← All Of It with Alison Stewart
All Of It with Alison Stewart
Why Are So Many Young People Being Diagnosed with Cancer?
00:28:35
Lately, studies have show that rates of cancer are rising among young people, including colorectal cancer, breast cancer, and prostate cancer.
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- [00:00]
Alison Stewart
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Jamie Ducharme
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Alison Stewart
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Jamie Ducharme
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Alison Stewart
Listener supported WNYC Studios.
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Jamie Ducharme
This is all of it from WNYC. I'm Alison Stewart. One study from the medical journal BMJ Oncology found that cancer diagnosis for patients under 50 has increased by 79% from 1990 to 2019. Rates of cancer among young people have been on the rise, breast cancer, colorectal cancer and stomach cancer. But the reason why isn't entirely clear. Joining us now to discuss it is journalist Jamie Ducharme. She's the author of the Time magazine piece titled the Race to Explain why More Young Adults are Getting Cancer. Jamie, thanks for being with us.
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Dr. Tricia Pasricha
Thanks for having me.
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Jamie Ducharme
We're also joined by Dr. Tricia Pasricha, who writes the Ask a Doctor column for The Washington Post. Dr. Pasricha, thanks for being with us.
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Alison Stewart
Glad to be here.
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Jamie Ducharme
Listeners, we want to hear from you. Are you a young person with cancer or young cancer survivor? How did your diagnosis change your life and your plans for the future? What do you wish you had known about cancer before your diagnosis? Or just share what you want about your experience? Our Phone number is 2124-3396-9221-2433, WNYC. You can call in and join us on air or you can text to us at that number. Jamie, when did doctors and researchers start to notice a rise among cancer in younger people?
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Dr. Tricia Pasricha
I would say the research has really reached a critical mass within the last five years or so. But what's interesting is that the trend has been in the works for decades. I mean, something that comes out of nowhere. It takes a long time for cancers to develop and a long time for trends to appear in the research. But there's certainly been a flurry within the past two to five years of studies tracking this really alarming uptick in early onset cancers.
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Jamie Ducharme
Dr. Pasrica, when did you first start noticing this?
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Alison Stewart
I would say in the last five years or so, I started to see more and more cases. My specialty is gastroenterology, so I'm starting to see more and more early onset colorectal cancer. I look back and I think maybe 15 years ago when I was in, in medical school, someone in their 20s or 30s with some bleeding, rectal bleeding, colorectal cancer would not have been the first or even top five things on my differential, things I'm thinking about. But today we have to start thinking about it, and we have to have it in the back of our minds, if not more, because it's just becoming more common.
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Jamie Ducharme
What kind of cancers are we talking about?
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Dr. Tricia Pasricha
There are at least 17 types of cancer that the American Cancer Society says are on the rise among younger generations. So millennials and the generation above, as Dr. Pastricha can probably speak to very intimately, Colorectal cancer is among the ones that are among the most concerning to researchers because there's been a particularly dramatic increase.
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Jamie Ducharme
Did you want to talk a little more about that?
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Alison Stewart
Yeah. Colorectal cancer screening in this country is typically recommended for the person of average risk at age 45 or older. And when we talk about early onset colorectal cancer, we're talking about people who are getting colorectal cancer diagnosed. We usually define it as less than age 50, so younger than that. And we're starting to see this rise among people who are otherwise not necessarily eligible for screening. But one sort of pearl that I hope people keep in mind is that about a quarter of cases of people who are diagnosed with early onset colorectal cancer actually could have been caught earlier if they had gotten screened according to guidelines because they have some kind of family history that actually would have warranted screening before that age 45. So people are not necessarily average risk. They may not know that unless they ask their family members. So we're talking about first degree family members. But it's also important to ask those second degree family members, aunts, uncles, and find out what your family history is, because it could actually be that you weren't earlier onset screening.
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Jamie Ducharme
Let's take a few calls. Let's talk to Amanda calling in from New Fairfield, Connecticut. Hi, Amanda, thanks for calling, all of it.
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Caller
Hi, thank you for having me. Let's hear your story covering this topic. Yeah. So I was 33 and got diagnosed with fertility stage 2B breast cancer. And I found the cancer myself. And I took action, really because of a friend of mine from high school who was 30 and got diagnosed and started to post reminders and just put it in perspective. So it was something that I found myself and I went and took action. And I'm really happy that I did because I'm not sure it was pretty advanced when they caught it. So if I had let it go any further, not sure that I'd be talking to you today, four years out.
