Why Adults Are Getting Cancer at a Younger Age

Summary

Podcast Summary: The Daily – Why Adults Are Getting Cancer at a Younger Age

Date: August 10, 2026
Host: Rachel Abrams (The New York Times)
Featured Guest: Nina Agarwal, Health Reporter
Notable Guest: Whitney Johnson, Cancer Patient

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Episode Overview

This episode digs into a surprising and troubling trend—rising rates of cancer among younger adults, often classified as "early onset cancer" (diagnosis under age 50). Host Rachel Abrams speaks with health reporter Nina Agarwal about new research, personal stories, and theories on why more young people today are getting cancer, the life-altering impact of such diagnoses, and what this means for patients, survivors, and society.

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Key Discussion Points & Insights

1. Defining "Early Onset Cancer"

• Scope: Cancers diagnosed before the age of 50. Traditionally, cancer has been considered a disease of aging, but rising incidence among younger adults is changing the landscape.
• Trends: Systematic studies since 1990 show a consistent yearly increase (1-6% per year, depending on cancer type and age group).
  • “Researchers have started to document…that cancer diagnoses are increasing in younger adults. This isn’t just an isolated phenomenon.” — Nina Agarwal [02:10]

2. Unique Impact on Young Lives

• Disruption: Compared to older adults, young cancer patients face disruptions in career, relationships, finances, family planning, and identity development.
• Testimonies:

  “You go into the chemotherapy room, and...I was there as a 25 year old.” [00:42]
  “I wasn’t able to be the kind of husband that I wanted to be, the kind of father that I wanted to be.” [01:08]

3. Whitney Johnson’s Story – An Intimate Portrait

• Background: Diagnosed at 36 with aggressive triple negative breast cancer in Portland, OR, after her boyfriend found a lump during an intimate moment.
  • “We started kissing…and he’s like, I don’t want to be weird, but I think I feel something in your boob.” — Whitney Johnson [05:23]
• Cascading Life Changes:
  • Rapid transition to treatment; faced the pressure of fertility decisions (egg freezing) in a new relationship.
  • Grappled with identity and femininity after chemotherapy and a double mastectomy.
  • Felt isolated as friends’ lives moved forward; struggled with loss of bodily autonomy and self-image.

  “It’s just like this perfect storm of stealing your femininity when you’re supposed to be feeling kind of at your height of womanhood.” — Whitney Johnson [08:48]

• Relationship Strain:
  • Her boyfriend, only 29, suddenly became a caretaker, was unprepared and unable to always provide needed support.

  “He’s like, I’m here with my friends. I need a break. I don’t have it in me. And that was terrible because you’re like, I’m at my darkest and I want my partner to see me through this time.” — Whitney Johnson [10:26]

  • Felt both supported and alone:

  “Everything was one sided for a long time and we weren’t there and it didn’t go well.” [11:28]

• Support System: Friends and family offered support, but she felt left behind socially:

  “Your friends...are able to be taking these next steps in their lives. And as I’m like, taking a step back into nothingness and the unknown.” — Whitney Johnson [13:10]

• Aftermath & Recovery:
  • Cancer-free for now, but living with physical/emotional scars:

  “I hate [my reconstructed breasts] a lot.” — Whitney Johnson [26:31]

  • Ongoing struggle to accept changes and process the trauma.

4. Causes Behind Rising Early Onset Cancer Rates

Which Cancers Are Increasing?

• At least 14 types, including breast, colorectal, uterine, testicular, pancreatic, among others.

Can It All Be Attributed to Screening?

• No. While some cancers (like thyroid) may be detected more often due to screening, most young adults are not regularly screened. Increases in mortality for cancers like colon and uterine cancers indicate it's not just over-diagnosis.
  • “People born in more recent generations are at greater risk of having cancer, which suggests there might be environmental or lifestyle exposures...” — Nina Agarwal [16:41]

Environmental & Lifestyle Hypotheses

• Obesity, poor diet (especially red meat, ultra-processed foods), alcohol, environmental chemicals (plastics/“forever chemicals”) are all implicated.
  • “There’s a fair amount of evidence linking obesity, alcohol use and poor diet...to some early onset cancers.” — Nina Agarwal [18:08]
• Complexity of Causality: Direct causality is hard to prove, as in the historical case linking smoking and lung cancer.

