The alarming rise of cancer in young adults and steps that could lower the risk

[0:00] I'm William Brangham and this is Horizons. We tend to think of cancer as a disease that [0:05] mainly affects older people, but an increasing number of diagnoses are happening amongst the [0:10] young. What is behind this alarming rise? And can anything be done to prevent it? Coming up next. [0:29] Support for Horizons has been provided by Steve and Marilyn Kerman and the Gordon and Betty Moore [0:37] Foundation. Additional support is provided by Friends of the NewsHour. This program was made [0:59] possible by contributions to your PBS station from viewers like you. Thank you. From the David [1:06] M. Rubenstein Studio at WETA in Washington, here is William Brangham. Welcome to Horizons from PBS [1:15] News. Young people today are getting cancer at higher and higher rates. While researchers have [1:21] been studying this for a while, it wasn't until a few years ago that this reality hit home for most [1:27] of us. Throw down your weapons and we can handle this another way. [1:34] That's when Chadwick Boseman, star of Marvel's Black Panther series, [1:38] died of colon cancer at just 43 years old. You're free. You can do whatever you want. [1:48] And then, earlier this year, another jarring loss. James Van Der Beek, star of the hit TV series [1:54] Dawson's Creek, was killed at age 48 by the same kind of cancer that took Boseman. [1:59] Just a short time before he died, Van Der Beek spoke publicly about this growing threat. [2:09] He said, [2:12] Colorectal cancer has now become the leading killer of people under the age of 50. But it's not just [2:18] that. More than 10 different types of cancer are on the rise among 20 to 50-year-olds, including [2:24] breast cancer, kidney cancer, and uterine cancer. The sharpest rise has been among people in their [2:30] 20s. In a few minutes, we're going to talk with some doctors who treat these types of cancers [2:35] to understand why these rates are going up and what people can do to prevent them. [2:38] In a few minutes, we're going to talk with some doctors who treat these types of cancers to [2:38] understand why these rates are going up and what people can do to prevent them. [2:38] And we'll be right back after this. [2:39] We'll be right back after this. [2:40] But first, we wanted to hear from someone who has successfully navigated this awful journey. [2:48] Laura Benke is a former TV sports anchor who lives in California's Bay Area. [2:53] Six years ago, she and her husband began trying in vitro fertilization. But her successful [2:59] pregnancy at age 41 at first covered up the warning signs of cancer. [3:05] Well, my husband and I had gone through three rounds of IVF that were unsuccessful. [3:11] And we had done our fourth and final round and finally had one healthy embryo. And a few days [3:18] before the transfer, I noticed blood in my stool for the first time. I told myself just to relax, [3:24] to not strain, and hopefully everything would go away. And it did. It did. And we had our transfer [3:32] a few days later. Thankfully, it was successful. When I told my OB, I kind of self-diagnosed [3:38] myself. I basically told her, I'm having some bleeding, so I assume it's healthy. And I told her, [3:42] I'm having hemorrhoids. I did have a hemorrhoid flare-up in my third trimester, which was unlike [3:46] anything I'd ever experienced before. So when my daughter was six months old, that is the only [3:52] reason that I was sitting in the office of a colorectal surgeon, was because I wanted the [3:58] hemorrhoid removed. I'm 42. I'm active. I felt, you know, I'd been through a year of IVF and then [4:05] pregnancy and postpartum. I truly felt good. I felt strong. I had just told my husband days [4:12] before that I was going to die. I was going to die. I was going to die. I was going to die. [4:12] Like, I feel like I finally turned a corner. After two plus years, I feel like my body is my [4:18] own again. She told me I needed a colonoscopy immediately. As I was waking up, I could hear [4:22] my surgeon on the other side of the curtain talking to the nurse saying, I'll come speak [4:26] to her when she's awake, make sure her husband is with her. And that's when I knew. I ended up [4:31] being stage 3B rectal cancer, which means the tumor had just broken through the rectal wall [4:38] and was in some of the nearby lymph nodes. But thankfully, [4:42] had not spread to other organs. The treatment