Cancer Rates Are Rising in the Under-50s. Can the Trend Be Reversed?
Looking back, all the signs were there: fatigue, lower back pain, blood in his stool. But back then, in late 2022, Dan Ridge could explain them all. He was tired because he stayed up late. His back hurt because he had a tricky bowel and was often constipated. Even on the persistent blood in his stool, Google was reassuring, suggesting it could be stress.
At the time, Dan was in full-time work and the father of two young boys; he’d also just finished planning his wedding and recently buried his father-in-law. ‘Dr Google said it was stress, so I thought that must be it,’ he says.
After all, Dan was still young. ‘If I’d been over 60 and noticing blood in my stool, maybe I would have thought a bit differently,’ he says. ‘But I was only 38.’
A few months later, early in 2023, Dan’s nine-year-old son brought home a new hoverboard. Dan stepped up to give it a go – and fell off, hard, injuring his back and neck. He joked with his family that it was an ‘epic dad fail’ – but it ended up saving his life.
When Dan went to make a physio appointment, the online self-referral survey flagged the abnormalities in his bowel habit and forwarded them to his GP. By then, he was using the toilet more than 10 times a day, sometimes for 30 minutes at a time.
When his GP got in touch to organise a prostate exam and stool checks, cancer was floated among a wide range of possible causes, including Crohn’s disease and IBS (irritable bowel syndrome). Dan wasn’t too worried; again, he had youth on his side.
But the diagnosis was swift and unambiguous: Dan had bowel cancer. ‘They couldn’t even complete the colonoscopy because the growth was so big,’ he says, still sounding disbelieving. ‘I didn’t think my symptoms were serious enough for it to be cancer – and I still thought I was too young to be getting it.’
The grim statistic that one in every two people will develop some form of cancer during their lifetime is now widely known – but if you’re not yet 60, you could be forgiven for thinking that it doesn’t apply to you yet. The disease overwhelmingly affects older people, with incidence rates in the UK peaking among 85- to 89-year-olds. Nonetheless, there are troubling signs suggesting that is starting to change, with consequences for how we think of cancer and how we treat it.
‘Early-onset’ cancer, in people aged under 50, is rising rapidly. According to research recently published in BMJ Oncology, global cases increased by nearly 80% between 1990 and 2019, with nasopharyngeal and prostate cancers seeing the fastest rise. Those with the heaviest death tolls, however, which resulted in the most serious repercussions among younger people, were the ones linked to the breast, windpipe, lung, bowel and stomach.
‘There is an increase in what we consider to be the kind of 14- to 49-year-old age group – and it’s a real increase,’ says Richard Sullivan, director of the Institute of Cancer Policy and a professor at King’s College London. Perhaps more worryingly, the disease tends to be more aggressive in younger people, as a result of later diagnosis and the number of naturally occurring protective processes and structures that have had to fail for it to progress. Professor Sullivan sums it up: ‘The younger you get it, the more things have gone wrong.’
Never Too Young
The changing face of cancer represents a challenge for experts, charities and policymakers seeking to cure the disease once and for all. In March, Cancer Research UK and the National Cancer Institute in the US dedicated £20m to investigating the increase in early-onset bowel cancer as part of their annual Cancer Grand Challenges.
‘I think the central question is: why are we seeing this?’ says Andrew Chan, a professor of medicine at Massachusetts General Hospital and joint head of the Cancer Grand Challenges’ Prospect team. ‘There’s a very clear trend in which cancer rates have been declining in older adults, yet increasing in younger adults.’ Not only does this have a number of implications for the burden of disease at a population level, but it also indicates that there are certain environmental drivers of cancer ‘that we don’t have a clear handle on’, says Professor Chan.
Some established risk factors – excess weight and obesity, diet, physical inactivity – have been increasing steadily for decades and apply to patients who are both young and old. ‘But it’s not the complete story,’ says Professor Chan. ‘Only by knowing what’s driving the increase will we know how to reverse the trend.’ In the meantime, awareness has been slow to reach the general public, with the result that more people are dying from the disease well before their time.
Bowel cancer – also known as colorectal cancer, and the focus of Professor Chan’s work with the Prospect team – is of particular concern, due to its prevalence in early-onset stats and its high death rate. Though it’s the fourth most common cancer in the UK, it has the second highest mortality rates. That, too, is on an upwards trend.
In January, research published in Annals Of Oncology forecast that deaths among Brits aged 25 to 49 would increase by roughly a third this year, reflecting a 39% increase among women and 26% among men. Key factors such as being overweight, obesity and related health conditions (such as high blood sugar levels and diabetes) were pointed out by the study’s lead author as contributing to the rise, as well as increasing alcohol consumption and less active lifestyles.
