The Decibel - Why more young people are getting cancer

Episode Date: February 18, 2025

Rates of cancer diagnosis and death are climbing worldwide in people under 50, according to the World Health Organization. A report, with data between 1990 and 2019 in 204 countries, showed early onset cancer grew 79 percent, while deaths also went up by 28 percent in the same time period.We follow the stories of two cancer survivors along with Kelly Grant, The Globe’s national health reporter. She’ll detail what we know about why younger people are being diagnosed with cancer, the symptoms to look for and why fighting cancer at a young age carries new challenges for Millennials and Gen Xers.Questions? Comments? Ideas? Email us at [e-mail] this Decibel survey: https://thedecibelsurvey.ca/ and share your thoughts for a chance to win $100 grocery gift cards

It is something no one can ever prepare you for. You can watch all the TV shows and movies depicting cancer, whether it's as a caregiver or as a person experiencing it yourself. However, that does really not prepare you for the reality of it. And it truly is different for everyone. Nicole McRoney Alpah was diagnosed with breast cancer at age 33. That makes her part of a worrying trend. Globally, more and more people under 50 are getting cancer.

Another millennial who experienced this is Jay Abramovich. He was told he had colorectal cancer shortly after he turned 36. It pulls the record from underneath you, like right at the prime of your life. You're not established in your career yet. You don't have a huge nest egg in the bank to fall back on. Your kids aren't grown, independent. You might not have your life really settled yet or even started. And this kind of just comes in and implodes all of that.

Kelly Grant is a health reporter with The Globe. She looked into why rates of early onset cancer are climbing. She's on the show to talk about what researchers think could be causing this rise. I'm Maynika Ramen-Wilms, and this is The Decibel from The Globe and Mail. Kelly, thank you so much for being here. Thanks for having me. So we just heard a little bit from Nicole and Jay off the top. These are two Canadians who were diagnosed with cancer in their 30s. Can

you just tell me how they found out they had cancer and their initial symptoms? Let's start with Nicole. Sure. So Nicole was 33 at the time. So leading up to my diagnosis, I would say I was in the best shape I've ever been in my life. The pandemic really gave me time to slow down and just focus on my health. But I found a lump in my armpit, in my left armpit, and I didn't have a matching lump on the right side. So she spoke with her doctor and eventually went in first for an ultrasound and then for a biopsy. And then two days before she was supposed to leave for a trip to Mexico, her

family doctor called and asked her to come in at seven o'clock at night, which let her know that something was going on here. And that's when she found out that she had cancer. Wow. And what about Jay? How did it go for him? Jay actually found out in the emergency room. So he was 36 at the time, living just outside of Ottawa. And he had been having some minor symptoms. My symptoms were very, very extremely minor. I was just noticing a little bit of abdominal discomfort but nothing like I've never felt before. But he was concerned enough that he

had gone to his family doctor and asked to have things checked out and eventually after some back and forth he decided to go to the local emergency room to try to see if he could get a colonoscopy to have this looked at. In the end, they actually started by doing a CT scan for him and he was then called in to see a doctor at the emergency room who handed him a piece of paper that said possible malignancy on it.

And that's how he first found out that he had colorectal cancer. Mm-hmm. Wow. One thing that really stuck out in Jay's memory was that when he was trying to have these symptoms explored, he went in to see his family doctor, who he said was great and super supportive. But there was a medical resident who was training in her office.

And when he came to review Jay's case, he was sort of dismissive and said oh you know it's probably just hemorrhoids and actually said to him oh but well you're too young to have cancer. How many other people like how many other young doctors like him are out there with that same information or that same lack of information right that are kind of sending that message to young people when they actually do decide to go to the doctor because they're worried about something and they're basically told like oh you're young, you're healthy, don't worry about it. What did he tell you about what that was like to be told

that you had cancer at such a young age? He said it was very shocking for him. Definitely went into a little bit of a little bit of shock for sure. You know the anxiety and I could feel my stomach basically right up into my throat and the room started to kind of shrink and was really spinny and was just kind of really confused. I think for him it was especially difficult because he got that news in the emergency room in November of 2020, which was, as you know, at the height of the pandemic and so his wife was outside waiting in the car because she couldn't come inside with him.

