I just received an update from one of my medical news sites and I don’t like the report. Cancer rates in the United States are going up especially in those under the age of 50. The data is a bit hard to deal with directly as there are many factors to take into account when interpreting, and then there are many different studies. But the big news is that rates are rising across the board in younger people. Younger people are defined as those in the 35-50 age range, and these folks typically have low rates of cancer. In other words if you were born in the X Generation years, 1965-1980, cancer rates are increasing. We are also seeing rising rates in the cohort following these years: with birth years 1981 and up, otherwise known as Millennials. This has been in the news a lot, for particular cancers, and recently the primary care recommendations are pushing screening for colorectal cancer down to age 45 due to these studies. It is possible that other recommendations will change over the next few years given this data. What does this mean, though, and how can the average person adjust their own cancer risk? What exactly is cancer anyway? 

Those are good questions! First, let’s just talk about cancer. It has been one of the most feared disease states for thousands of years. I’ll never forget my own grandfather succumbing to a version of lymphoma probably related to years of smoking. On the other side of things, diagnosing cancer and then communicating that to patients is so very difficult. That phone call or face to face meeting when you relay the news is heart wrenching, painful, and the last thing you want to do as a provider. The main reason is that people have a visceral fear of cancer, and there is good reason. Cancer is basically the out of control growth of cells due to mutations in the genetic code. Almost all cancers start with this basic problem due to many different causes that could be genetic, environmental, or sporadic.  I think this is just a wild concept. One cell’s misfortune could lead to your demise. What is an example of this? For instance, sunlight has rays in its spectrum that can disrupt the genes in cells. Significant sun exposure increases mutations in the genetic makeup of skin cells leading to our most common cancers: basal cell carcinoma and squamous cell carcinoma. Tumors, clumps of these mutated cells, are like aliens, living in your own body, that then begin taking over all or your resources, and killing you with time in the process. It is a frightening disease. I don’t think anyone likes the idea of a part of their own body turning against them. How this all works is very complicated and there is a large spectrum of disease. So don’t take my quick summary as the whole story. I would recommend the following book to learn more: The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee. You can do a deep dive into the history and pathophysiology of cancer by an expert who also won the Pulitzer Prize for this work. 

What this means is that there is something going on environmentally or behaviorally, which is increasing cancer rates. The classic example of this was the huge increase in lung cancer rates, starting in the mid 19 century and extending until recently. There was an obvious behavioral cause: tobacco smoke. This was finally and definitively discovered in the 1960s, but the lag effect continues to plague patients who smoked when they were younger, and especially those who continue to smoke. What is it for us? Is it our lifestyle, food production chain, or any number of different chemicals that surround us every day? I know there is a lot of noise out there about the causes: everything from genetically modified food to plastics. Maybe it’s a combination of all these things. 

Will I be a cancer victim someday? You probably have been, but only at the cellular level. The reality is that every day our bodies deal with random and unpredictable mutations by destroying them. The immune system is really good at it! This is good news. The bad news is that so many habits and probably many things we have no control over contribute to our risk. Some of this is genetic, so know your family history. Learn about the your family’s health history and communicate this with your medical provider so you can work together to understand and mitigate your risk. Then, let’s work on the stuff we can control – the bad habits.  We do know that the following behaviors will greatly reduce your risk of developing cancer and rev up your immune system:

• Quit smoking
• Limit alcohol
• Avoid midday sun
• Eat a healthy diet, heavy in fruits and vegetables
• Maintain a healthy weight and exercise, be active
• Vaccinate: hepatitis B and HPV
• Have a primary care provider, and do screening as recommended

Screening is important: A good example of this is colon cancer, as I mentioned above. The increase in colorectal cancer has been significant especialliy among folks under the age of 50. This is scary as this type of cancer is insidious and the results can be from horrible to deadly in your body. In other words, you might not know it is happening as cancer forms in your bowel, and when detected early, treatment is no fun but you survive, but if detected late, treatment can be horrible and the disease can be fatal. Not good. I’ve had multiple patients under the age of 65 over the last decade who didn’t want to have a colonoscopy, but I finally convinced them, and we found a developing cancer which was able to be treated. For all the folks who had their colonoscopy on time, I can’t even count the number of polyps (precancerous lesions) removed as part of this procedure. If not caught and treated, many would have developed colon cancer as these little lesions can grow out of control, developing into tumors. A colonoscopy is the gold standard screening tool for colorectal cancer.

What type of screening testing is available and when should it happen?

Breast cancer: Mammograms, start at age 50 for sure, and 40 if you and your doctor decide to screen a bit early. Every two years. If you have family history of breast cancer, talk to your provider about starting earlier.

Cervical cancer: PAP tests, start at 21, repeating every 3 years if normal. Remember, we know that 9/10 cases of cervical cancer are caused by the HPV virus (especially certain types of this virus) which is sexually transmitted. Vaccination has greatly diminished this cancer. 

Colorectal cancer: Colonoscopy, starting at age 45, and every 10 years if normal. Other testing is possible, like the Cologuard test, but not the gold standard, or the best. 

Lung cancer: If you smoked for more than 20 years and are over 50, then discuss a low dose CT scan to screen for lung cancer.

Prostate cancer: PSA blood test – there is significant variation in the recommmendations, but I have started screening most males by age 45 and repeat if normal every 3 years but all of this is based on shared decision making between the patient and me. We review the data together and then proceed based on preference and family/personal history. 

Skin cancer:  Every yearly visit, have your provider take a look at any skin issues you have noticed. Look for changes in a skin growth or sore: asymmetrical, irregular border, uneven color, larger than a pea, and observed changes over time. Skin cancer is the most common cancer. 

Remember, many other factors in your history and your family history can effect when to screen so this is why having a trusted primary care provider is so important. 

Check out this website from the CDC for more information:

https://www.cdc.gov/cancer/dcpc/prevention/screening.htm: Cancer rates are rising…

Finally, think through the products you use. Can you move to a more natural environment? My own ideas are to microwave and store food only in glass or ceramic, grow a garden organically, and spend as much time in natural places as possible. 

I’ve basically barely touched the subject in these paragraphs, and the rabbit hole is deep. I just want to warn you that cancer is a big deal. You don’t want to contribute to your own risk, so learn the risk factors. Reduce your odds for this scary disease. Consult with a trusted primary care provider on risk, history, and any symptoms you may currently be dealing with. I say this again because I believe it is vital to your health and future. Take care of yourself!

More information: These are trusted websites that have great info. 

https://stanfordhealthcare.org/medical-conditions/cancer/cancer/cancer-causes.html

https://www.mayoclinic.org/diseases-conditions/cancer/symptoms-causes/syc-20370588