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Jamie Ducharme
What was your doctor's response when you went to Your doctor. And you said, I'm not sure what's going on with me.
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Caller
Yeah, they. I went to the gynecologist first, and he took it pretty serious. And he said, you know, I don't think it's anything he said, but you're young and we do take it serious. So I'm going to send you almost immediately to get a ultrasound and mammogram.
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Jamie Ducharme
And that's when they found it.
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Caller
They found it. They pretty much knew that day. They kept me in office to do a biopsy, which usually doesn't happen same day. And I remember looking up at the doctor who was doing the biopsy and saying, so is it like a 50, 50% chance? And she said, I'm really sorry. She said, but you're young and you're going to get through it. And so I knew that day, but I got the call two days later that confirmed that it was breast cancer.
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Jamie Ducharme
Amanda, thank you so much for calling in and sharing your story. Dr. Pasricha. At the same time, cancer rates are rising, we should point out that fewer people are dying of cancer. Why is that?
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Alison Stewart
Well, there's a number of different reasons. I mean, one, our treatments have gotten a lot better, and that's really important. And getting connected to treatment is important. Getting a doctor to take you seriously, as we just heard, is paramount. And what I really liked about that story is how she was her own biggest self advocate in the beginning. And I think you have to be sometimes, because even though I think a lot of us are aware of these numbers and this trend and these statistics, it's somehow just not registering sometimes. And so you really have to push if you're worried about that. I think the other thing to keep in mind is that with younger people, often the cancers are inherently biologically different in these early onset cancers. Right. So they tend to be a little bit more aggressive. They're caught a little bit later. And that goes for breast cancer, as it goes for colorectal cancer screening. And some of it is, yes, possibly it's because, you know, there's a little bit of a delay in seeking treatment or getting the kind of diagnosis. But there is something a little bit that we found across multiple different cancers that's a little bit biologically different about these cancers that really warrants early and aggressive intervention. But people tend to do pretty well.
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Jamie Ducharme
Let's take another call. Let's talk to Peter, who's calling in from Queens. Hi, Peter. Thank you so much for making the time to call all of it.
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Caller
Hey, great to see you Great topic. I got prostate cancer symptoms when I was 41. My uncle and father both had it, but they didn't test me. They said I had benign prostatitis. Finally I was told at 44, oh, we were wrong, you have cancer and I'd have surgery. And now it's back and, you know, they're very, like, light about it, like, not a big deal. It's prostate cancer. Just go get the treatment. You'll be cured. And I'm not cured. It's come back and people die of it. My friend's dad died of it 49, two months ago. I just want to say that there's a company called mailcare.org that doesn't take any money. It just provides educational support. And they saved my life by getting me to the right doctors to get me an mri, get a biopsy, get diagnosed and get surgery. And I don't know if I'll be alive in 10 years, but I hope so.
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Jamie Ducharme
Peter, thank you so much for sharing your story. Let's talk to Steven from Armont. Hi, Steven, thank you so much for calling all of it.
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Caller
Hi.
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Alison Stewart
So my question is, has the research.
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Caller
That'S been done shown any correlation, any.
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Jamie Ducharme
Type of directly proportional aspect to the.
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Caller
Level, the levels of plastics and exposures.
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Alison Stewart
To plastics and all the residual chemicals that are far more present in the last 15 to 20 years?
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Jamie Ducharme
We're going to let Jamie take that. That was in your story.
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Dr. Tricia Pasricha
Yes, it was. And thank you for the question. I will start with the disappointing news that there is no conclusive proof of what is driving this uptick. It is still very much a topic of active research. However, plastics and microplastics are among what I would call the leading hypotheses about at least part of the uptick in cancers. I spoke to several researchers who believe that the timing makes sense. In the same amount of time that we've seen early onset cancers increase, we have also seen the proliferation of microplastics in the environment. And they believe that that is more than a coincidence. So again, nothing is definitively proven, but that is certainly something that's under active investigation.
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Jamie Ducharme
Dr. Pazricha, you can understand why a person who is out in the sun might get skin cancer. Why would a non smoking young person develop lung cancer, for example?