sent me into immediate menopause as well. So not [4:47] only was I dealing with cancer and the repercussions of a cancer diagnosis, but I found myself at 42 [4:54] suddenly in menopause. So that changes how you view your health and the things that you need to [5:00] do. Denial was a very easy place to be given my age, given my health, given my lifestyle. It just [5:07] did not seem like something that could possibly happen to me. [5:10] Denial is an easy place for many of us. And so we're going to try and push back on that to [5:17] understand clearly what is going on here. Joining us to help with that is Dr. Vedagiri. She's an [5:23] oncologist who specializes in the genetics of cancer at Yale's Cancer Center, where she's also [5:29] the director of the Early Onset Cancer Program. And Dr. Shanti Savendran. She's an oncologist [5:35] and hematologist at Penn Medicine. And she's also a senior vice president at the American Cancer [5:41] Society. [5:41] Where she focuses on patient and caregiver support. Thank you so much to both of you for [5:47] being here today. Dr. Geary, to you first, we are seeing this sharp rise in cancer among young [5:53] people and all types of cancer, colorectal being the big one. Tell us a little bit about the [5:59] patients that you see. What kinds of cancers are they coming in with? How old are they? What is it [6:05] you're seeing at your center? [6:06] Yes, thank you so much. This is such an important topic for discussion. And it's a real pleasure to [6:13] be here. We really are seeing a rise in these early onset cancers at Yale Cancer Center and [6:20] Smilo Cancer Hospital. What we are noticing is that about 15% of our total cancer patient [6:28] population is diagnosed with cancers at age 45 or under. And so this is a substantial proportion [6:37] of our patient population. And we really feel that it is important to address the needs of these [6:43] patients from a clinical perspective, a research perspective, and a psychosocial support [6:48] perspective as we increase our education of our patients and our communities about early onset [6:54] cancers. We're seeing patients with early onset breast cancer, colorectal cancer, gynecologic [7:01] cancers, and really across the spectrum of cancers. So it's been quite striking. [7:06] Dr. Svendran, as I'm hearing Dr. Geary talking, and I think about cancer patients in their 40s [7:12] and under. [7:13] In their 30s, in their 20s. That's a very different population than we're used to, [7:18] than the stereotype. But I also imagine caring for those people is very different. [7:22] Yeah, it is. I mean, we often think about cancer being a disease of older people, [7:28] right, over the age of 65. [7:30] What grandpa gets. [7:31] Yeah, what grandpa gets. And so I think what's hard is shifting the mindset of both health care [7:37] providers and patients and people, you know, every day of thinking that cancer can happen, [7:43] to them, right, no matter what, no matter the age. And what we're seeing is that even though we [7:48] still see grandpa getting cancer, that 40% of cancers are actually happening to people under [7:55] the age of 65. And we heard it today, right? Like, people are living their lives, they feel the best [8:00] that they've ever felt. They're not thinking about things like, you know, am I eligible for screening? [8:06] Do I have a risk for cancer? How is my lifestyle sort of affecting my risk of cancer? And then when [8:13] that symptom happens, something maybe like bleeding, there are a thousand other reasons, [8:18] right, why that could be. [8:19] So easy to explain it away. [8:20] So easy to explain it away. And so I think what's really important, all of us as a community, [8:25] is to really understand that the shift is happening, that, as we said, 40% of these [8:29] cancers are happening under the age of 65. And we really need to reframe how we talk to younger [8:36] people in their medical appointments, through the media, and really getting to people to understand [8:41] that they have that same cancer risk. [8:42] Dr. Geary, [8:43] the glaring question here is, if we are seeing this rise amongst younger people getting cancer, [8:50] what is driving this? There's obviously something that has changed in our world, [8:55] or in ourselves, or some combination of it. What are the leading theories as to what's going on here? [9:00] Yes, this is a key question that we are asked quite often, [9:06] and it's likely a multifactorial