So getting that piece of news, I think, is difficult under almost any circumstance, but the pandemic restrictions made it especially tough. And what about Nicole? What did she say about how that changed things? So she too was very shocked, as I think is pretty typical of young people who get cancer. And for her, she went through this phase

where for about a month, she was waiting to get into the Princess Margaret Cancer Center in Toronto, where she just didn't even really know what type of cancer she had. Ultimately, they determined it was breast cancer, but she had very little information about how sick she was or what this would mean for her future. And she found that month of limbo very difficult. It was terrible. Knowing something is wrong and not being able to do anything about it was really, I felt powerless.

So both Nicole and Jay, they're part of this trend that we're actually seeing, Kelly, right? Where more Gen Xers and millennials are being diagnosed with early onset cancer. Can you tell me about this trend? What exactly have we seen? Dr. Kelly S. Hickman So what we're seeing is really an international trend. Whereas cancer is still generally, you know, considered a disease of age, it is much more common in older people.

We are seeing this increase in rates among people who are younger than 50. And so there have been a couple of large international studies that have looked at some of these numbers. And one, for example, that was published in the BMJ Oncology Journal found that the global incidence or rate of new cases of early onset cancer increased by 79% between 1990 and 2019. And that was a study looking at 29 different types of cancer in more than 200 countries and regions. There have been other studies that have looked at, you know, what are the types of cancers

that we're seeing this increase in? You know, two of the most prominent or the ones that have been studied the most are colorectal cancer and breast cancer, where we are seeing this increase in the rates among younger people. But you know, we're also seeing that same trend in some other types of cancers, at least at this sort of high level, kind of international level. So some of the other cancers include cancer of the endometrium, the esophagus, the bile duct, the gallbladder, the head and neck, kidney, liver, bone marrow, pancreas, prostate, stomach, and thyroid. And I'm actually reading that list from a major study that was published in 2022 that

had the headline, Is Early-onset Cancer an Emerging Global Epidemic? Wow. And do we know, is there also a corresponding increase in deaths in young people with early onset cancer? So that study that I mentioned that found that 79% increase in incidence did say that the rates among young people have gone up by about 28%. Now that's a global number. And I should say that it's important to point out that cancer treatment has really improved

in many ways for many types of cancers, not all. But survival rates generally are higher. But of course, if you have more people getting cancer, you're going to wind up unfortunately having more people who do die than you would if those people never got cancer in the first place. Yeah. Do we know how this breaks down at all in terms of race? Is that a factor here? So one thing to say is that our data around health and race, particularly in Canada, is not always great. So one of the issues is if you want to sort of ask the question of how have the rates changed over time, then you historically need really good race-based data, and we're not awesome about that in Canada. But what we do know is that snapshot in time right now that in the case of breast cancer, for example, the risk in the incidence does seem

to be higher among some ethnicities, black women in particular. There was a really interesting study that a couple of doctors at the Ottawa Hospital working with Statistics Canada did, that did find that black women tend to be diagnosed earlier and die earlier. They're getting breast cancer at younger ages. And in the states where actually the race-based data collection tends to be a bit better than it is here, that is something that they've reported on for a lot of years and haven't really totally understood

why the rates seem to be higher among black women than among other women. And I think the key thing here is that this Canadian study just found that like they were getting cancer at younger ages. Why is it so rare, Kelly, for younger people to have cancer? I guess the other way of asking this question is the flip side is why does cancer usually affect older people? So cancer is a disease of age and getting older is a major risk for cancer in general. And there's a couple of different reasons for this. I mean, think about your body as something that just takes some wear and tear over time, right?

Unhealthy exposures that you have over a lifetime pile up, and it takes longer for those exposures to start affecting your cells. Random mutations that can cause cancer, those pile up as well over time. People's immune systems weaken. And so all of those things add up to the older you get, the higher your risk for cancer, which

is part of the reason why it is something of a surprise to see the rates rising in younger people. And just to be clear, this trend is not a result of medical science just getting better at detecting cancer. Like, are there more cases now because we can find the better than we could a generation ago? So some of the studies that have looked at this on an international level have said that screening may be playing a small role here.

