Cancer diagnoses before age 50 used to be rare, but they are becoming all too common, and Orlando doctors are sounding the alarm.
According to the Florida Cancer Connect Collaborative’s annual report, rates of new cancer diagnoses in people ages 20-39 rose to 91.9 per 100,000 in 2020, the latest figures available. In 2010, it was 79.4 per 100,000.
County-specific trends in cancer diagnoses by age were not available on the Florida Department of Health’s cancer incidence database.
Nationwide, millennials are pushing up early-onset cancer rates, according to an August study in JAMA. Doctors say it’s important to spread awareness about the increasing numbers of early diagnoses because in many cases, these cancers can be prevented.
Some cancers are on the decline, like lung cancer, the deadliest cancer in the country. But a growing body of research suggests that the Western diet, sedentary lifestyle, use of tobacco and alcohol and stress are driving up young and middle-aged adults’ cancer rates overall, particularly breast cancer and gastrointestinal cancers. These risk factors are in part decided by individual choices but also determined by systemic barriers.
“Having people in the 20s and 30s was rare and now it’s the norm,” said Dr. Mohamedtaki Tejani, the medical director of the gastrointestinal oncology program at the AdventHealth Cancer Institute in Orlando. “And what’s really sad is … younger patients typically present with more advanced disease because it’s not on their radar. It’s not on their primary care doctors’ radar.”
The American Cancer Society in 2021 began recommending people get screened for colorectal cancer starting at 45 rather than 50 in response to this trend.
Advice on avoiding cancer
The list of things unhealthy about the American lifestyle can be daunting to a young person who may have thought they wouldn’t need to worry about cancer for a long time, said Dr. Amber Orman, a radiation oncologist and board-certified lifestyle medicine specialist at AdventHealth Celebration.
Orman specializes in breast cancer, the most prevalent cancer in the state among women and the third most deadly, according to the state Cancer Connect Collaborative’s annual report.
She, like Tejani, has seen an increasing number of young patients in recent years. She said for those looking for ways to reduce their risk, they could begin eating whole fruits, vegetables, beans, grains, nuts and seeds.
Diet is the No. 1 risk factor for early death worldwide, beating out smoking, according to a 2019 study published in the Lancet.
“The most kind of tangible thing to start approaching is probably changing the way that you eat and incorporating more and more whole plant foods,” Orman said.
This change alongside other healthy lifestyle switches can also reduce the risk of reoccurrence in cancer survivors.
Orman runs a virtual program called HEAL (Healthy Eating and Active Lifestyle) Breast Cancer for breast cancer survivors. The program emphasizes lifestyle medicine with the goal of decreasing cancer recurrence risk.
Systemic change needed
At the same time, certain groups face an elevated risk of cancer and poorer outcomes due to systemic barriers to health care.
American Indian, Alaska Native people, Black people, Hispanic people and mix-raced people get most types of cancer far more frequently than white non-Hispanic people and Asian people.
Black Americans have the highest rate of colon cancer, the second-deadliest cancer in the U.S. They are 20% more likely to get it and 40% more likely to die from it than most others, according to the American Cancer Society.
“The reasons for the differences are complex, but they largely reflect differences in risk factors and in health care access, both of which are related to socioeconomic status,” a 2020 fact sheet from the organization reads.
Breast cancer follows the same trend.
Black women are more likely than white women to develop breast cancer before age 40. At every age, they are more likely to die from the disease than any other racial or ethnic group, the society shares.
The Sisters Network, a group that raises awareness of Black women’s high breast cancer mortality rate, calls breast cancer the “most imperative issue” facing Black women.
Research suggests this trend could be at least partially influenced by biology, but it’s also due to a lack of private health insurance, a higher risk of other health conditions and limited access to care.
A 2017 study published in the Journal of Clinical Oncology calculated factors contributing to Black women’s excess deaths from breast cancer compared to white women. The study found a lack of private insurance was the biggest factor in determining the difference in survival outcomes.
“This is something that I think we have to address in the way that we deliver health care, in the way that we design our cities, in the way that we live in community with our neighbors,” Orman said.
Staying aware
Cancer symptoms can start small. Signs of cancer, particularly gastrointestinal cancers, can be easy to dismiss as something less serious, said Tejani.
“I’ve had so many patients, the story just is eerily similar,” he said.
Frequent bleeding, trouble with bowel movements and discomfort after eating should set off alarm bells and should prompt doctors to order colonoscopies or endoscopies, especially if they aren’t fixed by a change in diet, he said.
The CDC says other common cancer symptoms include a lump anywhere in the body, unexplained weight loss or gain, a sore that won’t heal, a cough that doesn’t go away, a hard time swallowing, weakness and fatigue.
Ccatherman@orlandosentinel.com, @CECatherman Twitter
