Raquel Campoy found out she had cancer one day after giving birth to her second daughter. Her chest felt hard and, after an ultrasound and biopsy, the gynecologist announced to her during the same admission for delivery that it was something bad that had to start treating “as soon as possible.” That “something bad” was metastatic breast cancer. He was 39 years old and another 18-month-old child was waiting for him at home.
His case, diagnosed in 2020, responds to a new profile of patients who did not usually attend oncology consultations so regularly. Those who treat the disease have the perception that they see more and more people under 50 years of age. And it’s not just a feeling. The studies that have been published so far on the matter confirm this with scientific evidence. An investigation collected by BMJ Oncology A year ago, the increase in the incidence of early-onset cancer stood at 79.1% between 1990 and 2019, with a growth in the number of deaths for this reason of 27.7% in the same period.
The last one appeared a few weeks ago in The Lancet Oncology and concludes that the incidence of colon cancer (the most common) has increased in young patients in many Western countries. New Zealand and the United Kingdom register, along with Chile and Puerto Rico, the most pronounced increases in a group of 50 countries. In 27 of them there are increases, according to the analysis of data from the World Health Organization. The authors warn, in an attempt to point to the causes, that the “global reach of this alarming trend demands innovative tools to prevent and control cancers related to nutritional attributes, physical inactivity and excess body weight, which could be more difficult to address than the tobacco epidemic.”
According to this study, Spain is currently saved from the trend that keeps the medical community in suspense, although different oncologists consulted by this medium assume that it is a matter of time before the number of cases ends up escalating. And in fact they are already seeing it in some hospitals. “The data is from 2017 and the perception of both myself and other colleagues is that it is already rising in Spain. The case mix, at least in the two Madrid centers where I have worked, is a peak in incidence, especially in the last two years,” says Raquel Fuentes, a medical oncologist at the Jiménez Díaz Foundation specialized in colorectal and family cancer.
In addition, there are very precise provincial registries in Spain, such as that of Granada, which confirm that the number of cases in all types of cancer has grown by 0.8% in men and 2.5% in women between 1985 and 2018. The largest increases were found in lung cancer (5.1%) and thyroid cancer (3.7%) for women. In men, thyroid diagnoses grew by 10.2% and testicular cancer by 7.8%, according to data shared at the last congress of the Spanish Society of Epidemiology, where there was a specific presentation on the epidemiology of the cancer in the young population.
The puzzle of causes
“We have the fly behind our ears because cancer is a disease whose probability increases as age increases, it is associated with aging,” explains María José Sánchez, professor at the Andalusian School of Public Health and director of the Institute of Biosanitary Research of Granada. Now, Sánchez emphasizes, it is a priority to “investigate the causes (etiology), not just record the cases.” “Collect information about healthy people related to lifestyles and be able to follow them over time to see who develops the disease and at what ages.” The Spanish Cancer Registry Network is working to confirm these trends and, says Sánchez, there will be results in 2025 with the available data. In Spain there is no monitoring in all territories. Less than 30% of the Spanish population is covered by the registries that exist in different communities and provinces.
“We have more and more patients under 50, 40 and even 30. We have seen this especially in the last five years,” says Ángela Lamarca, member of the European Society of Oncology and part of the same team as Fuentes at the Jiménez Foundation. Diaz. The oncologist warns that what is “most worrying” is that there are more diagnoses in “advanced disease states.” The scientific community wonders if they are more aggressive or detected later because no one assumes as a first hypothesis that a specific symptom is associated with a cancer diagnosis in one’s thirties.
We don’t have much of an idea either. We know that we are transitioning towards a lifestyle with low physical exercise and higher calorie diets, more obesity… That could be a hypothesis, but it is still more of a speculation.
Josep Maria Borràs, director of the Catalan Oncology Plan
More aggressive?
Some studies, says Fuentes, already delve into the fact that these young tumors “respond worse to treatment and have worse survival.” In colon cancer, he continues, some molecular differences have been observed depending on age. But not in all of them.