However, in the kinds of cancers that we're seeing, the largest rises among young people, and here I'm thinking really about colorectal and breast cancer, in most places, and particularly in cancer, there is not widespread screening for these types of cancer before the age of 50. OK. When we're talking about doctors finding cancer in young people, Kelly, is it generally

at a fairly early stage where they can actually do something about it? Not necessarily. The studies and surveys that we have seem to point to younger people being diagnosed later. They generally don't qualify for this proactive screening. And sometimes young patients present to their doctors with symptoms of cancer, and their doctors or others in the healthcare system aren't used to seeing cancer in patients so young. So they may assume there are other reasons for their symptoms, and will sort of either brush them off or not send them off to get tested specifically for cancer. And then patients themselves don't necessarily expect to have a cancer diagnosis when they're very young. It's not a thing that they're hearing about from their friends or family or other people their age. And so they themselves might not

think to get some of their symptoms checked out because it just wouldn't occur to them that they've got cancer. Obviously of course each patient's journey is unique, but in general, Kelly, like what is the difference between having cancer in your 30s and your 40s as opposed to, you know, later in life, like in your 60s or your 70s? A lot of the differences are really about the stage people are at in their lives. So imagine if you are diagnosed with cancer when you're 70 and you have your mortgage paid off, you're retired and you have a pension, your children are grown and launched into the world

versus if you are somebody who is 30 just really getting their career up and running, you've just bought a house, you have bills, you have small children at home where you have not yet had children and that's something that you hope to do in the future. at home where you have not yet had children and that's something that you hope to do in the future, your life needs are very different when you are diagnosed at 30 or 40 versus at 70. Yeah. If we talked about Nicole and Jay off the top, did either of them tell you about I guess what that was like trying to balance treating their cancer and maintaining their jobs, maintaining their lives? Nicole I think had a lot of really interesting things to say about this because she was 33 when she was diagnosed and she was

single at the time. So while she was dealing with all of the trauma of a cancer diagnosis, she also was offered the opportunity to go through fertility preservation and she ultimately decided to freeze her eggs. That process on my mental health was really stressful because not only was I dealing with a very recent cancer diagnosis but I was also having to make family planning decisions right now. And as you can probably assume with fertility treatment your hormones are all over the place and to be like mentally in a state where you've just found out you have cancer, plus introducing a bunch of medications that can exacerbate an already stressful situation just made it very, very dire, I would say.

I mean, that is not something that happens to a woman who gets diagnosed with breast cancer when she's 70. Yeah, that's a very different situation to deal with then. For Jay, he and his wife had been starting the process of trying to adopt a child. And now, all of a sudden, he's got to go into chemotherapy and other types of treatment for cancer. And they wound up deciding to put that on hold. And ultimately, because his treatment was successful at the end of the process, right after he finished his treatment, he and his wife were actually offered a baby girl and

they chose to adopt her and she's four now and they're all doing quite well. We'll be back in a moment. All right, so Kelly, I think the big question here is what is going on with these early onset cancers, right? Can we look at what cancer researchers think is happening? Are there factors that could be contributing to this? What are the leading theories? One of the things that I thought was most interesting about this is that there isn't

a clear answer. The researchers, scientists, doctors I spoke with said there are a lot of good hypotheses and the thinking is that it seems to be a combination of a bunch of different things involving lifestyle and environmental exposures from childhood. So it's very interesting that when you look at some of the charts in these studies you can see that the difference in the rates really starts to rise when we're talking about people who were born in like the late 70s and then into the 80s and into the 90s. So you're like late Gen Xers and then into your Millennials. So some of the thinking is that like what were the changes in lifestyle for people

in this generation? And so leading factors are changes in diet. Way more processed food, more red meat, more sugar, less of a traditional style diet. Increases in just sitting around all day and being sedentary and not getting as much exercise. Changes in sleep patterns. Increases in stress. Obesity, right, which is very clearly linked

to certain types of cancer, although it doesn't seem to be the story all on its own. Some of these diet-provoked changes to the gut microbiome. There is some thinking that increased use of antibiotics in childhood may be playing a small role. It could be exposure to certain chemicals, pesticides, air pollution in childhood. And then it comes to breast cancer specifically. Another interesting factor here is changes in reproductive patterns. So estrogen exposure is associated with an increased

risk in breast cancer. And girls are starting their periods earlier. And women are having children either later in their life or not having children at all. And that just leads to a sort of longer lifetime load of exposure. So if you have children early in life and if you have a lot of children, then you get those early benefits of those holidays from estrogen that aren't present if you don't have children or you have them really late in life. So if we are seeing this trend now, Kelly,

to younger people getting cancer, are we actually changing the way that we screen for it to maybe try to catch some of these cases? This is such a huge and contentious debate in Canada especially. On the breast cancer front, we have a federal expert panel that makes national recommendations about this and they did a review and last year put

out a new recommendation that was really the same old recommendation that organized breast cancer screening doesn't need to begin until women are 50. However, they did say if you're a woman in your 40s and you really want a mammogram, you should be able to get one after talking with your doctor about the risks and benefits of the procedure. So quite a few provinces have actually chosen to proactively lower the age below 50.