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Alison Stewart
Yeah, it's a fantastic question. And I think an even bigger question is a lot of patients who come to me with early onset cancer say, why me? I feel like I've done all the right things. Or maybe you don't always. None of us are Perfect. And that's perfectly human. And I'll tell you, it's a couple of things. One, we don't know all of the exposures that we have in childhood. And that's one of the biggest challenges we have in the research landscape right now is we have a lot number of studies that are looking at people who are currently getting diagnosed with cancer. And we're trying to go back in time and ask what were the exposures they may have had in childhood. Right. And if I asked you today, well, how much time did you spend in the sun when you were 7 years old? You know, living in that, like, it would be so hard to recount that and quantify that. But we also know that sun, and we do know that obviously sunlight, smoking, pollution in the air, these things do contribute to cancer. There's a whole host of environmental factors that we have not yet fully identified. In the case of breast cancer, only about 20% can be accounted for by genetics. That means the environment has to play a big role. So that's kind of the next frontier of the research landscape is to design these prospective studies starting to follow kids at a younger age, ask the right questions, and then it takes time to follow them up and see what happens.
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Jamie Ducharme
Let's talk to Marie, who's calling in from Kingston, New York. Hi, Marie, thank you so much for making time to call all of it today.
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Caller
Hi, thanks for taking my call. So I'm a 15 year breast cancer survivor. I was diagnosed when I was 33. And one of the things that, you know, I know another caller mentioned is also that there is a lot of dismissal. So it took me a long time, from the time of me finding a lump until I was actually, you know, checked and then diagnosed. And I can give a lot of credit to the Breast Examination center in Harlem because they, you know, I had to push a lot. I had to advocate a lot for myself. And sometimes it feels like you're just screaming to get some attention. But they did eventually, you know, help me get into Memorial Sloan Kettering. And, you know, I had multiple surgeries there. One thing that concerns me about young cancer is that it is dismissed, that it's not taken seriously. One of my oncologists patted me on the knee like, oh, you're going to live happily ever after. But I didn't want to hear that. I wanted, you know, real information. And so, you know, the mental health aspect and how it wears down on people to go through the treatment is not often taken into consideration. And in fact, I became a therapist Partially because of my experience with that. So I, you know, I'm hoping that as this is increasing in numbers with young people that, you know, the need for other care, other types of therapies, occupational therapy, physical therapy, after all of the treatment that we go through, that we really need that and that that mental health aspect considered because a lot of people I know who've gone through breast cancer also were already very anxious people to begin with, and it just increases your anxiety.
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Jamie Ducharme
Thank you so much for calling in mental health issues. Jamie, you mentioned in your piece that some of the people said the cancer treatment is as tough as the disease. In what ways might that play out?
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Dr. Tricia Pasricha
Yes, so many standards of cancer care are quite effective, but can also be pretty devastating to the body. So things like surgery, chemotherapy, radiation, those are, those are tough treatments to go through. And especially for a young adult, what can be particularly difficult is that something like a cancer surgery could leave you with lifelong side effects or complications. Incontinence, infertility, early menopause. And if you're a young person who has decades of life ahead of you, you're hoping to have a family, maybe you're still looking for a partner. Those side effects can be really, really devastating and in some cases, as difficult or almost as difficult to deal with as the cancer diagnosis that you've been given.
- [13:41]
Jamie Ducharme
We're talking about the rising rates of cancer among young people. My guests are Jamie Ducharme, she's the author of the Time magazine piece the Race to Explain why More Young People are getting cancer, and Dr. Tricia Pasricha, author of Ask a Doctor column for the Washington Post. Listeners, we want to hear from you. Are you a young person with cancer or a cancer survivor? How did your diagnosis change your life? What are your plans for the future? What do you wish you had known about cancer before your diagnosis? 212-433-969-2212, wnyc. Dr. Pazricia, what are some factors that might indicate to a young person whether they could be at a greater risk for developing cancer? You mentioned family history, but what else?
