When I entered medical school, cancer was generally viewed as an older person’s disease. The facts were clear. According to Roswell Park Cancer Center, the oldest cancer center in the U.S.:

• Age 66 is the average age at diagnosis
• 60% of cancer patients are 65 or older
• The most common cancers occur more often in older patients. Average ages include 66 for prostate cancer, 61 for breast cancer, 68 for colorectal cancer, and 70 for lung cancer.

Why does the risk for developing cancer increase as we age? Normal processes in healthy cells gradually begin to break down over time, though scientists don’t yet know exactly why this occurs. As damage slowly accumulates, the genome (information encoded in our DNA) can change, leading to abnormal changes called mutations which alter genes that regulate how cells divide and grow. Thus, cells begin to get out of control, duplicating and forming clumps called tumors.

Tumor cells can generate signals that further cause abnormal behavior in nearby cells and in the programming of the immune system. Some types of tumors such as prostate cancer (PCa) can make themselves “invisible” to the immune system, while other types can aggressively overcome the immune system’s defenses. Cancer tumors characteristically generate their own blood supply, and hijack fuel resources used by healthy cells.

For older individuals who develop cancer, their bodies are in worse shape to defend themselves. A family history of cancer aside, older people have had more years of exposure risks to known carcinogens (e.g., sunlight, environmental toxins, radiation), and more time for cellular mutations to happen. Other age-related factors may include “the long-term effects of chronic inflammation, cancer-promoting DNA changes caused by oxygen free radicals, [and] less-effective DNA damage-repair mechanisms.”^[i] Cancer is a high price we pay if it’s the result of poor self-care habits such as consuming non-nutritious food, becoming lax about exercise, indulging in overuse of alcohol, working long hours in high stress jobs, etc.

Early-onset cancer is on the rise

It now appears that cancer is no longer the sole property of an aging population. It is becoming more prevalent among people younger than age 50. This is called early-onset disease. A compelling article asks, “Is early-onset cancer an emerging global epidemic?”^[ii] The authors identify 14 types of cancer that are striking more people at midlife or younger: breast, colorectal, esophagus, extrahepatic bile duct, gallbladder, head/neck, kidney, liver, bone marrow, pancreas, prostate, stomach, and thyroid.

Experts suspect that exposures to environmental risk factors during childhood and young adulthood may be causal. The article notes “substantial multigenerational changes” that have occurred since the mid-20th century in local, national and global environments. This may not only result in worldwide
exposure to carcinogens, but may have created subtle negative influences on personal diet, lifestyle, obesity and the microbiome, “all of which might interact with genomic and/or genetic susceptibilities.”

Of particular concern is the observation that early-onset cancers may have a variety of features that distinguish them from the elder-years cancers with which science has more familiarity. The authors point to differences in epidemiology as well as clinical, pathological, and molecular characteristics. Does what we’ve learned so far based on older-onset cancer have application to younger-onset cancers—or do we find ourselves at a brand-new starting line and different obstacles in the race to conquer cancer?

It’s important to start now by acknowledging what the data from around the world is showing. The authors identify the tasks that lie ahead:

To study early-life exposures and their implications for multiple cancer types will require prospective cohort studies with dedicated biobanking and data collection technologies. Raising awareness among both the public and health-care professionals will also be critical.

At our Center, we are seeing more men with early-onset PCa, which aligns with WebMD’s online information from 2021: In the U.S., about 10% of men newly diagnosed with prostate cancer are under 55; globally, there’s been an increase in early onset prostate cancer in men between 15 and 40 years old.

Again, the exact reasons for this are under study, but there’s genuine cause for concern. Since the USPSTF recommendation that men ages 55-69 “discuss the possible benefits and harms of prostate specific antigen (PSA) screening with their health care provider and make an individualized decision about whether to get screened,” it’s possible that men under age 55 interpret this as no need to pursue an annual PSA test. While recent data suggests that men younger than 50 who are diagnosed with low risk PCa have favorable outcomes, those diagnosed with high-risk disease have higher rates of biochemical recurrence and worse oncological (cancer treatment) outcomes.^[iii] This speaks to a need for early detection and correct diagnosis.

We encourage all men age 50+, and Black men age 40+, to participate in annual PSA screenings. If a blood test returns a suspicious result, our 3T multiparametric MRI can help rule biopsy in or out. Our in bore MRI-guided targeted biopsy offers the most accurate diagnosis available. With the growing number of younger PCa patients, it is more important than ever to be vigilant about your prostate health.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] “Why Does Cancer Risk Increase As We Get Older?” Dana Farber Cancer Institute, updated May 18, 2017.
[ii] Ugai T, Sasamoto N, Lee HY, Ando M et al. Is early-onset cancer an emerging global epidemic? Current evidence and future implications. Nat Rev Clin Oncol. 2022 Oct;19(10):656-673
[iii] Zheng Y, Lin SX, Wu S, Dahl DM et al. Clinicopathological characteristics of localized prostate cancer in younger men aged ? 50 years treated with radical prostatectomy in the PSA era: A systematic review and meta-analysis. Cancer Med. 2020 Sep;9(18):6473-6484.