reason, or multiple factors coming together to [9:15] explore and to understand and better define what is contributing to this rise in early onset cancers. [9:22] Some of these are, for example, things like environmental factors or dietary changes. [9:30] Where this is coming from is that there has been research that's looked at birth cohort effects. So [9:35] when we think about generations that were born, for example, Generation X, and more recently, [9:41] the rates of early onset cancers have gone up, [9:45] from those generations compared to generations before, such as the baby boomer generation. [9:49] And so we think what changed in the lifestyle patterns with Gen X and more recently, [9:57] and we think about things like ultra-processed foods, potentially more sedentary lifestyle, [10:04] rising rates of obesity. And so we think about what are the ways that those types [10:09] of environmental or lifestyle factors could have influenced the development of early onset cancers. [10:15] Many of these things can, for example, influence biological factors such as the gut microbiome, [10:21] which are the healthy microbes in our gut that are really there to help develop an immune defense [10:29] against cancers, and really keep this tumor immune defense in check. And so, if the gut microbiome is [10:37] altered, that can certainly lead to, there's some lines of evidence and research about how that can [10:44] be influencing cancer disease. And so, that's a great question. And I think it's a great question. [10:45] development. There's also these underpinnings of understanding that there might be some genetic [10:51] basis. This may not explain the rise of cancers, but there could be genetic underpinnings as well, [10:58] in addition to these lifestyle factors that could be involved in terms of potentially contributing [11:03] to this rise in early onset cancers. So likely there's not going to be one smoking gun, but a [11:08] mix of factors. And then we have to think about this individually on a patient by patient basis. [11:13] And given that we do have this circumstance of a myriad of factors, as Dr. Geary is describing, [11:20] what do you tell people as far as prevention? I mean, if someone comes to you and says, [11:23] I've read about this, I see that this is going on, what can I do in my own life [11:28] to potentially protect myself? What do you tell people? [11:32] Yeah, it's a great question. I think Dr. Geary brings up really important points, [11:35] which is that there are what we call modifiable risk factors that can help with prevention [11:41] against cancer. So some of those modifiable risk factors are, for example, [11:43] we brought up are, you know, we don't need to smoke, right? We know that smoking is implicated [11:49] in many different kinds of cancers. We know that obesity is linked to many different types of [11:55] cancers, causes inflammation in the body. So thinking about, you know, how can I get moving, [12:00] active lifestyles? How can I be intentional about my diet? So we talked about ultra processed foods, [12:07] red meats, alcohols that increase the risk of many different types of cancers, [12:11] including colorectal cancer, which is- [12:13] Alcohol. [12:13] Yeah, today. And so being thoughtful about what we actually put in our bodies. We only get one, [12:20] right, body. And so being really thoughtful about our fruits, our vegetables, our lean meats, [12:26] our whole grains. And then really making sure that we are aware of screening, right? So that we know [12:34] based on our risk, whether that's our genetic risk, or if we have other medical conditions, [12:41] when is it the right time to get screened? [12:43] And Dr. Giroux, how do you counsel patients about that with regards to screening? If someone comes [12:47] to you and says, I'm worried, I may have a family history, I may not. What are the types of [12:53] screenings that are available that might give people a better insight into their risk factor? [12:59] Absolutely. It's such an important question because we commonly get asked, how would I [13:05] know that I should be screening at a younger age? And so we spend a lot of time talking with [13:12] not only our patients and our healthcare patients, but also our patients and our healthcare patients. [13:14] But our communities about what is the current guidance about who should be getting screened at a [13:19] younger age? So some of that information goes back to knowledge of