Editor’s note: Dr. Jalal Baig is a physician and writer based in Chicago whose work has appeared in The Washington Post, NBC News, The Atlantic, Foreign Policy and other publications. The views expressed in this commentary are his own. Read more opinion at CNN.
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.”
As these cases of early-onset cancers mount, there is added urgency to identify why this rise in cancer among younger people is unfolding and who is at heightened risk. At least part of the answer appears to be found in the changes to nutrition and lifestyle that took hold in the middle of the last century.
Notably, the population’s underlying genetic risks haven’t changed in the past several decades, bolstering the case that environment and lifestyle have a greater role in these cancers than our genes. Culprits may include ultraprocessed foods, sugary drinks, red meat, smoking, alcohol, sleep alterations, obesity and physical inactivity. Alone and especially in concert, these factors can alter the internal processes of our bodies by upsetting metabolism and ratcheting up inflammation.
Further research efforts are underway examining whether changes in the gut microbiome, the trillions of microbes that reside inside us, are increasing our bodies’ vulnerability to cancer. This community of microbes is a crucial contributor to health, affecting digestion and the immune system. Poor diet, excessive antibiotic use and certain medicines can cause an upheaval in this microbiome, which could then play a role in facilitating cancer.
Because cancer is a disease understood to develop over decades as changes in DNA accumulate and spawn tumors, a person diagnosed at a younger age may have been exposed to risk factors as a baby or in utero. Research is also focused here currently, with studies associating greater risk with cesarean delivery in females and a synthetic form of progesterone used to prevent premature labor.
But as I have seen regularly in my own cancer clinic, obesity and lifestyle…
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