Why Are MoreYoung People Getting Cancer?

How safe is that food, even if there is no Listeria or E coli?

We all have heard that a variety of cancers are occurring more frequently now in young people than in recent decades. Studies from around the world have confirmed this. Most of the studies come from the more highly developed nations, which probably simply reflects the greater medical and public health infrastructure present to accurately diagnose these cancers, collate and report the data—but perhaps it’s something else. The magnitude of the cancer increase in young people has public health officials, scientists and doctors alarmed. Data was presented in September at the Union for International Cancer Control (UICC), that during the past decade, 24 of 50 countries surveyed including: US, UK, France, Canada, Australia, and Norway have reported rising rates of colon cancer, and in 14 of these countries the increase was seen only in younger adults, with rates in the older age group remaining static. The American Cancer Society’s biennial update on breast cancer statistics was published in September and showed a 1% rise annually in the incidence of new cases from 2012-2021, with a steeper rise in women less than 50 years old of 1.4% /year, compared to 0.7% /year in the group over age 50. The rate of increase was highest in Asian American women in both age groups, leading to the alarming statistic that young Asian Americans went from having the second lowest rate in the year 2000 (57.4 per 100k) but the highest rate in 2018 (86.3 per 100k), surpassing the rate in both White and Black American women.

https://doi.org/10.3322/caac.21863 CA: Cancer Journal for Clinicians/ vol 74, #6, Oct. 01, 2024.

When it comes to breast cancer you might be tempted to ascribe the increase to more or better screening—but in the case of colon cancer and other GI malignancies, the younger age group is not receiving routine screening, with the exception of high risk people and that group has not expanded. It’s not just breast and colon cancer; a number of studies from around the world have consistently reported this trend for a wide variety of different cancers, like the following study from September 2023 BMJ Oncology which found that over a 30 year period the global incidence of early onset cancer increased by 78%. None of these cancers are routinely screened for in the young age group, so increased early detection is not the answer; and we are left with the unpleasant reality that a whole range of different cancers are appearing with unprecedented frequency in young, and in some cases very young adults. I’m not talking about the tumors that have traditionally afflicted children and young adults: childhood leukemias, rhabdomyosarcoma, Wilm’s tumor, testicular cancers, neuroblastoma, or osteogenic sarcoma, but cancers that have traditionally been diseases of much older individuals.

Global trends in incidence, death, burden and risk factors of early-onset cancer from 1990 to 2019 | BMJ Oncology https://doi.org/10.1136/bmjonc-2023-00004

Obviously nobody has the answer as what is causing this, and people with letters after their names and credentials which suggest that their opinion might be more informed than my own, repeatedly offer up the usual list of suspects: smoking, alcohol, obesity, highly processed foods, carcinogenic chemicals in the environment. I like to go on record with guesses as long as they are logical and supported by data, so I will start with ruling out smoking. I’m not harking back to those old adds from the 1950’s, “Chesterfield, the cigarette recommended by more American doctors”. There is no doubt that smoking remains the single greatest preventable cause of premature morbidity and mortality, but the following statistics lifted from somebody named AI, show that is not the cause for increasing early onset cancers.

• Smoking rates in the United States have been declining over time, with the percentage of adults who smoke dropping from 42.6% in 1965 to 11.6% in 2022:

  • 1965: 42.6% of adults smoked

  • 2009: 20.6% of adults smoked

  • 2018: 13.9% of adults smoked

  • 2019: 14.2% of adults smoked

  • 2022: 11.6% of adults smoked

The decline in smoking rates is particularly noticeable among young adults, who were previously more likely to smoke. In 2023, only 1.9% of high schoolers reported smoking, down from 36.4% in 1997.

How about Demon Rum, that shows up frequently in discussion as a possible cause for the cancer epidemic. The following graphs from Statista show that, while it’s not exactly health food, it also can be dismissed as the culprit of the hour. (Sorry about the alignment of the charts, it’s above my pay-grade, which is non-existent). The data shows that American’s consumption of ethanol has been remarkably stable over a long period of time. Yes there was a small increase after the Pandemic lockdowns, but that seems to be falling back toward the trend line in the last 2 years, and the trend of increasing cancer rates predates this mild increase by at least a decade. Furthermore, biologic mechanisms would dictate that there would have to be a significant lag time of years before increasing alcohol consumption shows up in the cancer incidence. No doubt about it Demon Rum causes cancer, but there is no case for it causing the the current surge in the young.