Indeed, according to Cancer Research UK, more than half (54%) of bowel cancer cases can be prevented with simple lifestyle changes, which highlights the urgent need to reach and engage new at-risk groups. For a decade, Bowel Cancer UK has campaigned under the slogan that you’re ‘never too young’, but most prevention, screening and awareness programmes largely target older people – meaning those not yet in their sixties may not act until it’s too late.
Know the Warning Signs
In six months from late 2020, Olly Whitman lost two people close to him from bowel cancer. Both were in their early forties, with young families. One was his best friend’s older brother, who he considered as a brother, too. He was diagnosed in November and did not see in the New Year.
‘I was freaking out,’ says Olly, a father of two. ‘How do you go from not knowing there’s anything wrong to not being here in the space of three months?’ So he decided to pay for a full health screening with Bupa. ‘I said, “Whatever you need to do – just test me.”’ He was told that he was too young to be checked for bowel cancer, but he was conscious that that was what had caught out his friends. ‘I was rattled: suddenly, you’re very aware that people your age are dying.’
Olly’s ‘MOT’ returned a clean bill of health, but two years later, in December 2022, he was brushing his teeth when he noticed a swelling inside his throat. It wasn’t sore, but it was sizeable. ‘Imagine an AirPods case but flesh-coloured,’ he says.
Being a ‘typical bloke about it’, Olly brushed it off as a flare-up of his historic tonsillitis. But when the swelling was still visible in mid-January, he realised that he needed to be ‘a responsible grown-up’. After a video consultation, he was referred to a specialist, then for surgery to have the lump removed and sent for a biopsy. Then, in late February, his doctor called him: Olly had non-Hodgkin lymphoma. ‘The short answer,’ he says, ‘is blood cancer.’
Olly was floored. At the time, he was just shy of his 41st birthday. ‘I couldn’t believe this was happening to me,’ he says. ‘Not like, “Oh, god, how unfair” – more, “But I seem fine… I don’t feel like there’s anything wrong with me.”’
When he met his consultant for the first time, Olly was still shell-shocked. He was presented with a chart that indicated an average life expectancy, post-diagnosis, of 20 years. He remembers his blood running cold: ‘You’re telling me that I’m just about going to see my kids off to uni?’
Then the consultant clarified: the graph represented cases among people mostly aged 65-plus. ‘He was not as clear as he could be,’ Olly says, with black humour. ‘I’m 40, not 65 – and I’ve still got this thing.’ Then ‘words like “early”, “fit” and “young” started being bandied around, and I started feeling a bit more confident.’ After 22 weeks of chemotherapy, Olly was given the all-clear in January and now seeks to spread awareness. ‘If there’s anything you’re in doubt about, get it checked.’
Suffering in Silence
Even with aggressive cancers, the prognosis in younger people tends to be good – if it’s caught early. But the well-established reluctance of men to be proactive about their health puts them at greater risk. According to the Men’s Health Forum, they are 32% less likely than women to visit the doctor, particularly when of working age.
It’s not just avoidance, as Professor Sullivan points out. Men who are reliant on their daily wages or are in insecure employment are further hamstrung by their inability to take time off to go to their GP. ‘They’re much more likely to ignore their symptoms and ergo they’re far less likely to present early.’
A notable number of young men are diagnosed only after presenting to A&E with a bowel obstruction, invariably indicating the cancer has spread to another organ, says Professor Sullivan. With bowel cancer and some others, such as oesophageal cancer, ‘you go from curable to incurable really fast’, says Professor Sullivan.
But symptoms can often be missed or dismissed. Among the more obvious causes for concern on Cancer Research UK’s list (unusual lumps or swelling, changing moles, coughing up blood) are those that might easily not register or are readily excused in our busy modern lives – such as tiredness, shortness of breath or persistent bloating.
With hindsight, Dan can see that the fatigue he felt in 2022 was worse than that which could be explained by being a working dad and some late nights. But, he says, he had always been inclined to take a ‘wait and see’ approach to his health. He rarely went to his GP or even took painkillers. ‘It’s a little bit of laziness, and a little bit of naivete – like, “I’ll be alright; it’ll sort itself out,”’ he says. ‘There’s a “man up and get on with it” kind of attitude buried somewhere in there.’ And the taboo over talking about prostate and bowels doesn’t help either, Dan adds.
According to Bowel Cancer UK’s chief executive, Genevieve Edwards, people with symptoms can wait up to six months before contacting their doctor – the impetus for its new behavioural-change campaign, ‘Tell Your GP Instead’, targeting those groups who are least likely to seek help.
The charity already tours the country with a ‘giant inflatable bowel’, says Edwards, raising awareness of the disease within communities that have an elevated risk and encouraging people to come forwards with any questions and concerns. At one stop on the roadshow, Edwards recalls seeing a young man being ‘literally dragged over’ by his partner. ‘She said, “He’s been bleeding from his bottom for over a year, he’s got a family history of bowel cancer and he won’t do anything about it.”’