New & Surprising Findings

• Gene-Environment Interactions: Evidence suggests environmental or lifestyle factors may cause genetic mutations after birth, increasing cancer risk.
• Colorectal Cancer Example:
  • Patterns of mutations in early onset colorectal cancer linked to childhood infection by a particular strain of E. coli.

  “He’s able to see a sign of an E. Coli infection…in the pattern of mutations in the patients who had early onset cancer.” — Nina Agarwal [19:39]

• Industrialization Links: The mutation-causing E. coli strain may be associated with changes in food production or antibiotics since industrialization.

Breast Cancer Factors

• Menstrual Cycle and Childbearing:
  • Earlier puberty and later first pregnancy/childbearing means more years of cyclical cell proliferation, increasing mutation opportunities.

  “Pregnancy, particularly a first pregnancy at a younger age, between…20 to 25…and breastfeeding, are protective against breast cancer in the long run.” — Nina Agarwal [23:52]

  • Rachel Abrams comments on how this is a tough and unfair implication for women’s life choices.

5. The Uncertainty – Why Me?

• Many patients seek reasons, but science often can’t provide conclusive causality. Even those with healthy lifestyles and protective factors can get cancer.

  “For most people, they’ll never know exactly why they got cancer.” — Nina Agarwal [25:36]

6. Ongoing Impact on Survivors

• Extended Recovery: Emotional and physical recovery stretches years beyond treatment. Social and relationship challenges persist.
  • “On her good days, [Whitney] can be sort of accepting…but on her bad days, there’s a mix of trying to move forward and also grieving what was or what could have been.” — Nina Agarwal [26:49]
• Loneliness and Lack of Awareness: The phenomenon is new enough that survivors often feel isolated and misunderstood.

  “This isn’t just like a temporary derailment and then you go back to your normal life.” — Nina Agarwal [27:04]
  “People want to help you, but also they might be really bad at it. You’re so totally alone and really are in charge of yourself.” — Whitney Johnson [28:05]

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Notable Quotes & Memorable Moments

• “It totally upends their lives in a way that is different from…older people, because this is happening at a really vital moment…” — Nina Agarwal [03:12]
• “It’s just like this perfect storm of stealing your femininity when you’re supposed to be feeling kind of at your height of womanhood in some ways. And so it’s pretty fucked.” — Whitney Johnson [08:48]
• “I think for most people, they’ll never know exactly why they got cancer.” — Nina Agarwal [25:36]
• “People want to help you, but also they might be really bad at it.” — Whitney Johnson [28:05]

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Timestamps for Key Segments

• [02:10] - Definition and scope of early onset cancer
• [04:51] - Introduction to Whitney Johnson’s personal story
• [08:07] - Whitney on femininity, hair, and self-image
• [10:03] - Grappling with mortality and relationship strain
• [16:13] - Which cancer types are increasing, and the (limited) role of screening
• [17:49] - Environmental and lifestyle hypotheses
• [19:39] - The E. coli–colorectal cancer mutation hypothesis
• [22:00] - Link between menstruation, childbearing age, and breast cancer risk
• [25:34] - Limits of scientific certainty in individual cases
• [26:40] - Whitney’s post-treatment struggles
• [28:05] - Loneliness and lack of a cultural script for young adult cancer survivors

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Tone & Takeaway

The episode is empathetic, clear, and investigative, blending personal stories with journalistic inquiry and scientific context. It delivers an urgent message: rising cancer rates among young adults are a real, poorly understood phenomenon, with deep personal and societal consequences—and much urgent work remains to be done, for science, health systems, and support networks alike.

Transcript

[Podcast Host / Advertiser]

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[Rachel Abrams]

The New York Times. I'm Rachel Abrams, and this is the Daily.

[Cancer Patient Testimonial]

You go into the chemotherapy room, and I remember sitting in a circle with like 60 to 80 year olds, and I was there as 25 year old

[Rachel Abrams]

for years now, cancer's been seen as a disease that people mostly get when they're older, but apparently that's changing. When I was diagnosed, I was 28.