family cancer history. [13:24] That's a really powerful tool to think about what age to start screening, but also to potentially [13:31] consider genetic testing based on family history of cancers. So for example, if I were to have a [13:39] mother that had colon cancer, say that was diagnosed at age 45, what would I do? I would [13:44] be recommended just by that family history alone to start my colonoscopies starting at age 35, [13:50] 10 years prior to having a first degree relative diagnosed with colon cancer. There can be some [13:57] similar guidance, for example, for breast cancer screening based on usage of risk models, which [14:04] can factor in family history and other types of risk factors for a woman and calculate a lifetime [14:10] risk for developing breast cancer. And if the lifetime risk is over 20%, then the risk factor [14:14] is 20%. And there's a family history. There can also be recommendations to start breast cancer [14:19] screening at a younger age, not only with mammograms, but also adding in modalities like [14:24] breast MRI. So it really can change the strategy and the age of beginning cancer screening for some [14:31] of these common cancers to the ones that we've been talking about, colorectal cancer and breast [14:36] cancer. But also this information can be brought to a person's doctor and really help to inform [14:44] whether a person's cancer is a cancer or not. So that's a really powerful tool to think about. [14:44] If a person meets guidelines for genetic testing. If genetic testing is pursued and there's a genetic [14:51] mutation identified, for example, in a gene such as BRCA, which many people are aware of, [14:58] linked with hereditary breast cancer and ovarian cancer, prostate cancer for males. For example, [15:05] breast cancer screening could be recommended to start in a person's 20s. Similarly, [15:10] for a cancer syndrome like Lynch syndrome associated with hereditary colorectal cancer, [15:15] and multiple other cancers associated with Lynch syndrome, colonoscopies would be recommended to [15:21] start in a person's 20s. So these are some of the ways that we really want to bring education about [15:27] soliciting family history information and also strategies to do that because that can be a complex [15:33] conversation, can be difficult to initiate. And so we're really giving communication strategies for [15:39] our communities and our patients to initiate those conversations and then empower our communities to [15:45] bring that information to your doctors. Dr. Sivendran, if one of my colleagues asked [15:49] me about this, she said she had done genetic screening and she got the all clear. She didn't [15:53] have any markers there. She thought then, does that mean I'm okay that I don't really have to [16:00] worry about this? Like how much faith should people put in a possible successful test, [16:05] quote unquote successful? Yeah, that's a great question. So [16:08] genetic testing is really important. And I think Dr. Geary really nicely described in these [16:14] populations, [16:15] or these families that have increased risk, right? So your mother had colorectal cancer, [16:20] or a sibling had a cancer. But at the end of the day, there are other risk factors other than [16:28] hereditary risk factors that can cause cancer. So it's not an all clear, right? So we know that, [16:33] for example, in breast cancer, one in eight women are going to get breast cancer, [16:36] regardless of family history, right? And so it still goes back to genetics is one part of it. [16:43] And especially when we're thinking about young, [16:45] people with cancer. But then there are all those other risk factors that we talked about, [16:49] nearly half of which are potential causes for cancer, right? So those lifestyle factors. [16:55] And so understanding that cancer can still happen to you and that getting that sort of [17:00] clean genetic test doesn't mean that you can't get cancer. [17:03] Got it. Dr. Geary, given that colorectal cancer is such a big part of early onset cancers, [17:11] what are the symptoms that people ought to be looking at? We heard Laura Benke, [17:15] for example, saying, you know, I was pregnant, I thought it was a hemorrhoid and she kind of brushed [17:21] it off. What are the other things that people ought to be looking out for? [17:26] Yes, absolutely. And this brings this point forward about symptoms that a person can [17:32] experience and, you know, to take