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Alison Stewart
Yeah, I mean, number one thing, very important to ask your family members about it. And different cancers manifest in different ways. And so I think the bigger picture theme here is that you know your body better than your doct. Something's off. Trust that instinct and push and advocate for yourself. In the case of, for example, colorectal cancer, some of the most common symptoms or early onset colorectal cancer, the number one among younger people is rectal bleeding, meaning you see blood in your toilet, in the bowl. By and large, most people who have that symptom, they're not going to have colorectal cancer. They're going to have something like hemorrhoids or something very benign and treatable. But it should raise a small, it should raise that question. Let me just run it by my doctor. And especially if you start to have other symptoms like fatigue due to iron deficiency anemia, which can happen with chronic blood loss, pain in your stomach, diarrhea, these types of things should raise your alarm. A number of our callers who've been diagnosed with early onset breast cancer have talked about finding that lump. And as you guys know, the U.S. preventative Services Task Force, we don't recommend doing these sort of manual self exams in a formal kind of way anymore. But we still, that's because the data has shown that women who do them on their own actually do a great job of recognizing them outside of this sort of formal way that one has in a doctor's office. So the take home from that is not don't do them, but keep doing them in the great way that you are doing them at home. And recognize and be familiar with your own bodies. And if you sense that something's off, talk to your doctor promptly.
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Jamie Ducharme
What should I be asking my family members about cancer?
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Alison Stewart
Yeah. Well, first about their history.
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Jamie Ducharme
Yeah.
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Alison Stewart
And first the C word's hard. Like ask them in as direct a way as possible. Were you diagnosed with cancer? A lot of times, you know, family patients come to me and say, well, I'm not that close to my uncle or I don't know. We'll ask a relative who is close and say, you know, this is about, about all of us. It's about my risk, my siblings risk. I'm trying to find out so that I can quantify. So ask about cancer and ask especially important is what age they were diagnosed because that age of diagnosis will really change the age at which you are recommended to get screened. So mammography, mammogram, age recommendations will change depending upon the age of your relative. And so do colonoscopy screening guidelines.
- [16:29]
Jamie Ducharme
We're talking about the rising rates of cancer among young people. You can call us at 2124-3396-9221-2433 nyc. We'll have more after a quick break. This is ALL OF it. You're listening to ALL OF IT on wnyc. I'm Alison Stewart. My guests are Jamie Ducharme. She's the author of the Time magazine piece the Race to explain why more young people are getting cancer. And Dr. Tricia Pasricha, author of Ask a Doctor column for the Washington Post. We're discussing the rising rates of cancer among young people. Jamie, one of the doctors you spoke to for this piece was Dr. Shuji Ogino in Boston, who has been working on some unique studies. Tell us what he's been studying.
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Dr. Tricia Pasricha
Yes. So as we mentioned a little earlier in the segment, it's incredibly difficult to nail down why more young people or why any one individual developed cancer. So Dr. Agino has pioneered this really unique approach that tries to combine epidemiology, which is the study of population level health trends and tumor pathology, which looks at an individual's tumor in a really granular way. So he takes samples from colorectal cancer tumors, stains them with dyes, puts them under a microscope, and uses that dye to look at the different cells that make up that tumor. And then he cross references the different cell types with published research on lifestyle, habits or risk factors or genetic conditions that might explain why a tumor has that cellular makeup. And by doing that enough times, he hopes to actually work backwards and understand what exposures are causing more people to get colorectal cancer. So we're ways off from having conclusive findings, but it's a really unique and innovative approach that could bring answers to this important question.
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Jamie Ducharme
Dr. Pasriccio, what are some questions that you'd like for researchers to think about when they're searching for answers?
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Alison Stewart
Yeah, I think all of us want to tap into what are those environmental factors that are, we think, contributing to this rise? And one of the big questions is diet. And our diet, as we all know, has changed dramatically in the US and really in the world over the last several decades. Some of the studies that have been in the works now for some time and are cropping up are these biobank studies where people are able to bank stool samples from younger individuals and track them over time? Or maybe it's blood or maybe it's saliva and these things. Even if at the time of the collection, we don't know exactly what the right question is, we can come back in time, later, we have that sample and we can test for that particular exposure because, for example, microplastics. Maybe 100 years ago, no one was thinking about it 50 years ago. I'm not sure that that was really the big thing. We were worried about getting into our intestines. Now we know it's in our brains, it's in our hearts, it's everywhere. If we had had this huge bank of specimen that we could go back and look at. Wouldn't that be wonderful? And could we correlate that? So there are a lot of questions that I think we're going to start to be able to answer because those kinds of studies are. But they take a little bit of time and they take a lot of coordination and effort.