[Nina Agarwal]

Yeah, I was 32.

[Rachel Abrams]

When I was 37, more young people are getting cancer than they ever have before. I wasn't able to be the kind of husband that I wanted to be, the kind of father that I wanted to be.

[Cancer Patient Testimonial]

Dating was like a new challenge for sure.

[Rachel Abrams]

I mean, I had to file for bankruptcy.

[Nina Agarwal]

I ended up having to do chemo

[Podcast Host / Advertiser]

while I was pregnant.

[Nina Agarwal]

At a time when you really feel

[Rachel Abrams]

like you have so much in control

[Nina Agarwal]

in your life, you're just like, you

[Podcast Host / Advertiser]

completely lose control of everything.

[Rachel Abrams]

And so today, health reporter Nina Agarwal explains what scientists are starting to learn about what's driving this rise and what it means for a generation of young cancer survivors. It's Monday, August 10th. Nina Aggarwal, welcome to the Daily.

[Nina Agarwal]

Hi, thanks for having me.

[Rachel Abrams]

Nina, your beat is chronic disease, and you recently published a series on the growing rates of cancer among young people. And we're gonna talk about what you found in your reporting. But before we do that, I just wanna define what we're talking about here exactly. Like who and what are we referring to when we talk about growing rates of cancer among young people?

[Nina Agarwal]

So early onset cancer generally means cancer in adults under 50. So not super young, but young for cancer. Cancer has historically been a disease of aging, but researchers have started to document in a pretty systematic way that cancer diagnoses are increasing in younger adults. And this is something, you know, we've been hearing about kind of in trickles. But, you know, in the last couple of years, there have been some comprehensive papers showing that this isn't just an isolated phenomenon. This is a pattern happening across cancers over, over decades. And it's been happening every year since 1990.

[Narrator / Reporter]

And, you know, the rates vary from cancer to cancer. So for some it's annual increases of 1 to 2% a year. And for others, and in certain age groups, the increase could be as much as, like, 6% per year.

[Rachel Abrams]

Wow. So you can imagine that over time, that is, like, quite an increase for certain types of cancers, as you said.

[Nina Agarwal]

Yes. And for younger people, it's very unexpected. I mean, I think a cancer diagnosis is unexpected and undesired at any time. But it comes out of left field for so many of these younger adults, and it totally upends their lives in a way that is different from the way it upends the lives of older people, because this is happening at a really vital moment in their life when they're still kind of putting down the roots and becoming the adults that they're gonna be.

[Narrator / Reporter]

And I spent a good part of the last year trying to understand exactly what the experience is like, not only what's happening and why, but what that means for the people who are getting diagnosed. We had hundreds of people write into us to share their experience of early onset cancer, and I spoke to dozens over months to just get a picture of all of the ways that getting a cancer diagnosis in that time of life, your 20s, your 30s, your 40s, how it changes the trajectory of everything that comes after.

[Rachel Abrams]

I wonder, out of all the people that you spoke with who are dealing with these issues at such a young age, is there somebody who stands out to you specifically that maybe illustrates some of what you're describing?

[Nina Agarwal]

Yeah, I mean, there were so many whose stories were really moving, and there were some common themes among many of the stories in terms of disruptions to their finances, disruptions to their family planning, disruptions to their careers, disruptions to their relationships. But one young woman I spoke with, Whitney Johnson, her experience and her story really stuck with me. Can you tell me a little bit about yourself, what your life was like before you got cancer?

[Whitney Johnson]

Yeah, so I. Whitney Johnson.

[Nina Agarwal]

And so she was 36 and living in Portland, Oregon, and she was just, you know, at a stage where a lot of people are in their 30s,

[Whitney Johnson]

trying to focus on my career, trying to focus on, like, redoing my house, trying to figure out if my boyfriend and I should stay together.

[Nina Agarwal]

She was in a relationship that was relatively new and trying to figure out where she was with her boyfriend and kind of where it was going.

[Narrator / Reporter]

And one night, about two and a half years ago, they were making out.

