Iana dos Reis Nunes was 43 when she told her husband she could feel something like a bubble in her abdomen when lying on her side.
An ultrasound found spots on his liver, which led to blood tests and a colonoscopy.
“There was a tumor the size of your fist, and she had no pain and no problems with bowel movements or anything like that,” recalls Brendan Higgins, her husband, who works as an artist in New York. .
By the time doctors found out, Reis Nunes dos dos colon cancer had spread. It was stage 4, which means he had reached other parts of his body.
The family was caught off guard.
“She’d had a baby 15 months before her diagnosis, so she’d had a million blood tests, you know, doctors care and ultrasounds…and there was no indication of anything, nothing at all .”
When cancer strikes an adult under 50, doctors call it an early-onset case. These cancers at a younger age are becoming more common.
A new review of cancer registries from 44 countries found that the incidence of early cancers is rising rapidly for colorectal cancers and 13 other types of cancers, many of which affect the digestive system, and this increase is occurring in many middle and lower cancers. students. -income countries.
The review authors say the upsurge in young adults is partly because of more sensitive tests for certain types of cancer, such as thyroid cancer. But tests don’t fully capture the trend, says co-author Shuji Ogino, professor of pathology at Harvard TH Chan School of Public Health.
Ogino says the spike is due to an unhealthy stew of risk factors that likely work together, some that are known and some that need to be investigated.
He notes that many of these risks have been linked to cancer such as obesity, inactivity, diabetes, alcohol, smoking, environmental pollution and Western diets high in red meat and added sugars, not to mention shift work and lack of sleep.
“And there are also many unknown risk factors, such as a pollutant or food additives. Nobody knows,” he said.
Ogino thinks the fact that so many of these cancers — eight out of 14 studied — involve the digestive system points to an important role for food and the bacteria that live in our gut, called the microbiome.
“I think that’s actually an important piece because what it indicates is the changing prevalences of exposure at an early age, which produce early onset cancers,” says Dr Elizabeth Platz. , an epidemiologist at the Johns Hopkins Bloomberg School of Public Health who also edits the journal Cancer Epidemiology, Biomarkers & Prevention, who did not participate in the review.
Take obesity. It used to be rare. Not only has it become more common to have a dangerously high body mass index, but people are becoming obese earlier in life, even in childhood, so these cancer risks increase decades earlier than for people. previous generations.
The surge in early colorectal cancers – Reis Nunes back cancer – has been particularly strong.
Ogino’s review found that over the years of the study, the average annual rise in colorectal cancer among young adults was about 2% in the United States, Australia, Canada, France and in Japan. In the UK, it’s almost 3% a year in England, Scotland and Wales. In Korea and Ecuador, it is about 5% per year.
“It doesn’t sound like a lot, but you can think about inflation: if it’s 2% every year, it’s going to be a big change in 10 or 20 years, you know?” said Ogino. “It’s not trivial.”
Between 1988 and 2015, these annual increases pushed early colorectal cancer rates from nearly 8 per 100,000 people to nearly 13 per 100,000, a 63% increase, according to another recent study published in New England. Journal of Medicine.
Studies show that approximately 1 in 10 colorectal cancers in the United States are diagnosed in someone between the ages of 20 and 50.
Ogino’s review found what’s called a cohort effect, which means the risk of early onset cancer increased for each successive group of people born later. People born in the 1990s have a higher risk of developing cancer early in life than those born in the 1980s, for example.
Other malignancies increasing in young Americans include those of the breast, endometrium, gallbladder and bile ducts, kidneys, pancreas, thyroid, stomach, and blood plasma cells – a cancer called myeloma.
Dr Karen Knudson, chief executive of the American Cancer Society, calls the review a “call to arms”.
Cancer is a serious diagnosis at any age, but when it appears in young adults, tumors are usually more aggressive and often go undetected for longer because routine cancer screening is not recommended for some of the most common types of cancer. more common, such as breast and prostate, up to age 50.
“Not only were these types of early cancers more likely to be diagnosed when the tumor is at a more advanced stage, but some of the reports that were tabulated here were also associated with poorer survival outcomes,” Knudson said.
Dos Reis Nunes started treatment in 2017 at Sloan Kettering and Mount Sinai Cancer Centers in New York.
Her husband remembers doctors explaining to him that she was one of a growing number of young patients they were seeing.
“I remember it was a talking point at both hospitals that people with colon cancer were getting younger and younger, younger and younger, and they couldn’t explain,” Higgins said.
Higgins says he spent a lot of time in online support groups, seeking answers and reassurance.
“And there were a lot of young people in those groups,” he said. “It wasn’t populated with people in their 50s and 60s. It’s like the 30s, 40s, 50s. So I was very aware that it was no longer an old person’s disease,” he said.
In fact, routine screening – with colonoscopies and tests that check for blood in the stool – has lowered colorectal cancer cases and made it less deadly in older people, even though cases have climbed. skyrocketing among those under 50.
Knudson says three things should happen as a result of big, definitive reviews like this.
“One is a call for research so that we really understand some of the specific trends we’re seeing,” she says.
Second, she wants to see greater risk awareness, which will hopefully help people change their behavior to control the risks they can.
Third, she says, groups that make recommendations for cancer screenings should reassess when those screenings should begin. Some might need to start at a younger age.
In fact, it is already happening.
Last year, the rising incidence of colon cancer in young adults prompted the US Task Force on Preventive Services to lower the age at which it recommends doctors begin colon cancer screening to 45.
“If you’re heading into 45, you really should think about it and not wait until 50 or 55,” Higgins said.
Higgins said his wife’s first 12 months of cancer treatment were almost miraculous, “like remarkable reactions to chemo.”
“And then – I’ve read about it actually – it can unfold very quickly,” he said. “And once it started falling apart, it went downhill extremely quickly.”
His wife died in 2019, leaving behind their daughter, Maeve, who was not yet 4, 11 and 20.
“We had a great love affair,” he said. “I’m still bitter. Still angry.
“Life is OK. Everybody’s fine. But I’m like, deep down, I’m seething that this happened to him. He was a really good person.”
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