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Jamie Ducharme
Let's take another call. Let's talk to Jonathan from Queens. Hi Jonathan, thank you so much for calling all of it. You're on the air.
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Caller
Thank you for having me. I'm 40 years old and I was diagnosed with lymphoma last year. It was discovered by accident. I was having stomach pains. I went to the doctor and they just kept on doing research and then they kept on doing more tests and then after a certain amount of time they diagnosed me with this type of cancer, which is a rare type of.
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Alison Stewart
Cancer and they couldn't believe it.
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Jamie Ducharme
How are you feeling? Mask?
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Caller
Well, actually I don't have any symptoms and they're just waiting for me to have symptoms to kind of treat it. So for now it's kind of more of an emotional thing. I had a very healthy lifestyle for the past six, seven years. I've been a pescatarian until last year. And I wonder like if that change, like there's so many questions that come up. I'm a single dad, so every time I go to the doctor, you know, I have to act like a strong person. And even though I'm now going to the doctor gives me like a phobia type of thing.
- [21:07]
Jamie Ducharme
Yeah. I'm so sure that I'm speaking on behalf of all of our listeners. We are sending you all of our best wishes and the best wishes for you and your family. Thank you for calling Jonathan. Let's talk to Seth from Merrick, New York. Hi Seth, thank you so much for calling all of it.
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Caller
Hi, thank you for having me on.
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Jamie Ducharme
Tell us your story.
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Caller
So I'm a 47, I'm now 50, but I was a 47 year old individual who started bleeding in the bowl and you know, I didn't think anything of it actually. I thought it was like a gluten issue or I thought it was, you know, maybe something that would tell me to stop drinking alcohol or something like that. But when I did get examined a or nine months after bleeding, it was clear I had colorectal cancer. I've been treated over the last, you know, three years. I'm still fighting it. I'm on a clinical trial right now and I'm still not out of the Woods. But I'm fighting it every day. But one thing that I do is I work in the advertising field. And, you know, part of my marketing background has, you know, introduced me to different people in the market, in the. In the cancer space. And so I've met a lot of people at the American Cancer Society and at different cancer charities. And so I started to think about, how can I help use my gift, how can I help use what I know, and, you know, educate younger people to know the signs of colorectal cancer and maybe see them before it becomes an issue. And so I thought of a campaign called Toilet Talk. And basically, I'm encouraging people to film themselves going to their bathroom. Show me your bathroom. And really, you know, just explain three things, because I think it boils down to three things. I think it's, you know, know and understand that colorectal cancer is on the rise. I think it's important to have family discussions. You know, know that. That if there's cancer in your family, you should get screened, you should get checked, and also know the signs. Know, you know, if there's bloating, if there's, you know, changes in your bathroom habit, if you see blood in the bath, in the bowl, or in your stool, certainly go get screened. And Certainly if you're 45 or above, you know, you should be screened anyway, you know, which, you know, I can say, you know, fun things like, if you know the sound of a dial.
- [23:36]
Jamie Ducharme
Up, go get the sound of a dial up. Seth, thank you so much for calling in. We appreciate that. Jamie, what are some of the ways that artificial intelligence might help with cancer diagnosis or even treatment?
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Dr. Tricia Pasricha
Right. I think the big benefit of artificial intelligence in terms of health research is that it can sort through far more data than any human ever could, and it can find patterns that maybe would not jump out to a human researcher. So when you're trying to tackle a huge question like what in the environment or what in our diets or what in our lifestyles is driving this uptick in cancers, it's really beneficial to have a assistance in picking out some of those patterns and correlations. So that's one way that researchers that I spoke to were hopeful that AI could help them.
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Jamie Ducharme
Is there anything revolving around AI, Dr. Pasrica, that you find interesting or helpful?
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Alison Stewart
We're using AI almost all the time now when we're doing colonoscopies for screening. So it's interesting. At the point of making the diagnosis, AI can actually help the endoscopist who's performing the exam identify A polyp, identify these precancerous growths and just sort of flag it that the human eye might miss. So there are ways that even from a research and just a practical clinical standpoint, AI is making a big difference.