[Whitney Johnson]

We started kissing and kind of stopped at one point. And he's like, I don't want to be weird, but I think I feel something in your boob.

[Nina Agarwal]

And that's how she found the lump.

[Rachel Abrams]

Oh, my God. That must have been so jarring to have him say that in the middle of this, like, very intimate moment.

[Whitney Johnson]

What was your diagnosis? Triple negative breast cancer, stage 2B. And so that means that the tumor was, I want to say, around 2 to 3 centimeters. Yeah.

[Narrator / Reporter]

She was diagnosed with triple negative breast cancer, which was a pretty serious and aggressive type. And when she got the diagnosis, she not only had the tumor in her breast, but also some signs of cancer in one of her lymph nodes. At that time, she had just gotten back from a family trip and vacation, and she ended up not going back to work because she needed to go into treatment immediately.

[Rachel Abrams]

What did that treatment look like?

[Narrator / Reporter]

So she was going to need chemotherapy and then also at least one surgery. But before she could even start, doctors asked her if she wanted to freeze her eggs.

[Whitney Johnson]

And so, first things first, like, my brain wasn't even on the cancer. My brain was like, all the things that go into freezing your eggs and what that meant for, like, my future and what that meant. Like, my boyfriend and I at that time, like, we weren't talking about having kids.

[Nina Agarwal]

Like, you know, she and her boyfriend had been dating a couple of years at that point, and all of a sudden, she had to think about, you know, is this something that I'm gonna want, that we're gonna want? And she's over the course of a few weeks, having to inject herself with hormones. And he was trying to be supportive, but they were not in a place in their relationship where they were both trying to do this of their own volition.

[Whitney Johnson]

And so it's just kind of a wild start to the whole situation that

[Rachel Abrams]

feels like so much pressure at the sort of newer end of a relationship when, as you said, they're not even talking about having kids. Kids aren't even on the radar. And just to say egg freezing is a really intense process. It's intense emotionally, and it's also intense physically.

[Nina Agarwal]

Yeah, absolutely. And the whole experience of having cancer and having then to go through treatment was upending her notions of what it was to be a woman in this relationship. One of the reasons I was really moved and struck by Whitney's story was she talked very articulately about being a woman in this phase of life as women.

[Whitney Johnson]

Like, we spend our whole lives trying to figure out, like, how can I show up in a way that feels right for me, and I can feel confident and, like, I can love who I am?

[Nina Agarwal]

Like, she talked about how it had taken a long Time, you know, to grow into herself. And she loved her hair. That was one of her defining features.

[Whitney Johnson]

It was, like, long and blonde and beautiful.

[Narrator / Reporter]

And she had come to, like, her breasts. That hadn't always been the case, but at this point, she was really comfortable with herself.

[Nina Agarwal]

And then here she is, and she's gonna get chemo, and it's gonna make her lose all her hair, and she's gonna have a bilateral mastectomy, and she's gonna lose her boobs.

[Whitney Johnson]

And then even if I do get through this, you're telling me that I wanna try to date someone when I don't have hair and don't have boobs and don't have estrogen.

[Nina Agarwal]

And it just totally shook her notions of being, like, a sexy, confident woman when she was also kind of early in this relationship where that's how she wanted to show.

[Whitney Johnson]

Like, it's just like this perfect storm of stealing your femininity when you're supposed to be feeling kind of like, at your height of womanhood in some ways. And so it's pretty fucked.

[Rachel Abrams]

I'm curious how her boyfriend navigated all of this because this is just so much pressure, obviously, to put on a relationship that is relatively new, where you have two people who are still trying to figure out what they want. They're still trying to get to know each other.

[Whitney Johnson]

So.

[Rachel Abrams]

So to have this giant tragedy dropped in the middle of that. I can imagine why that is a different dynamic than when this happens to a couple that is established for many, many years and just has a different familiarity with each other.

[Nina Agarwal]

Yeah, I mean, one of the things that she said was, like, we had no practice, you know, like, we didn't have peers and friends who were in this situation. And his friends didn't really know how to support him. And all of a sudden, he's thrust into this role of being caretaker. He was, like, 29, I think, when she was diagnosed.

