In just a few short years, the face of some cancers has seemingly changed. Diseases that were once associated with older people are all of the sudden striking more young people than you may expect. Three cancers in particular have concerned health officials for their unexpectedly young targets.
Experts have noted a surprising shift in colorectal cancers. According to a study published in the “Journal of the National Cancer Institute,” colon cancer incidence rates in 20- to 39-year-olds have gone up by 1 to 2.4 percent every year since the mid-1980s, and rectal cancer incidence rates increased 3.2 percent annually between 1974 to 2013 in 20- to 29-year-olds.
Two other cancers have also had a surprising increase among younger people. While rates of mouth and throat cancers have declined over all, they’re actually on the rise in young adults, and young women between the ages of 15 and 34 have been hit especially hard. And although the rate of cervical cancer among young women in the United States continues to be low (an average of only 14 cases per year among those ages 15 to 19, and 125 annual cases among those ages 20 to 24), these cancers are often less detectable by traditional screening (routine Pap tests) because they’re often more aggressive and develop quickly in the window of time between tests.
So why are millennials and Gen Xers suddenly dealing with diseases once thought to affect mainly older generations?
Why These Cancers Are on the Rise
At the root of several of these cancers is one common culprit: human papillomavirus (HPV). The virus is a known cause of cervical and oral cancers, as well as some vulvar, vaginal, penile, anal cancers and more. According to the Centers for Disease Control and Prevention (CDC), of the 38,793 cancers that occurred each year in the US in body parts associated with HPV (like the cervix) between 2008 and 2012, about 30,700, or 79 percent, could be attributed to HPV.
“Cervical cancer is caused overwhelmingly by HPV infection,” says Malcolm Thaler, a primary care physician at One Medical in New York City. “And the majority of head and neck cancers, which in the past were due almost entirely to smoking and alcohol, are now caused by HPV infection as well. The incidence of these cancers thus rises and falls with the rate of HPV infection. And HPV is largely sexually transmitted, so there's a pretty straight line from increased sexual activity to increased cancer risk.”
HPV is the most common sexually transmitted infection in the US. According to a study published in the “The Journal of the National Cancer Institute,” people with HPV-positivethroat cancers tend to have had many oral-sex partners, compared with people with HPV-negative throat cancers who are more likely to be heavy drinkers or cigarette smokers.
“Cancers of the oral cavity and pharynx that are associated with HPV are increasing,” says American Cancer Society researcher Rebecca Siegel, noting that the other 60 percent of these cancers not associated with HPV are actually decreasing. “The increase in HPV-associated cancers in the oral cavity is thought to be due to changes in sexual practice.”
While experts can make a confident connection between HPV and cervical, oral, and throat cancers, not all of these cancers are so easy to explain. “Reasons for the increase in colorectal cancers in ages under 55 are unknown,” Siegel says. But increased obesity and a sedentary lifestyle are likely contributing to the trend.”
In a recent study, Siegel and a team of researchers reported that nearly one-third of rectal cancer patients were under age 55, and in another study, researchers found that the demographic characteristics of patients below age 50 were different from those who developed cancer later (in particular, a higher proportion of black and Hispanic patients were diagnosed younger).
“Rectal cancers appear to be rising in the US in men and women under the age of 50 years, despite a decline in colon cancer incidence for the same age group,” says Pamela Kunz, MD, medical oncologist, gastrointestinal specialist at Stanford Health Care. “The reasons for the increase are not known, but include increasing obesity and increased consumption of red and processed meats.”
While the rates seem high, it’s also important to keep statistics in perspective. “The increase in colorectal cancer in younger people has caught many people by surprise,” Thaler says. “However, in absolute terms, these numbers are still very very small. For every 10,000 adults in their twenties, there will be just one case of colon cancer and one of rectal cancer each year. Pretty good odds!”
Colon Cancer: Know the Symptoms
Regardless of the relative risk or statistics, Thaler says it’s important for people of all ages to remain aware of warning signs and symptoms, even if screening isn’t typically offered for younger people, as is the case in colorectal cancer.
“Screening is still not standard for men and women under age 50; though this may change with increasing incidence of rectal cancer,” Kunz says. “Signs and symptoms for cancer are similar regardless of age or gender and include rectal bleeding, abdominal pain, and/or a change in bowel habits (including narrowing of stools, constipation, diarrhea). If these signs or symptoms occur, a colonoscopy is recommended. For patients with a family history or inherited predisposition to colorectal cancer, screenings start earlier.”
