Rising rates of early-onset cancers have prompted shifts in management strategies and new research avenues.
The rise of early-onset cancers, defined as cancers diagnosed in patients under 50 years of age, has become one of the most urgent and perplexing developments in modern oncology.1 Research has documented rising rates of colorectal cancer (CRC), along with increases in breast, pancreatic, gastric, and gynecologic cancers, in younger adult patients.
“[Early-onset cancer] is a devastating diagnosis at a very vulnerable age. [Patients] are not retired with savings and retirement accounts. They are working, they’re in school, [and] they have young families,” Christopher Lieu, MD, a professor of medicine-medical oncology, associate director for clinical research, and codirector of gastrointestinal medical oncology at the University of Colorado Anschutz School of Medicine in Aurora, said in an interview with OncLive. “There’s the perfect storm of financial toxicity, and then the perfect storm of what survivorship looks like, because you may not be looking at 20 years of survivorship. You might be looking at 50 to 60 years [for younger patients].”
On top of managing the disease itself, factoring in quality of life (QOL) considerations is paramount for patients with early-onset cancer. As this population has grown, clinicians have attempted to balance treatment with helping patients achieve life goals.
“Younger patients are considering things; perhaps they might want to get pregnant, and they have to consider fertility concerns in their treatment as well,” Kristen Brantley, PhD, a Susan G. Komen research investigator at Dana-Farber Cancer Institute and an instructor of medicine at Harvard Medical School in Boston, Massachusetts, said in an interview with OncLive. “[QOL] becomes more of an issue for this younger group in that way.”
In CRC, research has continued to paint early-onset disease as a distinct biological entity fueled by a multitude of factors, including biological, genetic, behavioral, and socioenvironmental variables.2
“Over the past 3-plus decades, there’s been this slow year-over-year rise in early-onset CRC that’s affected more or less [patients of] every single gender, race, and ethnicity. This is a trend that’s been seen in the United States [as well as] globally,” Lieu explained. “The problem is, anything that you’re exposed to over the course of your life can contribute to the development of cancer, but particularly CRC. There have been studies on antibiotic use and alcohol use, and there’s some association seen, but nothing is truly causative.”
According to the American Cancer Society, the incidence of CRC is rising 3% per year in people 20 to 49 years of age; in contrast, this incidence is rising 0.4% per year in people 50 to 64 years of age and decreasing by 2.5% per year among people 65 years of age and older.3
Additionally, among the 158,850 estimated new cases of invasive CRC that will occur in the US in 2026, approximately 16% will be in patients 49 years of age and younger.4 Notably, approximately 3 of every 4 patients diagnosed with early-onset CRC in the US will be diagnosed with advanced disease, and within that subgroup, approximately 27% will have distant-stage CRC.
“Within the US, CRC is the leading cause of cancer-related death in our younger population. That was predicted to happen in 2030. It’s actually, unfortunately, happening now,” Lieu said.
Early-Onset Cancers Are Rising and Changing How Doctors Treat Younger Patients
Although multidisciplinary care is a pivotal strategy across the oncology realm, Lieu noted that this method is particularly important for the early-onset population. On top of specialists managing treatment decisions, other specialists are crucial for driving QOL outcomes and ensuring patients receive full support.
“This [care] doesn’t mean just the multidisciplinary team of physicians and advanced practice providers. It also includes nutrition, social work, oncofertility, financial counseling, and counseling in general,” Lieu said. “This is the team that needs to surround every young patient who is diagnosed with cancer.”
Ongoing research is also diving deeper into management strategies for patients with early-onset cancer to address the unique needs and disease biology of this patient population. Within the breast cancer realm, Brantley and colleagues sought to evaluate risk factors associated with early locoregional recurrence (LRR) among patients with early-onset disease. Data from a single-institution prospective data set study presented by Brantley and colleagues during the
In evaluable patients (n = 1058), the overall incidence of LRR was 4.1% (IQR, 2.8%-5.7%) at 5 years. Univariable models demonstrated that an increased cumulative incidence of LRR was reported among patients who underwent lumpectomy over mastectomy (P < .001), patients who did not receive adjuvant chemotherapy (P = .004), and patients with hormone receptor–positive disease who did not receive endocrine therapy (P = .01).
Brantley explained that although she would not use data from this study to directly drive current treatment decision-making for patients with early-onset breast cancer, this type of research represents a step toward building a clearer vision for caring for this patient population.
“On an individual level, every breast cancer is unique, and a patient’s needs are unique and need to be discussed with their clinician,” she said.
As efforts continue to improve outcomes and QOL for patients with early-onset cancer, emphasis on education and awareness regarding rising rates in younger patients remains pivotal.
“If you get the word out, people will understand: ‘I may not be too young to have cancer,’” Lieu said. “Increasing awareness on both the patient side and the provider side will make sure that delay [in diagnosis] can be shortened.”
With oncologists experiencing an influx of patients from younger age ranges, research will continue to define optimal treatment approaches and key differences in cancer management for older and younger populations. However, that represents only part of the picture of detecting early-onset cancer and, ultimately, preventing it.
“All of us have a handful of patients who have early-onset cancers, so this requires national and global collaboration for research,” Lieu added. “We need to work together, and research funding needs to increase because the most important thing is, we’ve got to prevent it.”