seriously and bring them to your doctor. So, for example, some [17:39] symptoms that could be related to colorectal cancer include things like blood in the stool, [17:47] pain that seems to be persistent and unresolved by trying conservative measures like changes in [17:53] diet or increasing fiber, long lasting constipation that doesn't seem to be resolving or any change in [18:01] bowel habits that doesn't seem to be improving over time. Some other conditions can be things [18:07] like anemia that could be picked up, let's say, from blood work, and that could be related to very [18:16] slow blood loss. [18:17] In the bowel, and that could be related to a polyp or a tumor, but needs to be evaluated when [18:24] there is newfound anemia. And then some other symptoms such as prolonged unexplained fatigue, [18:31] particularly if it's linked with any of these symptoms, [18:35] weight loss that's unexplained, you know, symptoms like this, [18:39] really that need to be taken into account and brought to your doctor, particularly if they are [18:46] new onset for some of them, but also that don't resolve over time. And that's a big point that we [18:51] bring up to our patients in our communities is that we don't want anyone to feel that this is not [18:59] taken seriously. Continue to seek out medical advice from trusted providers until you are able [19:07] to achieve, you know, some solutions, some ways forward with these symptoms and evaluation. [19:12] Right. Dr. Savendran, when I was talking to Laura Behnke, she came to me and said, you know, the [19:15] she kept saying, please tell people to look at their poop. [19:19] And part of what she was pushing back on [19:21] is just the stigma around this. [19:22] I mean, when you are young, as you were saying before, [19:25] it's so easy to brush this off, [19:26] to think I have a stomach ache, [19:28] it's probably gonna be nothing. [19:30] But there is a sort of a wall of denial [19:33] and stigma around some of this that we have to push through [19:35] to get younger people to pay attention to this. [19:38] Yeah, I agree with you. [19:40] I mean, it is so easy to blame it on something else. [19:43] And this is a generation, [19:45] as we think about Gen X and millennials [19:47] that probably have kids of their own, [19:50] are potentially taking care of older adults, [19:52] older parents, are working. [19:55] They feel tired. [19:56] I feel tired, right? [19:58] They feel tired. [19:59] And so it's really easy to blame it on hemorrhoids [20:03] or blame it on something else. [20:05] And I 100% agree, like look at your poop, right? [20:09] If you feel a lump in your breast, don't ignore that, right? [20:12] If something doesn't seem [20:15] right, you know your body the best. [20:17] It's really important to bring that up. [20:19] And it kind of goes back to, [20:20] it's really important to regularly see your doctor, [20:23] to have the kind of relationship [20:25] where you feel like you can bring that up. [20:27] And then to also, [20:28] just going back to that screening part again, [20:30] to understand when is the right time for you to screen. [20:33] So when we think about colorectal cancer, [20:35] it always strikes me, so the average risk person, [20:37] so we've been talking about kind of special populations, [20:40] but the average risk person should start their screening [20:44] at the age of 45. [20:45] And that's a change. [20:46] It used to be 50. [20:47] And I think that that's still, [20:49] that sort of idea that it's 50 still exists out there. [20:52] You're 50, you get gray hair, [20:54] then you get a colonoscopy. [20:55] Is the gray hair coming? [20:56] No, yeah. [20:57] So, but it's 45 now, right? [21:01] And we, and people seem to be surprised about that. [21:04] And so we need to continue to push that message [21:08] that cancer is happening in younger people. [21:11] Get your mammogram, get your cervical cancer screening, [21:15] think about HPV vaccination, [21:18] get your colon cancer screening, [21:21] whether that's a stool-based test or that's a colonoscopy, [21:24] and pay attention to your body. [21:27] Dr. Geary, we have about a minute left. [21:29] Let's say someone does test positive for cancer, [21:33] that lingering suspicion in their mind gets tested, [21:37] they have it. [21:38] Have we gotten better at treating these cancers [21:41] amongst young people? [21:42] Are they different than older people? [21:44] Like, how, how would you say, like, how