“Today I deal very frequently with cases of 40 year olds or younger with various types of different tumors. Tumors that are not typical of young people.” This was explained to Adnkronos Salute by Giampaolo Tortora, director of the Comprehensive Cancer Center of the Gemelli Polyclinic in Rome. “Those who work as clinicians don’t see the numbers, but the patients who come into the clinic. I have been an oncologist for almost 35 years and I can say that 15-20 years ago I didn’t see any 27-28 year olds with pancreatic cancer“.
What increases in this age group, under 40, “are typical adult tumors”. “We oncologists have these patients in front of us. We will understand exactly how much the phenomenon affects in epidemiological terms when we have larger numbers or a broader trend, but the specialist must worry and must investigate now because it is happening now”.
The expert starts from his personal experience as a doctor to launch an alert and delves into the reasons why the Capitoline structure has decided to engage in a project called ‘G-Aya’, dedicated precisely to tumors in adolescents and young adults, to patients diagnosed with oncological disease between the ages of 15 and 39. A sort of “maxi-container where studies that explore multiple aspects come together, from the epidemiological to the social to the technologically advanced genomic, to create a large 360-degree observatory and database on tumors in those under 40”, summarizes the expert, highlighting the urgency of tackling such a job. In fact, more and more studies report an increase in diagnoses in this age group, in particular some types of neoplasms which generally arise in a more advanced stage of life. What is the real range? We are working on epidemiological data, Tortora points out.
The increase in cases among those under 50
“The Italian epidemiological observatory makes normalized calculations for age, early diagnoses and so on, and highlights that the trends do not seem very dangerous. But in a recent analysis by the University of Edinburgh and a Chinese university the numbers were anything but comforting, noting an increase of almost 80%” in cancer cases among the under 50s globally over the course of thirty years.
“And since we also see tumors linked for example to the digestive system, therefore an increase in those of the colon or pancreas, nutrition must also come under scrutiny. In addition to smoking, alcohol, the increase in overweight and obesity, further predisposing factors, in turn bringing with them diabetes and some metabolic diseases. Recent work indicates that there has been cellular aging of the population, a worsening of the biological age of the current 40-50 year olds, which emerged from a comparison on 9 parameters between those born in the 1950s and those born in subsequent years. Cellular aging classically predisposes to a greater number of mutations and, therefore, increases susceptibility to cancer”. In short, a series of aspects are emerging. “We must try to connect the dots.” And this is the reason why Tortora launched also “an appeal” to colleagues.
Work at a Case Observatory
“If I’m seeing an age group in the clinic that I’ve never seen before, I have to point it out and ask myself questions,” he reasons. His message is: “Shine a spotlight on these cases, because we could make a national database. Collect data to get a little more precise information, and if there is profiling, note it. We must go beyond observation on a single case, otherwise everything else escapes us. And if those who work in smaller institutions cannot do it”, cannot face systematic collection and analysis, “then send the data to a larger collection center”. A common effort is needed, is the invitation.
“In our reality we have started working on the colon, on the pancreas – he lists – we are collecting data, but with the G-Aya project we aim to have an increasingly precise database with reliable numbers”. The Aya (Adolescents and Young Adults) chapter “has already been developed by the US National Cancer Institute, this has become a sensitive area in all cancer centers around the world, not only because there is a trend of increasing tumors in young adults, but also for the need to increase the level of awareness among young people, beyond whether or not they can participate in oncological screenings”, which perhaps start from an older age. At Gemelli, as part of the project which is also being developed with young specialists, such as the gynecologist Inge Peters, multiple lines are being followed. “We try – explains Tortora – to intercept any genomic alterations that may predispose to the development of tumors”.
“We – he continues – today know that in general, in less than 10% of cases, hereditary-familial responsibility is identified. The remaining 90% are alterations acquired during life. With the genomic profiling that is being carried out we can go further in depth, and identify alterations that could play a role in predisposing those young people to the development of tumors. We want to study the genes with the modern technologies we have now, of Next Generation Sequencing (NGS)”.
“We are using all the tools we have available – assures Tortora – from mapping the type of tumors we see to identifying factors that can be an obstacle for those who have had the tumor, therefore also with a social perspective. We want to study well and follow up over time those who have already had a neoplasm, which would also allow us to intercept any second tumors earlier and also understand what lifestyles can expose young people to this oncological risk forward with Giovanni Scambia, scientific director of Irccs and colleagues”, and “there are a thousand implications”.
“There is also a European project, and we are linked to this European project on cancers in young adults”, he explains. How does the observatory under construction work? The institute’s patients under 40 “automatically, for demographic reasons, enter our databases. Furthermore – he recalls – we had already been working for two years on what we call ‘Early Onset Cancer’, that is, precisely those tumors that arise early and that we usually saw more frequently in adults. We were studying them with very advanced computer technologies, machine learning, with the whole group of bioinformaticians, to try to understand what is different about a 25 year old boy who is not familiar, does not have a syndrome. Lynch syndrome or other clearly predisposing elements, but develops colon cancer. We hope to have answers to questions like these as soon as possible.”
How important is lifestyle
Lifestyle matters, from an early age and can turn into an uncomfortable burden in the future – if you make wrong choices. How much and how this aspect affects the increasing cases of cancer among the under 40s is becoming increasingly clear. Sedentary lifestyle, increase in obesity and overweight, bad habits that don’t even spare the table. “We felt the need at this moment to focus on this population, to have an observatory also aimed at the social aspects, therefore the future of these patients, the construction of their careers, the difficulties they encounter”. But they wear it lifestyles are also under the lens “compared to the phenomenon we are observing”. And we are drawing the attention of young people who get sick early and who do not have hereditary-familial susceptibility genes to this. They must have somehow acquired the mutational load that led to the tumor.”
“And in addition to professional exposures”, in the workplace, which in young people will not have such a preponderant role, “there must be something else – reflects the expert -. We think that lifestyles are responsible. We consider that from the 90s onwards there has been an acceleration in processed industrial foods, in the use of sugars, sugary drinks and junk food. A reduction in the quality of nutrition has been observed, “and in the end all this, combined with other elements, must have an impact”. It’s an effect that can be seen from a long distance. This is why, observes Tortora, “we need to go to primary schools to talk to students”.
“What would I say to the kids? I’m doing it in various circumstances, I invite them to be more demanding with their parents too. It must be the kids, the children, who return home to convince them of the importance of healthy food choices, for example.” Education from below. And from the first years of life. “In England they have launched this very strict campaign on the ban on smoking up to 18 years old.” There are those who object that “protectionism can stimulate violation of the law. Ok, but in the meantime I as a State are sending a message”.
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