For colorectal cancer screening, that remains, as a general rule, limited to people who are 50 or older. In the United States, their equivalent expert panel has recommended and implemented a lowering of that screening age to 45 for colorectal cancer. COLLEEN O'BRIEN Okay. So obviously there's a cost associated with lowering the age, but what are the concerns

around lowering the age for screening? Why not just do it? Yeah, it's really funny because cost, I think, in a public health care system like ours is obviously a consideration. But the federal panel that makes these recommendations explicitly does not address the question of cost. They say they are trying to balance the risks and harms

of screening with the benefits of catching these early cancers. And what they identify as some of the possible harms are things like false positives. So that's where you go for a mammogram, they find a shadow on the image and they say, oh, looks like something might be wrong here. Let's come back and give things a closer look. And it turns out it's fine. You don't have anything. And you had to sort of go through the stress of thinking, gee, maybe I have cancer. There's also concerns fine, you don't have anything, and you had to sort of go through the stress of thinking, gee, maybe I have cancer. There's also concerns about things

like unnecessary biopsies or treating cancers that, had they not been caught very early on screening, they might never have grown to pose any health harm to people. Now, those who are in favor of lower than the age obviously dispute those arguments pretty strongly and so that remains a real point of contention in the cancer world. I imagine a lot of people listening to this Kelly might be a little unnerved to hear these numbers and these stories. If you're someone in your 30s or 40s or you know you have family members who are,

what are some things I guess to keep in mind in order to try not to find yourself in one of these situations? When I spoke with with doctors about this, the big message I took away was don't dismiss any symptoms of cancer that you might have because you think you're too young to be sick. Chances are that you are still probably fine. I really do want to emphasize how much higher the rates continue to be in older people, but it's not zero in younger people. So if, for example, you see changes in your breast texture or odd discharge coming from your nipples, or obviously if you find a lump in the case of colorectal cancer, if you notice blood in your stool, if you have very consistent and difficult sort of stomach pains

and trips to the bathroom. If you notice unexplained weight loss very suddenly, those are just a few examples. Symptoms obviously differ for some other types of cancer, but don't dismiss them. You know, if you're fortunate enough to have a doctor, go talk to him or her about what you could do to find out what's going on. Just lastly here, Kelly, we started off talking about Nicole and Jay and their situations. How are they doing now? Both of them are doing really well in terms of their health.

Jay ran a half marathon in the fall. His daughter, as I mentioned earlier, is four now. Nicole is also really doing well in terms of her health. She got to finish her treatment in May and rang the cancer bell. But both of them talked to me about the kind of long tail of having a cancer diagnosis when you're young, even if it turns out that you're successfully treated the way these two both have been. It follows you around for the rest of your life. You always have to

be worried about whether it might recur. Yeah, you finish all your treatments. everybody's happy for you, wonderful, but like, yes, it's great. But not only do you have to, you know, relearn yourself and relearn how to live again and find your new purpose and figure out what you want to do with your life now, you have 30 or 40 years of dealing with those scans and blood tests and worry and febric currents and the anxieties of just all the different things that kind of get put on your plate during a cancer diagnosis. That's a long time. And it also affects things like, you know, Nicole talked to me about what it was like

to try to date as a woman who had had cancer. It feels like you're damaged goods a little bit. Even though I know I'm not, I do believe that that is a perception of like from other people or men. These are sort of long term issues that are going to come when you have more people diagnosed with cancer at a young age, and there'll be issues that follow them for the rest of their lives. It's not normal at this age to like face your mortality and wonder if you're gonna be around

for the next 10, 15, 20 years. That's not a normal experience. So the gift of that though is that it's not a normal experience. Right, and that being my age, being able to see things is that it's not a normal experience. Right? And that being my age, being able to see things in that light is not something that many people my age understand or will ever understand. Kelly, thank you so much for taking the time to be here. Thanks again for having me.

That's it for today. I'm Maynika Ramin-Wilms. Our producers are Madeleine White, Michal Stein, and Allie Graham. David Crosby edits the show. Adrian Chung is our senior producer, and Matt Frainer is our managing editor. You can subscribe to The Globe and Mail at globeandmail.com slash subscribe. Thanks so much for listening and I'll talk to you tomorrow.