[Whitney Johnson]

And then I remember there was this one weekend that he was out with his friends, and that was the weekend I realized I might die.

[Nina Agarwal]

She told me one story about how

[Whitney Johnson]

some family coming in.

[Nina Agarwal]

She was at a really low point in her treatment when she was really sick. And she sort of had this realization, like, oh, I might die.

[Whitney Johnson]

Because, like, you know, you always kind of know, but you don't ask directly. And then I'm like, oh, this might be 50, 50, that I'm here in five years. And I think it was the first time that I had let myself think about it, like, this might be it.

[Nina Agarwal]

She was kind of just Spiraling. And her boyfriend was out at a cabin that weekend with friends.

[Whitney Johnson]

I remember, like, I was trying to process this and then like, you know, texting, but he's like, at a cabin partying with his friends. But I'm like, I need to, I need to talk. And I'm like, I might die. Like, talk to me about that. But like, he couldn't. He's like, I'm here with my friends. I need a break. I don't have it in me. And that was terrible because you're like, I'm at my darkest and I want my partner to, to see me through this time.

[Narrator / Reporter]

And.

[Whitney Johnson]

And he just couldn't.

[Nina Agarwal]

And she needed him in a way that their relationship kind of hadn't experienced before and maybe wasn't ready for.

[Rachel Abrams]

God, that sounds so tough for both of them.

[Nina Agarwal]

Yeah, definitely for both of them. I mean, she told me I don't think it's easy to get cancer at any age, but that she was jealous of people who got it when they're older because maybe where they are in their relationship can withstand it a little better.

[Whitney Johnson]

Everything was one sided for a long time and we weren't there and it didn't go well.

[Rachel Abrams]

Did they consider breaking up?

[Whitney Johnson]

Nina?

[Nina Agarwal]

I asked her and she said, you

[Whitney Johnson]

know, at that time you're like, she

[Nina Agarwal]

was really just like in survival mode, like trying to deal with cancer. And it felt like thinking about her relationship ending was just like too much to think about taking on that would make my head explode when that was the source of support. And she was just trying to get through the day to day of fighting the cancer.

[Rachel Abrams]

What about her friends? Did she have friends that were part of a support system, not just her boyfriend?

[Nina Agarwal]

She did, but her family didn't live in Oregon and her friends were in a similar stage of life as she was before the cancer. Some of them were getting married and having babies and, you know, it was hard to be around people whose lives were moving forward. And this is something many people told me. It was really hard to watch their friends and their peers and their colleagues move forward in their lives and you're just sort of stuck or maybe even moving backward.

[Whitney Johnson]

I remember the walk I went on a friend with, she told me about

[Nina Agarwal]

how she had gone for a walk with a friend and her friend told her that she had just gotten pregnant. And she could see that the friend was having a hard time sharing this with her. And.

[Whitney Johnson]

And it was one of those moments that like, I feel so bad because she was, she was sad to tell me because she knew it would be

[Nina Agarwal]

hard, but, you know, it was sad to see her friend moving forward in this way, and she was having to put this pause on everything.

[Whitney Johnson]

And so, you know, your. Your friends are who you spend your time with. You kind of compare yourself against. And so they're, like, able to be taking these next steps in their lives. And as I'm like, taking a step back into nothingness and the unknown.

[Rachel Abrams]

So how did Whitney's treatment go?

[Narrator / Reporter]

So it was grueling. She completed her chemotherapy, you know, lost all her hair. She had a double mastectomy. For now, the cancer's gone, but that doesn't necessarily mean it's gone forever. And a fear of recurrence is real. And I think Whitney's still dealing with how unexpected this cancer diagnosis was at this time in her life and kind of grappling with why it happened at such a young age, you know, and that's something I've also been really interested in. I've been reporting on what scientists are learning about what's driving these rates of early onset cancer. And scientists are starting to find some answers.

[Nina Agarwal]

We'll be right back.

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[Rachel Abrams]

Nina, I want to better understand what we understand about what's driving this increase in cancers. So maybe just to start, can you lay out, when we say that cancer diagnoses in young people are rising, which cancer specifically are we talking about?