would you say, like, [21:45] how worried should people be [21:47] if they, if they get one of these diagnoses? [21:51] Yeah, you know, the, the key is, [21:54] when these cancers are caught early, [21:55] for example, colorectal cancer or breast cancer, [21:58] the cure rates are incredibly high, [22:01] particularly for early stage cancers. [22:03] They are curable. [22:05] And so the point is, [22:06] if we can catch these at a curable point, [22:09] the, the outcomes are amazing. [22:12] The, the challenge that can happen is that, [22:16] because it's a younger population, [22:18] and to what Dr. Suvendran talked about, [22:20] is that they may be not aware that, you know, [22:23] somebody should be getting screened at a younger age, [22:25] or even getting that colonoscopy [22:27] at a population level guideline at age 45, [22:31] the issue becomes that, potentially, [22:33] the cancer is caught at a later stage. [22:36] And when the cancer is caught at a later stage, [22:38] it becomes tougher to treat, [22:40] and there's a higher chance that it could spread. [22:44] So as much as we can, as much as we can, you know, [22:46] devote time and energy [22:48] to currently thinking about public awareness [22:50] about who should be getting screened at a younger age, [22:53] that will be incredibly important [22:55] to be able to catch these cancers at a curable point. [22:58] Great. [22:59] Such an important conversation. [23:00] I want to thank you so much, Dr. Vedagiri, [23:02] at the Early Onset Cancer Center at Yale, [23:05] and Dr. Shanti Suvendran from Penn Medicine. [23:08] Thank you both so much for being here. [23:12] Before we leave, [23:13] we heard earlier from actor James Van Der Beek, [23:15] who, as he was dying, talked publicly, [23:18] about his cancer, [23:19] trying to warn his generation of this threat. [23:22] And it reminded us of another young actor [23:25] who did the same thing many years ago, [23:27] but in a very different environment. [23:30] The gold ship, lolly pop. [23:34] Shirley Temple, later known as Shirley Temple Black, [23:39] started her acting career at the age of three. [23:42] With her iconic ringlet curls, [23:44] she sang and tapped and charmed her way [23:47] into Hollywood history. [23:49] Hi, did I hear you spinach? [23:53] After showbiz, Black pivoted to politics, [23:56] inspired by actor-turned-governor Ronald Reagan. [23:59] She ran for Congress, did a stint at the UN, [24:02] and served as U.S. ambassador to two different nations. [24:06] But in 1972, after performing a breast self-examination, [24:11] and this was well before that became common practice, [24:14] she discovered a lump in her left breast. [24:17] This was a very different era, [24:19] both in how the medical establishment treated women, [24:22] but also in how we treat women. [24:23] This is when we talked about breast cancer. [24:26] As recounted in Siddhartha Mukherjee's book, [24:28] in the 1950s, the New York Times refused to print an ad [24:33] for a breast cancer support group [24:35] because it had the words breast and cancer in it. [24:38] An editor reportedly suggested it be referred to [24:41] as diseases of the chest wall. [24:45] Even in the 1970s, amid feminism's second wave, [24:48] it wasn't uncommon for a woman like Black [24:51] to be told she was getting a simple biopsy, [24:54] only to wake up and find the surgeon had instead [24:57] given her a radical mastectomy, [25:00] removing her entire breast and muscles and lymph nodes [25:03] without her consent. [25:05] Shirley Temple Black was having none of that, [25:08] famously saying, [25:10] the doctor can make the incision, [25:12] but I'll make the decision. [25:15] Days after her lumpectomy, at the age of 44, [25:18] Black called reporters to a press conference [25:20] in her hospital room. [25:22] Sitting in her bed, Black broke the taboo, talking openly, [25:25] personally, about her diagnosis, her treatment, [25:28] and urged other women to pay attention [25:31] and get medical care if they had symptoms. [25:34] She admitted she had to do some soul searching [25:37] before talking publicly about what was then [25:39] still such a fraught topic. [25:42] She said, quote, [25:43] there was no reason anyone else should know, [25:46] but being open about it just may help other people. [25:51] That is it for this episode of Horizons. [25:53] You can find us on YouTube [25:55] and wherever you get your podcasts. [25:56] See you next week.