Even if screening is still a way off, certain signs and symptoms can suggest a call to action. “Any person of any age who develops rectal bleeding or a significant change in the color or caliber of their stool should see their health care provider,” Thaler says. “The vast majority of these cases will prove to be completely benign disorders such as hemorrhoids or irritable bowel syndrome, but it is prudent to at least get checked out. Certainly if these symptoms persist or are accompanied by weight loss, a visit to your local clinician should not be postponed.”
Cervical Cancer and HPV Screening
When it comes to HPV-related cancers, there are some routine recommendations that can save lives.
For cervical cancer, routine Pap tests can allow doctors to identify abnormal cells on the cervix and remove them before they develop into cancer. The Pap test is among the most reliable and effective cancer tests available. It is recommended for all women between the ages of 21 and 65, and if results are normal, it can be repeated once every three years. However, if unusual signs or symptoms develop, women are encouraged to see their doctors right away, even if they’ve had regular Paps. While early cervical cancer typically doesn’t cause any signs or symptoms, as the disease advances, it can cause unusual vaginal bleeding or discharge.
Cervical cancer screening includes both the Pap test and HPV testing. While the Pap looks for abnormal cells or cells that have already developed into cancer, HPV testing looks specifically for HPV infections that can cause cells to become abnormal. HPV testing is recommended along with the Pap for all women between the ages of 30 and 65.
Unlike cervical cancer, there are no approved tests to find early signs of mouth and throat cancers. That makes prevention crucial.
The Keys to Prevention
When it comes to preventing oral and cervical cancer, the key is to target HPV. While there’s no cure for HPV, according to the CDC, vaccination could prevent most cancers and other diseases caused by the virus, such as genital warts.
There are currently three FDA-approved vaccines available to prevent HPV infection: Gardasil, Gardasil 9, and Cervarix. The vaccines are all given in a series of two to three injections over a six-to-twelve month period, and experts recommend beginning the routine at age 11 or 12 (although it can be started as early as age 9). While it’s best to get the vaccine before becoming sexually active, it is approved for women up to 26 and men up to age 21. So it may be possible for some adults to catch up on the HPV vaccine.
Unfortunately, many young people aren’t getting the potentially life saving vaccine. According to the CDC, only 60 percent of girls and 42 percent of boys between the ages of 13 and 17 received one shot in 2014, and only 40 percent of girls and 22 percent of boys finished the entire series.
“We have a vaccine that protects against the most dangerous HPV strains, but not enough young men and women are availing themselves of it,” Thaler says. “If they did, with the encouragement of their health care providers, those cancer rates would surely decrease.”
Other ways to prevent HPV-related cancers is to avoid smoking and limit drinking, which can contribute to cancer risk. And having fewer sexual partners can mean a lower risk of HPV infection. Using condoms and dental dams can help cut HPV exposure somewhat, but not entirely. Finally, keeping regular visits to your dentist can help with early detection, since dentists are often the first to spot oral cancers.
While there is no vaccine to protect against colorectal cancer, diet and lifestyle modifications can help lower the risk. Since being overweight or obese increases the risk of colorectal cancer, maintaining a healthy weight and avoiding weight gain around the midsection may help lower risk. Physical activity and diets high in vegetables, fruit, and whole grains (and low in processed and red meats) are also associated with a lower risk of colorectal cancer. Doctors also recommend avoiding excess alcohol since increased intake has been associated with a higher risk of the disease.
Despite these statistics, with the proper education, awareness, and action, people of any age can reduce their risk of developing cancer.
Selected References
A. Bleyer. Cancer of the Oral Cavity and Pharynx in Young Females: Increasing Incidence, Role of Human Papilloma Virus, and Lack of Survival Improvement. “Seminars in Oncology.” October 2009.
Rebecca L. Siegel, et al. Colorectal Cancer Incidence Patterns in the United States, 1974–2013, “Journal of the National Cancer Institute.” August 2017.
VB Benard, et al. Cervical Carcinoma Rates Among Young Females in the United States. “Obstetrics and Gynecology.” November 2012.
LJ Viens, et al. Human Papillomavirus–Associated Cancers — United States, 2008–2012. Morbidity and Mortality Weekly Report July 8, 2016.