[Nina Agarwal]

So there are a number of cancers that appear to be increasing in the earlier age group. One paper from last year showed that 14 different types of cancer Were increasing in the early onset age group. And that includes some common ones like breast and colorectal cancer, as well as uterine cancer, testicular cancer, pancreatic cancer, and several others.

[Rachel Abrams]

And just to ask a question that I'm sure is on a lot of people's minds listening to this, these increases cannot just be attributed to increased screening?

[Nina Agarwal]

No. I mean, depending on the cancer, some might be attributable to increased screening. Like thyroid cancer is one that comes to mind. But for a number of reasons, A lot of experts I talked to said they don't think it's all screening or incidental diagnosis. For one, most of these cancers, when we're talking about people under 40 or under 50, these are not populations that are regularly screened. For another, you know, some of the cancers certainly are showing not just increased incidence, which could be they're just finding them, but also increased mortality. And that's particularly true for colon cancer and uterine cancer. And something else that we're seeing Is that people born in more recent generations Are at greater risk of having cancer, which suggests that there might be environmental or lifestyle exposures, Things that have collectively happened to us as a society over time that could be affecting our cancer risk.

[Rachel Abrams]

Well, let's talk about that a little bit more Because I like to understand what we do know about what is driving these upticks. So talk to us a little bit about those environmental factors and how they're interacting with our biology in a way that may be contributing to these trends.

[Nina Agarwal]

Sure. So I will say, because the phenomenon has really pretty recently been identified, Researchers don't know for sure what's driving it, but they have some hypotheses, and, you know, they're building off of what we know about what causes cancer generally. So there's a fair amount of evidence linking obesity, alcohol use and poor diet,

[Narrator / Reporter]

Particularly red meat and ultra processed foods, to some early onset cancers.

[Nina Agarwal]

And then there are other questions that researchers have about potential other exposures like plastics or forever chemicals. But it's really hard to tell at this stage because it's very hard to link things in our environment directly to a cancer outcome. One of the most classic examples of this is smoking. It took researchers a long time to link smoking to lung cancer, but eventually there was such a large body of evidence that they could make that causal link.

[Rachel Abrams]

Right. Cancer is notoriously difficult to prove causal links to whether it's, you know, where you live or what you're eating.

[Nina Agarwal]

Yeah. But some of the more emerging evidence is showing some surprising things as well that suggests the drivers of earlier onset cancer are different from some of the things we've historically thought about.

[Rachel Abrams]

Tell us about some of those surprising findings.

[Nina Agarwal]

One of the things that researchers are really trying to look into is how our environment or things in our lifestyle might be affecting our genes. So it's unlikely that as a population, our genome has changed dramatically in the last 50 years to make us, as a population, more susceptible to cancer.

[Podcast Host / Advertiser]

Right.

[Nina Agarwal]

So one area that researchers are looking into is how things in our environment might be affecting our genes once we're already alive to maybe make us more predisposed to cancer. Like what? So one example is in colorectal cancer. You know, I spoke to a researcher

[Narrator / Reporter]

who's been doing some work analyzing the

[Nina Agarwal]

pattern of mutations in patients who had early onset colorectal cancer.

[Rachel Abrams]

Mutations in their genome, Right?

[Nina Agarwal]

Exactly. Changes to their genes. And he's able to see a sign of an E. Coli infection with a particular kind of E. Coli in the

[Narrator / Reporter]

pattern of mutations in the patients who.

[Nina Agarwal]

Who had early onset cancer.

[Narrator / Reporter]

And he also was able to say that the E. Coli infection had likely happened pretty early in life, like within

[Nina Agarwal]

the first few years.

[Rachel Abrams]

Meaning what? These patients showed signs that they had gotten infected with E. Coli when they were that young. And so he's now making some sort of connection between E. Coli and colorectal cancer.

