An ultrasound found spots on his liver, blood tests and a colonoscopy were done.
“There was a tumor the size of your fist, and she had no pain and no bowel problems or anything like that,” recalls Brendan Higgins, her husband, who works as an artist in New York.
By the time doctors discovered it, dos Reis Nunes’ colon cancer had spread. It was stage 4, meaning it had spread to other parts of his body.
The family was blindsided.
“She had a baby 15 months before her diagnosis, so she had a million blood tests, you know, doctors’ attention and sonograms … and there was no sign of anything, nothing.”
When cancer strikes an adult under the age of 50, doctors call it early stage. At younger ages these cancers are becoming more common.
The review’s authors say the rise in younger people is partly due to more sensitive tests for some types of cancer, such as thyroid cancer. But the test doesn’t fully account for the trend, the author says Shuji Ogino, professor of pathology at the Harvard TH Chan School of Public Health.
Ogino says the point is probably due to a bad pot of risk factors working together, some known and some that need to be researched.
He notes that many of these risks have established links to cancer, such as obesity, inactivity, diabetes, alcohol, smoking, environmental pollution and Western diets high in red meat and added sugar, not to mention shift work and lack of sleep.
“And there are also many unknown risk factors, like a pollutant or food additives. Nobody knows,” he said.
Ogino believes that the fact that many of these cancers — eight of the 14 studied — involve the digestive system indicates that diet and the bacteria that live in our guts, known as the microbiome, play a major role.
“I think this is an important piece because what it points to is a change in the prevalence of exposure at earlier ages, which is causing early-onset cancers,” says Dr. Elizabeth Platz, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, and also He edits the journal Cancer Epidemiology, Biomarkers & Prevention, which was not involved in the review.
Take obesity. Once, it was rare. Not only has it become more common to have a dangerously high body mass index, people are becoming obese earlier and earlier, even in childhood, so these cancer risks are building decades earlier than in previous generations.
An explosion of colorectal cancer in young adults
The early onset of colorectal cancer — the cancer Reis Nunes had — has been particularly hard.
According to Ogino’s review, over the years of the study, the average annual increase in colorectal cancer among young adults was about 2% in the US, Australia, Canada, France and Japan. In the UK, it is almost 3% per year in England, Scotland and Wales. In Korea and Ecuador, it is approximately 5% per year.
“It doesn’t seem like much, but you can think about inflation: if it’s 2% every year, it’s going to be a big change in 10 or 20 years, you know?” said Ogino. “It’s not trivial.”
Research shows that about 1 in 10 colorectal cancers in the US are diagnosed in someone between the ages of 20 and 50.
The younger you are, the greater the risk
Ogino’s review found something called a cohort effect, meaning that the risk of early cancer increased for each group born later. Those born in the 1990s have a higher lifetime risk of developing early stage cancer than those born in the 1980s.
Other malignancies in younger Americans include breast, endometrial, gallbladder and bile ducts, kidney, pancreas, thyroid, stomach and blood plasma cells – a cancer called myeloma.
Dr. Karen Knudson, CEO of the American Cancer Society, calls the review “a call to arms.”
Cancer is a serious diagnosis at any age, but when it appears in younger adults, the tumors are usually more aggressive and often go undetected for a long time because routine cancer screening is not recommended for some of the more common types of cancer, such as as breast and prostate, up to 50 years.
“These types of early-onset cancers are not only more likely to be diagnosed when the tumor is at a more advanced stage, but it was also associated with worse survival outcomes in some of the reports tabulated here,” Knudson said.
“It’s no longer an old man’s disease”
Dos Reis Nunes began treatment in 2017 Sloan Kettering and Mount Sinai Cancer Centers in New York.
The husband remembers that the doctors were explaining one of the younger patients they were seeing more and more.
“I remember a point of contention at both hospitals was that people with colon cancer were getting younger, more and more, and they couldn’t explain it,” Higgins said.
Higgins says she spent a lot of time in online support groups, looking for answers and comfort.
“And there were many young people in those groups,” he said. “It wasn’t populated by people in their 50s and 60s. It’s more like 30s, 40s, 50s. So I was very aware that this was no longer an old man’s disease,” he said.
In fact, routine screening — with colonoscopies and tests that check for blood in the stool — has reduced the incidence of colorectal cancer and made it less deadly in older adults, although cases have risen in the under-50s.
Knudson says three things should happen after major, definitive reviews like this one.
“It’s a call for research so we can really understand some of the specific trends we’re seeing,” he says.
Second, he wants to see greater awareness of the risks, which will hopefully help people change their behavior to control the risks.
Third, he says groups making cancer screening recommendations should reevaluate when those screenings should begin. Some may start at a younger age.
In fact, this is already happening.
“If you’re going to be 45, you should really think about this and not wait until you’re 50 or 55,” Higgins said.
Higgins said his wife’s first 12 months of cancer treatment were almost miraculous, “like a remarkable reaction to the chemo.”
“And then — I actually read it — it can clear up very quickly,” he said. “And once it started to clear, it went down very quickly.”
His wife died in 2019, leaving behind his daughter Maeve, who was not yet 4, an 11-year-old and a 20-year-old.
“We had a great love story,” she said. “I’m still bitter. Still angry.
“Life is fine. Everyone is fine. But I, deep down, am predicting that it happened to him. He was a very good person.”