2024-07-27 06:28:00
Long considered an “old person’s” issue, cancer is becoming more prevalent among the young, including in France, albeit at levels significantly lower than among seniors. This phenomenon is complex to explain for specialists.
Every day, at Cathy Eng’s clinic, seemingly “perfectly healthy” patients come through the doors. A 32-year-old marathon runner, a 27-year-old mother of two… What do they all have in common? They are young and suffering from cancer.
“Unfortunately, many of my patients are between 35 and 49 years old,” laments this professor of oncology and hematology based in Tennessee (United States), who is also in charge of the “cancer and young adults” program at the Vanderbilt-Ingram center. “I have even seen patients aged 16 to 32, which is very concerning.”
In recent months, scientific studies have succeeded one another on the issue of cancer among “young people,” with numerous high-profile examples, such as the announcement of illness affecting Princess Kate Middleton (42), Caroline Receveur (36), or the late Chadwick Boseman (who died at 43). This is a global phenomenon but also distinctly French.
“Overall, there is an increase in cancer figures linked to the growth of the population and its aging,” notes Lionel Lafay, head of the observation and documentation department at the National Cancer Institute. However, as we know, “cancer is primarily a disease that develops with aging.”
A sensational figure has crystallized concerns: an article published in September 2023 in the British Medical Journal mentioned a 79% increase in cancer cases among young people over the last 50 years. However, the article, far from scientific consensus, did not account for the increase in the population size during that period, its aging, or the evolution of screening policies.
Cancers on the decline, others on the rise
Official statistics show that the scourge is progressing across all age groups—well before the pandemic and its vaccines, contrary to the most conspiracy-minded. Among the French aged 15-40, particularly among women, there has been an increase in the number of cancer cases of about 1% each year since the 1990s.
In detail, in 2023, Santé publique France recorded “969 new cases of cancer among 15-19 year-olds (487 boys and 482 girls) and 1,335 new cases among 20-24 year-olds (608 men and 727 women).” This represents a drop in the ocean—barely 0.5%—compared to the 433,000 cases reported that year in the general population.
Worrisome increase or marginal growth? It is challenging to provide a straightforward answer, as “young people” are not a homogeneous population. Not to mention that various cancers are experiencing different progressions, with equally diverse causes.
Some may be experiencing a decrease. For example, lung cancer’s incidence appears to be declining—more so among men than women. Nicolas Boissel, head of the adolescent and young adult unit in the hematology department at Saint-Louis Hospital (AP-HP), points to the beneficial effect of anti-smoking efforts.
“Some cancers are also declining due to preventive actions, such as cervical cancer, thanks to the HPV vaccine,” he notes. “Some countries have drastically reduced these cancers.”
Colorectal cancer, breast cancer, bladder cancer, kidney cancer, and intestinal cancer seem to be significantly on the rise instead. “We expect colorectal cancer to be the leading cause of cancer mortality among young adults under 50 in the United States,” regrets Cathy Eng, an authority in the field.
Is our diet to blame?
In principle, age is the primary factor determining the onset of cancer. But in this case, how do we explain the disease in a twenty-something or a thirty-something? Scientific literature has not specifically illuminated the issue of genetic heritage in this rise of cancers among young people. The causes therefore seem to be environmental (diet, sedentariness, exposure to products…)
Scientists are primarily looking towards the United States, where the rise in these diagnoses began earlier than in France. This occurred while another epidemic was hitting the country: obesity.
“Digestive cancers are particularly related to diet, especially an unbalanced one, and to overweight,” recalls Lionel Lafay.
“We have known since the 1980s-1990s that the overweight and obesity rates among children have really increased, and this condition tends to persist into adulthood. This is a factor that could explain these cancers in young adults,” suggests the head of the National Cancer Institute.
The disease takes years to develop. Obesity, being overweight, and an unbalanced diet, “are each responsible for 19,000 new cases of cancer” in France each year.
Could our hyper-caloric diets and the ultra-processed products we consume partially explain the resurgence of digestive cancers? Some warning signals have already been raised, and specific products are already subject to safety guidelines under the precautionary principle.
In 2022, the National Agency for Food Safety (Anses) recommended, for example, reducing the consumption of nitrites and nitrates, which are widely used in charcuterie, due to the “association” between this molecule and colorectal cancers. An example among many additives regularly criticized by studies, but other more “natural” products like red meat are also controversial.
Environmental factors?
But our food is not the sole key to the puzzle. “For pancreatic cancer, which is rising slightly among young people despite typically developing around 70 years of age, we cannot exclude, in addition to better diagnosis (…) an exposure to environmental risk factors, perhaps to pesticides,” notes Lionel Lafay. “This hypothesis needs further investigation.”