[Nina Agarwal]

I mean, that's a big leap because you can't infer causality, but because you're getting this hit to your gene within the first few years of life, and then that mutation is gonna be compounded by other mutations or by factors, maybe like inflammation. You're sort of getting put on the fast track to cancer, and that might be one explanation for earlier onset cancer. But, you know, that being said, we don't necessarily know. And I asked, you know, have we been, as a society, having more E. Coli infections over time? Right.

[Rachel Abrams]

That would be my question. Are we getting exposed to E. Coli more and more?

[Nina Agarwal]

So I think some researchers are trying

[Narrator / Reporter]

to look at samples that were biobanked decades ago and see if they can track E. Coli in the samples over time. I don't think that research has been done yet.

[Nina Agarwal]

But the researcher I spoke to did

[Narrator / Reporter]

tell me something interesting, which was that there are some suggestions that the particular type of E. Coli that may be creating this set of mutations has come with industrialization. So it's kind of like a hand wavy way to say maybe it's something in the food that we now eat or the antibiotics we use. They don't really know, but they are

[Rachel Abrams]

seeing this link even if we don't fully understand it. There's some connective tissue there, is what you're saying?

[Nina Agarwal]

Yes.

[Rachel Abrams]

What about some of the other cancers you mentioned, Nina? Do we know more about what is driving those? What's contributing to the upticks there?

[Nina Agarwal]

Yeah. So researchers have also done a fair amount of work on breast cancer and are also looking at this interplay between our environment and lifestyle and how that might be increasing our predisposition to cancer. And so one of the things that they found is the role that the menstrual cycle and how many menstrual cycles we have might be playing here, because some research has shown that girls now get their periods a little bit earlier than they did in the 1950s, and women are having their first pregnancy later than they did in the 1950s. And the menstrual cycle is this time where your cells are expanding and proliferating and your hormone levels rise and fall. And as the cells are dividing, they're more susceptible to mutations. And so during that time, if you're exposed to something that's harmful, like alcohol or something that can increase your risk of a DNA mutation, the effects of that can accumulate. The longer you have this time period where you're kind of going through these monthly cycles of cell proliferation expansion and then dying off and pregnancy kind of stops that prolonged period of increased risk. Because there's something protective about a first pregnancy, particularly at a younger age, and breastfeeding after that. In the long run, your breast cells, they spend more time doing DNA repair and they've sort of changed in a way that is protective against breast cancer.

[Rachel Abrams]

So basically, this combination of women getting their periods earlier in life and also having children later in life is expanding that in between period where they are most vulnerable to breast cancer. Is that right?

[Nina Agarwal]

Yeah. Or most vulnerable to the changes that can lead to breast cancer.

[Rachel Abrams]

I'm also hearing, by implication, I think, something that feels a little shocking, which is that women who don't have kids, whether because they can't or they don't want to or whatever the reason they are more vulnerable to breast cancer. Is that the right inference to be drawing from this.

[Nina Agarwal]

Yeah. It's totally crazy and unfair. And I know that that can just sound like we're blaming women for their own cancers, which is not at all what researchers say. You know, they're saying these are societal shifts, and it's totally reasonable in this day and age that women want to have a career or not have a baby at age 20. But at the population level, when they look at kind of what are the factors that are linked, they do find that pregnancy, particularly a first pregnancy at a younger age, between kind of the ages of 20 to 25 and breastfeeding, are protective against breast cancer in the long run.

[Rachel Abrams]

What you have laid out, some of these findings are really genuinely surprising. I think a lot of people know by now that toxins like alcohol and smoking may contribute. But the thing you said about pregnancy, the idea that there's bacteria hanging out in your gut from when you're a kid that could cause cancer or could lead to cancer in some way, I don't think that those are factors that are really on people's minds.

[Nina Agarwal]

Yeah. And I think people want to know if there's a reason for their cancer. But I talked to so many people who were diagnosed with early onset cancer, and it's so out of their control. Like, there are lots of people who ate their vegetables and had a good diet and exercised and had babies pretty young and still got breast cancer. I've talked to patients in that situation.

[Rachel Abrams]

It feels like it's worth saying that even if we start understanding more and more about why younger people are getting cancer, getting that kind of clarity is not necessarily going to be total comfort for people who are sick. They're not gonna know exactly for sure what caused their cancer. That's just not how science works. And that's probably gonna just be very unsatisfying. Even if we are more educated.

