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Greenville Business Magazine

Cancer on the Rise Among Young People

Jun 03, 2024 08:47AM ● By Liv Osby

Wendy Hill had already scheduled her first-ever mammogram for the spring of 2022 when she unwittingly discovered a lump under her arm.

A month later, she went for the screening test. It led to an ultrasound, then a biopsy, and sadly, a diagnosis of Stage 3C breast cancer. 

She was just 40 years old.

“It was quite a shock,” she recalls. “I was young and healthy. Everyone else I’ve known (with cancer) has been older.” 

But the Chapin, South Carolina, woman is one of a growing number of people developing cancer at younger ages.

While deaths from cancer overall have declined, leading to more than 4 million fewer deaths nationally since 1991, the incidence of six of the top 10 cancers is increasing, according to a new report from the American Cancer Society.

And mortality tends to be higher among African Americans and Native Americans, the society reports.

Rebecca Siegel, the report’s lead author, said in a release that the drop in cancer mortality from reduced smoking, earlier detection, and improved treatment is encouraging, but that the incidence “continues to increase for many common cancers – like breast, prostate, and endometrial, as well as colorectal and cervical cancers in some young adults.”

For instance, colorectal cancer – the fourth leading cause of cancer death in men and women younger than 50 just 20 years ago – is now first in men and second in women, the group reports.

And breast cancer is the leading cause of death in women younger than 50, with 2,251 deaths in 2021, according to the report.

Nationally, about 80,000 people between 20 and 39 are diagnosed with cancer every year, making up about 5 percent of all cancers, according to the society. And about 9,000 people in this age group die of the disease annually, the group reports.

In addition, the proportion of cancer in people 50 to 64 increased from 25 percent in 1995 to 30 percent in 2019-2020, according to the society. Meanwhile, cancers in people 65 and older decreased from 61 percent to 58 percent during that time frame, largely due to declines in prostate cancer and cancers related to smoking.   

Overall, more than 2 million Americans are expected to be diagnosed with cancer this year, and 611,720 people are projected to die from the disease, the society reports. 

Dr. Kevin Choong, a surgical oncologist with Prisma Health Richland in Columbia, South Carolina, said he’s seeing younger patients with colorectal cancers in his practice. And his partners who treat breast cancer are seeing younger patients, too. 

“A number of patients are presenting at younger ages,” he said. “Maybe 6 percent of all breast cancer and colorectal cancers are these younger patients. But when you see them, it can be quite shocking.”

Moreover, he said, they tend to occur more often among African Americans and Hispanics, and some cancers tend to be more aggressive than they are in older patients.

These patients also tend to have later stage cancers with more advanced disease, he said.

“I had a rectal cancer patient that was in their early 30s,” he said. “And one at 40 … (who) had metastatic disease to their liver when they presented at Stage 4.”

While patients with Stage 4 cancer typically have the worst outcomes, new treatments have emerged in the last few years that have improved survival, said Dr. Maggie Westfal, a colorectal cancer surgeon with the Hollings Cancer Center at the Medical University of South Carolina, who’s also seen patients being diagnosed at earlier ages.

“Over the past … two decades,” she said, “there’s been a steady increase in early onset colorectal cancers in people younger than 50.” 

Both doctors say no one knows for sure why this is happening, but that it’s most likely the result of several factors, including smoking, diet, obesity, carcinogens in the environment, and genetic predisposition. 

Westfal said a lot of the research points to a Western diet, which is higher in red and processed meats and processed grains like white bread versus whole grain bread, which is higher in fiber and less inflammatory. 

“One of the leading hypotheses for a higher risk of colorectal cancer, could be … chronic inflammation of the bowel wall,” she said. “And that it can lead to adenomas and polyps that can become cancer.”

Another hypothesis, the doctors said, is the role that the microbiome – or bacteria in the gut – plays in the early development of cancer. 

“A bunch of research is looking at what specific bacteria live in average-risk people and … at-risk people,” Westfal said, “and whether people with cancer have a less diverse microbiome.”

Choong said that some environmental exposures could have damaged people’s DNA years ago putting them at risk now, or someone may develop cancer because of an accumulation of mutations over time on top of genetics.

“I don’t think it’ll be one thing,” he said. “All we can do is keep looking.”

