Increase in Early Onset Incidence May be Driven by Breast/Gynecologic Cancers

Monique Gary, DO, MSc, FACS

Grand View Health, Penn Cancer Network

Patterns with increasing incidence of early onset cancer are being primarily driven by patients around 30 years of age and women’s cancers such as breast and gynecologic cancers, Monique Gary, DO, MSc, FACS, said in a conversation with CancerNetwork^®.

The increase may be attributed to risk factors often seen with sedentary lifestyles such as obesity, poor diet, and a lack of physical activity. Of a total of 35,721 incidences of early-onset cancer that occurred in 2019, 12,649 were breast cancer, according to a study assessing patterns in cancer incidence in patients less than 50 years of age from 2010 to 2019. This represents the highest cancer incidence in this time period.

In addition to examining these patterns, Gary, a breast surgeon and medical director at Grand View Health, indicated that patients need to be thought of at an individual level.

“We should pay attention to the patient, and not just the patterns,” she said. “Too often, young people are dismissed because they don’t fit the typical mold of what cancer looks like. We have historically been taught that cancer is largely a disease of aging. While there are juvenile and pediatric cancers, historically, breast cancer hasn’t been one of them, [as well as] uterine cancer and colon cancer.”

“Because we’re seeing younger and younger people develop these cancers, it means that we need to pay attention to those symptoms, [and] it means that we need to teach young people to pay attention to their bodies and not just power through without understanding the changes because they’re too young for screening. We need to teach that we have to learn to listen to and believe our patients.”

CancerNetwork^®: What were some of the patterns in breast cancer incidence that were observed in this study?

Gary: The study looked at over 500,000 individuals from 2010 to 2019. What they found was that the increase in cancer in younger individuals is being driven by cancers in women and adults in their 30s. When we say cancer in women, we particularly [mean] breast and gynecologic cancers like uterine cancers. There were 34,233, [women diagnosed with] early-onset cancers in 2010 and 35,721 in 2019; that increase was about 4.35% or so. While breast cancer showed the highest total of all the cases among the early onset, it’s an interesting juxtaposition because we’re also noting that there’s a decrease in overall cancer mortality. That’s something that we need to look into a little bit further.

Although it’s still early days, what are some theories as to why these patterns might develop in these populations?

There are no definitive explanations that came out of this study. This was a study that was population-wide and designed to look at a cross-section of where we are and see where there might be some leads. There were some interesting associations with things like smoking, obesity, and physical activity. When you look at the number of gastrointestinal cancers, for example, that have increased, those are all going to be related to those risk factors [seen in] sedentary lifestyles. There are some opportunities for us to do some interventions on that population’s health and wellness because much of what we’re seeing has a lot to do with what’s been happening to us as a society.

What I mean by that is, when you look at even the rates of obesity, they’re mirroring the rates of increase in cancer in young people. We know that younger people are struggling with their weight. Those increases are probably going to—at least we believe in the scientific community—result in some increased cancer incidence and may be part of the phenomenon that we’re experiencing.

Where do you think that future research efforts need to be focused?

Our focus needs to be on teasing out the data that relates to marginalized and at-risk communities. Even though we see some changes in the incidence and changes in mortality, those individuals who are at the highest risk of breast cancer. Women of color, Black women [specifically], have the highest mortality of any group. These types of studies did not necessarily include a large cross-section of women of color [including] Hispanic women. We need to look into those data and see where those concomitant increases are.

We need to look at the screening guidelines, and this should be a huge clarion call for all those individuals who are involved in making guidelines because they continue to say there is insufficient evidence to recommend that things such as supplemental screening for women with dense breasts and starting screening earlier for women of color—Black women, in particular. As we continue to say there’s insufficient evidence, we have to then build upon this growing body of evidence. I would love to see us look to do things like more trial recruitment and enrollment in younger patients. We need to make sure that we think of their unique considerations. They may be working; they may have issues with childcare; they may need supportive therapies like fertility preservation.

There are a whole host of things to think about, even down to supportive therapies like cold caps and preserving their hair follicles. There are so many things that you think about when you involve young people in this oncologic treatment journey, that we need to look at from the treatment lens, but also from the research lens. Can we validate what we’re seeing? What’s happening in our Asian and Pacific Islander [patients]?

We [also] need to look at the screening technologies and make sure that they’re appropriate for the age and incidence of people who are developing these cancers. Mammograms continue to be based on density. If we’re finding cancers in younger and younger people, are we using the best tools for that?

Are there new and emerging technologies that could perhaps even support that. This gives us an opportunity as a scientific community to look to innovation and to be creative about how we look to screen younger people, and not just fall back on the same patterns of the retrospective studies that we have seen that are informing current practice. I have a saying that you can’t walk forward while looking backward. We have to make sure that we are doing everything we can to be inclusive of these younger and higher-risk populations. As a scientific community, we’re getting there.

What should your colleagues within the breast cancer space take away from our conversation today?

The only other thing I [want] to mention is that the one thing that these [themes] have in common is that this is teaching us about the need to focus on wellness. What I mean by that is when you look at the associated or the potentially associated risk factors for why we’re seeing this increase in cancers, things like a sedentary lifestyle, obesity, mental health, depression, anxiety, and stress are all preventable risk factors. There is a message of hope that I want people to take away from all of this; no matter which cancers we’re looking at, we, as a global community, need to focus on those preventive best practices that promote wellness because the rising tide floats all boats. When we focus on the things that prevent inflammation in our body to decrease the rates of diabetes and heart disease, they also help to decrease the risk of cancer and cancer recurrence.

When we address our mental health, we typically will address other aspects of our physical health our nutritional wellbeing, and even sleep. The impact of all these things that we had historically considered to be things that people know that they should do, but maybe not have such an impact on overall health. We’re finding it does, not just for chronic illnesses, but also for life-threatening illnesses like cancer. It’s just so important for us to take that message home, which is that we need to focus on eating good food, getting good rest, making sure that we are doing practices to reduce our stress, and that we are moving our bodies. Those things are going to yield some dividends that hopefully reverse some of these very disturbing trends that we’re seeing.

Reference

Koh B, Hao Tan DJ, Ng HN, et al. Patterns in cancer incidence among people younger than 50 years in the US, 2010 to 2019. JAMA Netw Open. 2023;6(8):e2328171. doi:10.1001/jamanetworkopen.2023.28171