[Whitney Johnson]

Yeah.

[Nina Agarwal]

I think for most people, they'll never

[Narrator / Reporter]

know exactly why they got cancer.

[Rachel Abrams]

Nina, I want to go back to Whitney for a second, because you said her initial cancer diagnosis was two years ago. How is she doing now?

[Nina Agarwal]

The last time I spoke with her, she was doing pretty well. She had gone back to work, and she and her boyfriend were moving in together, but she was still kind of dealing with the emotional and physical scars of this experience.

[Whitney Johnson]

I think that's going to take a lot longer to deal with.

[Narrator / Reporter]

For example, after her double mastectomy, she did eventually have a reconstruction.

[Whitney Johnson]

Having this reconstruction, like, it's been one of the hardest parts, like lasting parts.

[Nina Agarwal]

She's had people say to her, like, oh, you know, you got your boobs done. And she's like, totally just incensed by that comment because she's like, do you

[Whitney Johnson]

understand that a mastectomy, this is not

[Nina Agarwal]

a walk in the park. This is not something I wanted. And even though her reconstruction was successful by standards of the surgery, I hate him.

[Whitney Johnson]

I hate him a lot.

[Nina Agarwal]

She kind of hates her new breasts, and they don't feel like hers. And it's a hard line for her to tow, much less her boyfriend.

[Whitney Johnson]

Cause, like, you're not supposed to like these better than the old ones. You're supposed to like the old ones better, but yet you're supposed to support the new ones and love the new ones and think they're beautiful.

[Nina Agarwal]

So she, you know, on her good days, can be sort of accepting of what she looks like and who she is now. And on her bad days, there's a mix of trying to move forward and also grieving what was or what could have been.

[Narrator / Reporter]

And she's trying to figure out what's next for her in her life. She's wondering whether she wants to have children, and if so, you know, maybe soon. She's, of course, worried about the cancer coming back, but really, the thing that sticks with me the most about her was just how lonely the experience was and also how unprepared she felt for it, because it's not something that typically happens in this stage of life. And I think that was true for most of the people I talked to. One of the things they wanted people to understand was this isn't just like a temporary derailment and then you go back to your normal life. And because this phenomenon is relatively new in the sense that researchers are able to see bigger picture trends and document it and talk about it, people who have been diagnosed at a younger age don't really feel like they, the public, or even their friends and family get what they're going through.

[Whitney Johnson]

People want to help you, but also they might be really bad at it. You're so totally alone and really are in charge of yourself.

[Nina Agarwal]

And I think a lot of the people I spoke to really wanted to speak to me and tell their story because they wanted other people like them to feel seen.

[Rachel Abrams]

Nina Agrawal, thank you so much.

[Nina Agarwal]

Thanks for having me. We'll be right back.

[Podcast Host / Advertiser]

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[Narrator / Reporter]

and talking to my therapist and really feeling seen and heard for the first time, I just felt like a weight just was lifted off of my shoulders and I felt like it was a good match. From the first time we talked. I could tell people from lived experience that they should try therapy. I could really be myself again and I have this continued support with Better Help.

[Rachel Abrams]

Wherever you are, that's where BetterHelp begins. Visit betterhelp.com New YorkTimes to get started.

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[Rachel Abrams]

Here's what else you need to know today. On Sunday, the Israeli government rejected President Trump's plan for rebuilding Gaza. The 15 point proposal included the gradual disarming of Hamas and the withdrawal of the Israeli army from more than half of the area that it still controls. But Prime Minister Benjamin Netanyahu dismissed the phased approach, saying that Israel won't leave Gaza until Hamas is completely disarmed. Today's episode was produced by by Alex Stern and Claire tennisgetter. It was edited by MJ Davis Lynn and contains music by Dan Powell, Marian Lozano, Sophia Landman and Chelsea Daniel. Our theme music is by Wonderly and this episode was engineered by Alyssa Moxley. That's it for the Daily I'm Rachel Abrams. See you tomorrow.

[Podcast Host / Advertiser]

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