In the specific case of breast cancer, “hormonal factors” are also at play. Early puberty or having the first child later in life may play a role. “In fact, long exposure to hormones (natural, note) is a risk factor,” explained Florence Coussy, breast cancer specialist at the Curie Institute, to BFMTV.com in July 2023. The gap between the first menstruation and menopause, during which the body is exposed to natural hormones, is lengthening, a known risk factor.
Alcohol consumption may also explain several cancers among young people. Certainly, overall, fewer and fewer French people drink regularly (39% consumed weekly in 2021, according to Santé publique France). “On the other hand, the phenomenon of binge drinking has taken hold in France,” according to Lionel Lafay. Nevertheless, the toxicity of alcohol and the risk it poses is recognized even at low doses, from the first glass.
In short, a bundle of hypotheses and very few certainties. All specialists consulted lean towards a multifactorial explanation for this phenomenon of cancer among young people, and point out the lack of sufficient studies to support these conjectures. However, one assumption can be made regarding the specificities in treating this pathology, which is less lethal than among older patients.
“In the age group 15-25, 85% of patients will be cured of cancer,” emphasizes the director of the unit dedicated to young people at Saint-Louis Hospital. This survival rate is higher than that of the general population, which varies depending on the pathologies.
These survival rates, however, are directly correlated with the stage at which the disease is detected. “Many of these young patients present with stage IV disease (the most advanced stage, note) because they are often misdiagnosed and/or ignore their symptoms,” warns Cathy Eng.
With the issue of specific prevention for young people, who are not targeted by screening campaigns, comes the question of care. When some young adults develop “old people’s” cancers, should they be treated like adults or like children? Both in terms of medical stricto sensu aspects and support, the cancer of 15-24-year-olds requires a middle-ground approach according to specialists.
“Young people are a fragile population, more vulnerable to cancer than older individuals. They are at a midpoint between childhood and adulthood, in a phase of construction. We know that cancer treatment has very particular impacts on this population,” insists the director of the unit dedicated to the hospital Saint-Louis.
In France, for two decades, it has been recommended that a young patient be followed by professionals experienced in adult treatment as well as pediatricians. This dual follow-up allows adaptation to patients whose needs may not be understood by a single specialist usually accustomed to treating people in their sixties. Specific follow-up is also put in place to inform about issues of fertility, educational follow-up, and even return to employment. A life after cancer.
Rising Cancer Rates Among Young Adults: Understanding Future Trends
Traditionally perceived as a disease affecting the elderly, cancer is increasingly being diagnosed in younger individuals, a trend observed globally, including in France. This shift is raising concerns among medical professionals, particularly as cases involving seemingly healthy individuals in their twenties and thirties are on the rise.
Alarming Statistics
Recent studies indicate that the incidence of cancer among those aged 15 to 39 is increasing by approximately 1% each year, with notable cases including public figures. Despite these increases, the actual number of young cancer cases remains relatively low compared to the overall population. For instance, in 2023, Health Public France reported almost 2,300 new cancer cases among those aged 15 to 24, representing a small fraction of the total 433,000 cancer cases nationwide.
Disparity in Cancer Types
While certain cancers are on the rise—such as colorectal and breast cancers—others, like lung cancer, are decreasing, attributed in part to successful anti-smoking campaigns. Factors like obesity and lifestyle choices are seen as root causes for increases in specific cancer types, particularly among younger populations.
Diet and Lifestyle Impact
An alarming trend correlates the rise of cancers with unhealthy lifestyles, including poor diet and lack of physical activity. Many health experts point to the uptick in obesity rates since the 1980s, associating it with a significant rise in digestive cancers. This highlights the urgent need for improved dietary practices and educative outreach on the risks associated with junk food and processed products.
Environmental Factors
Environmental exposure to harmful substances, including pesticides, is also being scrutinized as a potential contributor to increasing cancer incidents in younger adults. Moreover, the correlation between hormonal factors and rising breast cancer rates adds another layer of complexity to understanding cancer among younger individuals.
Survival Rates and Treatment Challenges
Despite the rising incidence, survival rates for young cancer patients are promising, with about 85% of those aged 15-25 expected to survive. However, late-stage diagnoses pose significant challenges. Young adults are often unaware of their symptoms, leading to advanced cases upon diagnosis, which complicates treatment strategies.
Need for Tailored Healthcare Approaches
The healthcare industry faces a pressing requirement to rethink how it treats cancer in young adults. Current recommendations suggest a dual approach, combining adult oncology specialists with pediatric care teams to support unique medical and psychosocial needs. This approach aims to ensure that young cancer patients receive comprehensive care tailored to their developmental stage.
As we move forward, raising awareness about cancer risks, improving lifestyle choices, and refining healthcare protocols for young patients is essential. The growing trend of cancer among younger demographics calls for innovative strategies and collective action to address this emerging public health challenge.