That takes alcohol off the table (sorry bad pun); let’s move on to obesity. Everyone knows Americans have been getting steadily fatter for several decades. Numerous studies have linked obesity to increased rates of a number of cancers including, colon, breast, pancreatic, kidney, uterine, biliary and other GI tumors. The following CDC data shows the magnitude of average weight gain in the decades up to 2000.

• The average weight for men aged 20-39 years increased by nearly 20 pounds over the last four decades, the increase was greater among older men:

• Men between the ages of 40 and 49 were nearly 27 pounds heavier on average in 2002 compared with 1960.

• Men between the ages of 50 and 59 were nearly 28 pounds heavier on average in 2002 compared with 1960.

• Men between the ages of 60 and 74 were almost 33 pounds heavier on average in 2002 compared with 1960. The trend continues with a further average weight gain from 2000 to 2016 of 15-16 pounds for men and women. 20% of US teenagers are now considered obese. Given a presumed lag time for obesity to trigger cancer, the timing seems correct for this to be a possible or probable cause of increasing tumors in young adults.

Consumption of ultra-processed foods (UPF) has been linked statistically with a variety of health problems including, obesity, cardiovascular disease, hypertension, diabetes and cancer. It’s hard to find reliable data on very long term increases in American’s intake of UPF, but it certainly has sky-rocketed in recent decades with the average US child now getting 50% of calories from UPF, and higher in certain ethnic and socio-economic demographics. The CDC reports that over the 19 year span from 1999 through 2018, children’s caloric intake from ready-to-heat-and-eat meals increased from 2% to 11% of total. Whether it is because of the tight association between increasing UPF consumption causing obesity, or some other as yet undefined mechanism, this profound, relatively recent dietary change seems to be a likely factor in the changing pattern of cancer. UPF consumption also seems to be a target amenable to intervention, although it will mean confronting and doing battle with the food industry (sorry I meant “enlisting their help”). I think after all the concentration on the elderly and the infirm, at the expense of the young and healthy, during the Pandemic, we ought to address this epidemic of cancer in the young as an emergency requiring determination, creative thinking and resolve. There is no rational person who can believe these adulterated foods are good for you—no argument that can be made other than the profit motive and “convenience”.

I haven’t addressed the issue of the blizzard of chemicals which are introduced into the environment, some of which are known to be carcinogenic, endocrine disruptors, allergens, or toxic in other ways. The subject is too gigantic, with so many possible contributors to an increase in early cancer. A good helping of common sense however would suggest that a most reasonable place to start is with what we ingest.

The latest on COVID is pretty straight forward. Levels both clinically and in the waste water are low. We can certainly expect the Thanksgiving bump to show up in the next two week data point. The graph of waste water COVID (which accurately tells how much virus is around) shows the interesting pattern that after every peak in disease it returns to approximately the same trough level. The trough we are in right now is very similar to the trough post Omicron in 2022. It never comes close to disappearing like some seasonable respiratory viruses. The adaptation of this new virus to humans remains a work in progress—it’s just a cold now, unless you’re one of the people it still kills, .09% of all deaths in the last 2 weeks, and 76,000 and counting in 2024.

This edition was a bit out of my lane perhaps, but this cancer increase is an issue I am sure we will be dealing with, both in the realm of science and medicine, and the culture war. My fervent hope for the New Year is that we don’t get to write the history of H5N1 Avian Influenza’s adaptation to humans. We are only a couple mutations away from that, but who knows, a diet rich in ultra-processed foods might be the key to defeating that virus. Years from now scientists may remark how silly it was that we didn’t understand how our diet high in UPFs was responsible for mitigating the severity of H5N1 infection in all the US dairy and poultry worker cases. They may find it amusing that we spent billions on vaccines and treatment, when all that was needed was more Hot-Pockets, Twinkies, and Fruit Loops.

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