreover, the longer the duration of breastfeeding, the greater the risk. This result remained consistently evident throughout the study.
The link between breastfeeding in infancy and the development of polyps, specifically in young individuals under the age of 50 with colorectal cancer, has been observed in various studies. These polyps have been identified as a precursor for the development of colorectal cancer in the future. This association has been consistently found in different research studies.
Dana Taylor:
It is projected that by 2030, the incidence of colon rectal cancer in Americans aged 20 to 34 will rise by 90%, while rectal cancer rates are expected to skyrocket by 124%. Due to the fact that young onset cancer is often diagnosed in advanced stages, there is a need to consider altering the age at which individuals undergo cancer screenings.
Dr. Kimmie Ng:
It is a challenging question to answer, but an important one. In response to the increasing incidence of colorectal cancer in young adults, the United States Preventive Services Task Force has recently revised their recommendations for screening individuals with average risk. The age for screening has been lowered from 50 to 45. Research shows that most cases of young onset colorectal cancer occur in individuals in their 40s. This change is expected to result in a decrease in cancer cases and an improvement in early detection, which increases the chances of successful treatment for young people.
Upon examining the data, it is evident that the sharpest increase in rates is among individuals aged 20s and 30s. However, despite the recent change in guidelines, this age group is still not qualified for screening, which is concerning. Therefore, efforts are currently being made to explore more effective and cost-efficient ways to extend screening beyond the age of 45, as well as novel methods to detect these cancers at an earlier stage in young individuals. The main takeaway is that there is a sense of urgency in conducting research to determine the underlying risk factors and causes of this rise. By doing so, we can pinpoint high-risk young individuals and prioritize them for early screening.
Name: Dana Taylor
What impact could the potential of developing cancer at a young age have on the way young adults navigate their lives while building their professional and personal lives?
Dr. Kimmie Ng:
It is a well-known fact that being diagnosed with cancer can be a difficult experience, regardless of one’s age. However, young individuals face unique obstacles when dealing with cancer and its treatment. According to our observations, 80% of our patients who develop colorectal cancer at a young age have children under 18 years old. Additionally, many of them were planning to start a family around the same time they received their diagnosis. Furthermore, a significant number of these patients are also responsible for caring for their elderly parents. This puts them in the “sandwich generation,” a group of people greatly affected by this serious illness. As you mentioned, these individuals are often at the peak of their careers or in the midst of pursuing their education when they are diagnosed.
The diagnosis of colorectal cancer in young individuals brings along with it a significant amount of psychological and financial stress. This stress is unique to this specific group and cannot be overlooked. One of the major concerns for these patients is the impact on their fertility, which cannot be emphasized enough. As most of these cases involve rectal cancer, the standard treatment usually involves surgery and radiation to the pelvis, both of which can have a negative effect on fertility. Therefore, it is crucial for healthcare teams to discuss fertility preservation options with patients before starting treatment, so that their life goals are not hindered by this diagnosis.
The person named Dana Taylor:
Individuals with an early onset disease may experience a more forceful progression. What are the indications that individuals should be vigilant for?
Dr. Kimmie Ng is someone who is highly knowledgeable and has expertise in her field.
This is an important question as it can greatly impact early detection and preventing delays in diagnoses, which are frequently observed in young individuals who often wait for extended periods of six months to over a year before receiving an accurate diagnosis of colorectal cancer. The primary symptom that young patients experience is seeing blood in their stool, while the second most common is feeling abdominal or pelvic discomfort and bloating. Other warning signs to watch out for include changes in bowel habits, such as new onset of diarrhea or constipation, changes in stool size such as pencil-thin stools, and abdominal pain. Additional symptoms that may indicate the presence of anemia include unintentional weight loss, fatigue, and shortness of breath during physical activity. These are the most commonly reported symptoms that often lead to a diagnosis of colorectal cancer.
The person’s name is Dana Taylor.
What does current research tell us and what can we anticipate in the coming years in an effort to address this increasing and life-threatening problem?
Dr. Kimmie Ng:
Ongoing research, including studies conducted by my team, is currently investigating the impact of known dietary and lifestyle factors on the risk of developing colorectal cancer, regardless of age. Environmental factors have been strongly linked to this type of cancer, and our focus has been on identifying and studying the risk factors that have seen a significant increase in recent years, coinciding with the rise in young people being diagnosed with colorectal cancer. Of these risk factors, obesity has been the primary hypothesis. The rise in obesity rates among adults, as well as children and teenagers, has been extensively discussed, and there is evidence that it is associated with an increased risk of developing colorectal cancer at a young age. However, it should be noted that the majority of patients we see in our clinic are not obese.
The examination of risk elements, such as inactive lifestyle, consumption of sugary drinks, insufficient vitamin D levels, have all been connected to the issue. However, it is likely that multiple environmental factors play a role. Our team is also making an effort to determine if the biology of tumors differs between younger and older individuals, by studying DNA mutations. Additionally, we are investigating the potential impact of differences in gut microbiomes on the increasing incidence of this issue among young individuals. These initiatives are currently in progress.
Dana Taylor:
There is a significant amount of valuable information present. I sincerely appreciate your presence on The Excerpt, Kimmie.
Dr. Kimmie Ng:
I am grateful to have been invited.
Dana Taylor:
We would like to express our gratitude to Shannon Rae Green and Bradley Glanzrock, our senior producers, for their invaluable help in the production process. Our executive producer, Laura Beatty, has also played a crucial role in this project. We would love to hear your thoughts on this episode, so please feel free to send us a note at podcasts@usatoday.com. Thank you for tuning in, I am Dana Taylor. Be sure to catch Taylor Wilson tomorrow morning for the next installment of The Excerpt.