Bowel Cancer UK has already successfully lobbied to lower the national screening age in England and Wales from 60 years old to 50, as it is in Scotland. But even men who are eligible for a free test every two years can blanch at carrying it out, says Edwards, with some 30% of kits dispatched never returned.
Shock to the System
When Matt Eamer went to hospital with severe abdominal pain while holidaying with his family in late 2020, he was sent away with Buscopan. When he followed up at his local A&E, it was found to be stage three cancer, leading to a swift operation to remove two-thirds of his large intestine.
But Matt’s cancer was of the fast-growing BRAF mutation – the same as the late Bowel Cancer UK patron Dame Deborah James, who died in 2022, aged 40 – and had already spread to his liver. For six months, he underwent a ‘pretty aggressive’ course of chemotherapy. ‘I was constantly encouraging doctors to chuck all the drugs at me, like, “I’ve got two kids, I’m not in my seventies – throw everything you can at me,”’ he says. ‘Then, on my 40th birthday, they phoned me and told me that I had six months to live.’
That was years ago now: the drugs that Matt was then prescribed defied doctors’ expectations to prove miraculously effective and eliminated all traces of the cancer – at least for now, he adds cautiously. ‘I’m a very optimistic individual,’ he says, ‘but I also have accepted that my life might not be long-term, and this drug could stop working.’
He continues to take the medication daily, on top of a fortnightly infusion and a scan every three months. As glad as Matt is to be alive, he says, life after cancer has come with challenges. For instance, he struggled to feel motivated to return to work, mortgage payments and the rest of the daily grind, having been so violently thrown off ‘the normal train track of life’. Last year, he began counselling, which he sought for himself through The Fountain Centre charity.
It reflects the narrow focus of cancer treatment, typically split into ‘curative’ (to eliminate the cancer) and ‘palliative’ (to relieve the symptoms, and improve quality of life). Often, as a younger patient, Matt felt like he was in no man’s land. ‘An oncologist treats the cancer and gives a little bit of thought to the patient,’ he says. But for young people, with a good prognosis, their needs and concerns might be different.
Matt only applied for his disability benefit recently, years after his diagnosis. At the time, he says drily, ‘there was a lot going on’ and he was given no specific advice or support. ‘There’s the treating-the-cancer piece, but I think there almost needs to be another role, highlighting the support that’s available,’ he says. ‘Certainly for young people, there are so many other things: mental health, job, coping with your kids, finances.’
Dan says the same, emphasising the mental health piece. The full weight of his diagnosis only hit him after he’d been given the all-clear, compounded by adjusting to life with a stoma bag. ‘I’m having a real tough time with that,’ he says. ‘When people are saying, “Congratulations, the cancer’s gone!”, to me, it hasn’t – the bag is the cancer.’
Dan has also had counselling, and he recently joined a support group, which has helped ‘massively,’ he says – though he’s still the youngest member.
It speaks to the specific needs and concerns of early-onset cancer patients, which treatment providers may not be familiar with or able to accommodate. People are often at the peak of their professional lives; they might be caring for their older relatives as well as young families. Women may even be advised to consider fertility treatment before starting chemotherapy.
‘Cancer is an awful diagnosis, no matter how old you are – but when it strikes at an age when there are so many other people who are reliant on you, and when you also have to be thinking about the future yourself, it can have terrible consequences,’ says Professor Chan.
On top of that, younger cancer patients may receive less support, socially as well as through the medical system. Mental health should also be a consideration with every diagnosis, Professor Chan continues, but ‘the sheer shock to the system of developing cancer at a young age, and the fact that society in general does not treat cancer as a disease of the young, makes it harder’.
Early-onset cases may still be in the minority now, but their growing numbers will test almost every aspect of our standard, structural approaches to cancer and care. People still speak, wistfully, of a ‘cure for cancer’ as though that is the sole issue, notes Professor Sullivan. ‘But people are not dying in the NHS because of a lack of drugs or technology.’
Last November, Professor Sullivan and other clinical leaders in the UK publicly called for a dedicated national strategy to tackle this and other looming challenges, but he is not optimistic that it will be implemented. ‘You can’t break cancer out from the rest of the NHS,’ he says. ‘Someone has to sit down and say, “This is what we’re going to put money into.”’
For now, younger cancer patients are having to find their own way through a system that’s designed for their elders, one that is certainly more comfortable with accommodating them. As Dan continues to navigate his new reality as a cancer survivor, he remembers being impressed by the speed of his treatment, and his doctors’ commitment to – and even enthusiasm for – ensuring his full recovery. ‘They kept referring to me as a “baby”,’ he says, ‘like they were quite excited to have me there.’
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