“For example, in the pancreas we have not seen too many differences at the genetic level. And if they are not always so different, why this increase? It is a little difficult to know if they are more aggressive or if this greater aggressiveness is associated with a later diagnosis; the relationship is not so simple,” adds Lamarca. One of the problems, several of the doctors consulted agree, is that doctors do not think about a disease like cancer in such young people. And that young people themselves do not give importance to their symptoms – if there are any – for the same reason: it is a pathology that does not affect that age. “Additionally, sometimes the signs are more latent, they are less visible,” says Fuentes.
“We also don’t have much of an idea why it’s happening. We know that we are transitioning towards a lifestyle with low physical exercise and higher calorie diets, more obesity… That could be a hypothesis, but it is still more speculation,” admits Josep Maria Borràs, scientific coordinator of the Cancer Strategy of the National Health System and director of the Catalan Oncology Plan.
It is known that there are factors that can cause a cell to go crazy and mutate to form a tumor, such as smoking or obesity, but cases do not always respond to these reasons. “We think that part of the key may be, at least in digestive cancer, in the microbiota, which are the set of bacteria that are formed in the intestine throughout life and that can favor or disfavor the formation of tumors. There are floras that are more pro-oncogenic and others less so,” says Fuentes. In the case of colon cancer, the percentage of cases in young people that respond to a family history, that is, that can be explained by a genetic factor, is higher (between 15 and 20%) than in diagnoses in older people. (between 5 and 10%). Another complementary hypothesis (the experts do seem to be clear that the phenomenon is multifactorial) is that more is detected because there is more diagnostic capacity, says Borràs.
“People think it’s your turn to be 70 years old and you’re not”
Cancer in younger people, in addition, “has implications that do not occur in older patients.” Lamarca cites a few: they affect productive people, at a time of personal and professional growth, and in some cases with young children. “This requires a new specialization, not so much in oncology but in the multidisciplinary group that treats the person. Now we have to cover aspects that were not discussed as much before, such as the economic fragility in which these patients remain,” the oncologist explains.
Virginia Gil was 39 years old when she was diagnosed with a rare tumor on her cervix. The cytology from a year earlier had been “perfect”, but she started having hemorrhages at Christmas 2019. The appointments she had in March were canceled due to confinement and two months later, when she was finally able to go to the gynecologist, the surprise came. : a stage 2B, a large tumor. “At first I wondered how it could be, how it was possible, if I was going to die. “That is the first association you make,” says Gil on the other end of the phone, who after a first effective treatment had a metastasis in the perineum.
Since then he has participated in different experimental trials in the advanced therapies unit of the San Carlos Clinical Hospital – financed by the CRIS Foundation against cancer – that keep the disease under control. “I get an intravenous treatment every 21 days that doesn’t hurt me as much as chemotherapy, but my quality of life compared to before is a shadow. I am on my way to five years of uninterrupted medication and I look like an old lady in terms of energy,” she describes. He worked in a supermarket but has been disabled for a long time.
Alberto Ocaña is the director of the unit that treats Gil, where therapeutic options are offered to patients who have failed more conventional treatments. “Here we see more and more young patients with aggressive tumors,” he confirms, and points to another possible cause in a million. “Patterns of reproductive behavior are changing. Before, women had children, which constitutes a prevention for breast cancer.”
“People think that this is going to happen to you when you are 70 years old and it isn’t. We continually see cases of breast cancer in young girls. “18 women die in Spain every day just from this type of cancer,” says Raquel Campoy. In the metastatic patient groups, she has met very young women who are left with “a ridiculous pension” because they have barely had time to work and are already completely disabled. “Personally,” Campoy shares, “I try to work on being here and now. There are moments of testing that make you feel down, but I try to think about the positive things I have: that I feel good and in the last three months the check-up has gone well and I shouldn’t be worried. If I went ahead I wouldn’t live, mentally I would have died.”
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