“The continuous sharp increase in colorectal cancer in younger Americans is alarming,” said Dr. Ahmedin Jemal, senior author of the cancer society’s study. 

“We need to halt and reverse this trend by increasing uptake of screening, including awareness of non-invasive stool tests with follow-up care, in people 45-49 years,” he said.

The cancer society adds that people younger than 65 are less likely to have health insurance and therefore less access to care and are more likely to be busy with family and careers. 

“When people start (hitting) 50 or so, they start thinking about the issues,” Choong said. “And when younger patients have symptoms, they tend to disregard them.”

The cancer society called for increased funding for research into the causes and preventive measures.

People at higher risk, such as those with a family history, often start to seek care earlier, Choong said, noting the beginning age for colon cancer screening was lowered in recent years from 50 to 45 to catch younger patients.

But society needs to be aware of the trends to plan for the future from a health care perspective, he said.

“Maybe we do have to start screening sooner,” he said, “or establishing care with primary care doctor so someone can watch them closer.”

The hard part with screening everyone earlier, Choong added, is the potential for a false diagnosis or injury from colonoscopy to people who didn’t need early screening, as well as the impact on health care costs.

“We are not even optimally screening people who are eligible,” he said. “So, it would be difficult to add people to the pool.”

A critical piece of the puzzle, Westfal said, is increasing awareness on the part of patients as well as providers.

Providers are getting better at thinking about cancer in patients in their 20s, 30s, and 40s who present with symptoms, she said, because they’re getting more used to seeing younger patients and are ordering screening tests sooner.

“Patients coming in with abdominal pain, bloating and cramping – a delay in getting a colonoscopy is happening less so now because people are more aware of the risk,” she said.

Meanwhile, patients should be health advocates for themselves, Westfal said, going to the doctor when they have symptoms. 

“It never hurts to ask,” said Choong.

After her diagnosis, Hill said she went into survivor mode.

“I said, OK, I just need to tackle this and get it over with,” she recalls. “Let’s get this done.”

She quickly began 16 weeks of chemotherapy including four weeks with Doxorubicin, known as the Red Devil because of its bright red color, she said. 

“My hair was hanging on,” she added, “but as soon as they gave me the last dose, it disappeared.”

Chemo was followed by 28 radiation treatments and two surgeries, she said. 

The first was a bilateral mastectomy and removal of 30 lymph nodes, six of which were cancerous, she said. Then came lymphatic reconstruction surgery under her arm to reduce the risk of lymphedema, a painful condition marked by a buildup of fluid and swelling after removal of lymph nodes, she said.

And while she’d already decided to have a bilateral mastectomy to appear symmetrical, subsequent testing revealed she had a genetic mutation that put her at increased risk for breast cancer, confirming she’d done the right thing. 

Finally, in December, she underwent breast reconstruction surgery, she said. But she still must take a daily maintenance medication and get monthly injections of another drug.

Hill considers herself blessed to be NED – or no evidence of disease – now. She also feels lucky that she had good insurance. 

“If I didn’t,” she wonders, “what would that have meant for me?”

But the last year and a half has taken its toll, she said. 

“A lot is thrown at you,” she said. “It’s not like you bounce back and you look the same. And I’m a healthy person, and I hiked and walked. And it’s hard to take when you have to slow down.” 

Nonetheless, while she has some limitations because her right arm can only move so far during workouts, for example, she doesn’t want to dwell on the cancer.

In fact, during it all, she says, she cried just twice before deciding that crying was giving in. Instead, she focused on beating the cancer, relying on her family, friends, and faith. 

“I was so young,” she said. “And having nieces and a nephew and two stepsons that I wanted to see grow up, I didn’t want to miss out. I wanted to stay positive.” 

Another happy event that occurred during the worst of it was that her future husband, Todd, whom she’d met 2½ years before the diagnosis, proposed. 

“He did ask me to marry him as I was going through chemo,” she said. “And we planned our wedding for six months after the radiation was done. By that time, my hair had grown back.”

Hill hopes that scientists continue their research into why younger people are getting cancer.

She advises others who find themselves in similar situations to do whatever they can to get through it, like finding the right doctor and leaning on them. And she hopes that sharing her story will help others too.

“I wasn’t going to let it beat me,” she said. “I want to move on and live my life.”