- [24:52]
Jamie Ducharme
I'm going to read this text. It says, hi, Alison. Both my husband and I were diagnosed with cancer under the age of 40. His is an advanced esophageal, and mine is early breast cancer. It completely upended our lives. We had just started to try to have kids when this all started, and that's probably not an option anymore. Both of our cancers were only discovered because we push doctors. FYI, when you're young, no one expects this, but things have obviously changed. More and more friends are being diagnosed between the ages of 38 and 40. Our generation has been deeply marked by something that's only just revealing itself. I did want to ask about fertility. Dr. Pesricha, what are some steps people can take to preserve fertility if they're going through treatment?
- [25:41]
Alison Stewart
That's a really important question, and it's one that affects both males and females. So first, first, it's important to have an individualized conversation with your provider. And sometimes, depending on the situation, you and your doctor can explore certain options, like saving or preserving your eggs prior to undergoing treatment and then thinking about IVF down the line. These are hard conversations. There's difficulties that can arise with insurance and all of the sort of healthcare system problems that we deal with. But they're important, especially because these are affecting people in the prime of their lives who are exactly as the writer had said, want to have children, and that be an option in many cases. But it's important to be very proactive in thinking about that.
- [26:25]
Jamie Ducharme
Jamie, what did the young cancer patients you spoke to? What do they wish they had known before they were diagnosed?
- [26:32]
Dr. Tricia Pasricha
I think this is a theme that's emerged from a lot of the calls we've taken today. People expressed to me that they just did not think this was a possibility for someone of their age. Many of the patients I spoke to were healthy. They were marathon runners, athletes, vegetarians, people who just did not think that cancer was in the cards for them. And then once they did notice that something felt off with their bodies. Again, a theme that's come up in these calls. They really had to often push for doctors to take them seriously because even their doctors looked at them and said, no, you're young and healthy. It couldn't be cancer. So I think the message that resoundingly has come out of both my reporting and what we've heard today is know that cancer is possible even if you're young. You know, it is still somewhat rare, but it's possible. Listen to your body if something feels off, and be a really strong advocate for yourself in the doctor's office.
- [27:22]
Jamie Ducharme
I'm curious what kind of response you had to your piece.
- [27:26]
Dr. Tricia Pasricha
The response was above and beyond what I could have expected. I think cancer is always something that's of interest to readers because it just affects so many people. But it seems that this increase in young cancers has really struck a nerve. I think people are rightfully concerned and scared and they want to know what's going on. And I can only hope that the research will provide those answers that they're looking for soon.
- [27:48]
Jamie Ducharme
Dr. Pesricha, what would you tell someone who has been listening to this segment and might feel a little bit scared right now?
- [27:54]
Alison Stewart
Yeah, I mean, I think I would say two things. One, that, you know, know that a lot of researchers and doctors are invested in this problem and are working very hard right now to try to help understand. And two, on a personal level, important to advocate for yourself. And sometimes if you come to an appointment, you feel like you're not being heard. I actually always tell my patients, bring in a person with you, someone who can a support person into your visit because sometimes having that person, and both for moral support, but also to just kind of reframe what you're saying and say, you know what, Like, I don't think you're hearing how important this and worrisome this is. It can really just sort of give everyone pause to reset that conversation and make sure that your concerns are really being heard.
- [28:33]
Jamie Ducharme
Is there anything that I forgot to ask you, you think is important for people to hear?
- [28:37]
Dr. Tricia Pasricha
I guess, I mean, sort of echoing what Dr. Pastricha just said. There's a lot of reason for hope as well as fear. And I mean, so many smart researchers are looking into this. They are working on new treatment approaches, new diagnostic approaches, new explanations for what could be driving this. So while it is a problem, it's a problem that a lot of people are trying to solve.
- [28:57]
Jamie Ducharme
My guests have been Jamie Ducharme and Dr. Tricia Pasricha. Thank you so much for joining us.
- [29:03]
Dr. Tricia Pasricha
Thank you.
- [29:04]
Alison Stewart
Our pleasure.
- [29:06]
Jamie Ducharme
This is Ira Flato, host of Science Friday. For over 30 years, the science Friday team has been reporting high quality science.
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Alison Stewart
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Jamie Ducharme
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Alison Stewart
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Jamie Ducharme
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Alison Stewart
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Jamie Ducharme
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- [29:41]
Alison Stewart
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- [29:47]
Dr. Tricia Pasricha
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