Transcription
Hello, I'm Jonny Dymond and from the BBC World Service. This is The Global Story.
There is a very strange and disturbing thing happening with cancer. Whilst huge strides are being made in treatment, at the same time, cases amongst younger people are rocketing, up 80% in the last three decades and often when the cancer is found, it is aggressive.
Today on The Global Story, what is driving the increase in cancer amongst younger people and what can be done to stop it? Joining me today is Dr David Cox, a former neuroscientist, now a freelance science journalist. Hi, David.
Hi, Jonny. Thanks for having me.
David, I want to hear more from you about why we're seeing this increase in cancer amongst younger people. But first, I've been speaking to one person who is part of this trend. Her name is Natalie Phelps. She has stage four colorectal cancer. She's in her early 40s, but she was diagnosed when she was 38 years old, just after she gave birth to her second child.
It still is upsetting to me to think that I was nursing a baby. I kept thinking I had just given birth and was nursing a baby, and I was going to have to stop all of that and undergo cancer treatment and potentially not even be able to watch this new baby I had just birthed grow up. I mean, it was beyond devastating, and it still is. It's still hard to think about. My daughter actually just turned five.
Congratulations. So. Yeah. Thank you. I started the year of 2020 pregnant. Then I gave birth and went into nursing. And then in the fall, I started aggressive chemotherapy and ended the year in menopause.
David, tell us about how scientists and cancer specialists first started to notice this rise in the number of young people like Natalie being diagnosed with cancer. When was the trend first noticed?
Well, it's very interesting actually, because it really has only been in the last five years. So it basically actually has been it's been the rise of electronic health records. The increasing digitalisation of health. Because without that, we probably wouldn't have spotted this. But basically we have all of this data which has been collected from hospitals and health systems across the world beginning in the early 90s. And it's really been over the past kind of 30 years, probably starting in the late 80s, early 90s, that this trend has kind of begun. It's in the last five years, we've had a few major studies which have really suddenly people have sat up and gone like, oh my goodness, you know, we thought we were making huge progress against cancer. And we are overall. But in the under 50s, you know, I think there was a study a couple of years ago which showed something like a 79% increase in rates of all cancers in the under 50s in the last 30 years.
Let's talk about the particular kinds of cancer that are being highlighted. Natalie, of course, was an example of one of the big cancers that is a problem amongst younger people, colorectal cancer. But there are others as well.
Yeah, well, colorectal cancer is the one which really has been highlighted a lot. And I think a lot of that is because of the possible connections to things like ultra processed foods and kind of changing diets, which are maybe more clearer with like colorectal cancer than other cancers. But we have seen this really with I think it's around 17 different cancers. Some studies have found that have been increasing in the under 50. So these are things like breast cancer, pancreatic cancer. I think actually funnily enough, the biggest rises have been seen in things like prostate cancer, cancers of the throat. But it's yeah, it's more than just kind of colorectal cancer.
And is this being found in young people in a sort of different way from the cancers that are found in older people? These tumours often seem to be more aggressive. So it seems to be a very different type of cancer. The the actual innate biology of the cancer is quite different, which is one of the big reasons why it's so concerning.
Is there a possibility that we're seeing more aggressive cancers in younger people because there's much less testing for cancer amongst younger people, and therefore these cancers are being caught later and therefore they're aggressive. Or is the belief that it's a kind of different kind of cancer?
It's actually both. It's both. It's both, to be honest. I mean, I think it's both a combination of obviously, like doctors are not expecting to see patients with prostate or breast cancer in their 30s. You know, these are diseases really, which typically are seen of people in their 60s, 70s and older. So the warning signs are being missed. So people are presenting at a later stage when the cancer is more advanced and has spread to more organs, but this is the concerning thing, I think there have been some studies where scientists have actually taken samples of his tumours, looked at them under the microscope and actually seen patterns, different patterns in the DNA which indicate that the cancer is progressing faster.
And is there a rise in a particular country or set of countries? Or are you seeing it all around the world?
I mean, it actually does, interestingly, seem to be more in higher income countries. There was one study which was presented at that cancer congress in Geneva, and they saw it in 24 different countries around the world, but predominantly it's countries like the US, the UK, Japan, countries like that, New Zealand, Australia, more than like the lower middle income countries. And I think that relates to a lot of risk factors for these cancers.
Well, it takes me on to the next question, David. Do we know why there is a rise in young people getting cancer?
The funny thing is it's actually a little bit counterintuitive, because what we thought of as the traditional risk factors for cancer, things like smoking, alcohol, we've actually seen a lot of progress in that rates of smoking and alcohol consumption have been declining for generations. So it seems to be perhaps newer carcinogens, things we haven't, you know, particularly traditionally thought of.
I note the word perhaps there. And to me it suggests, I mean an admirable degree of qualification, but there's also a degree of doubt as to whether or not we've pinpointed this yet.
It's not going to be one or two things. It really is going to be, you know, a dozen different things which are driving this. And we need a lot more at the moment. A lot of it is just theories, kind of speculation. We have some ideas, but scientists really haven't pinpointed yet that it is these three things which are driving the rising rates of cancer. You know, we need a lot more information. And it's going to take a while until we can really pinpoint this, but we have some ideas. Let's discuss what they are.
The most obvious one is obesity. Obviously we've seen these massive rising rates of obesity since the 1970s. And we know that obesity is linked with I think it's about 18 different cancers. It's quite a clear link there between obesity and inflammation and risk of DNA damage. But when you speak to oncologists, they often tell you that the patients they're seeing are, you know, they're not obese, they're young, they're healthy, they're fit. These are people who often are doing everything right. But they've been struck down with one of these cancers. And that was the case with Natalie as well.
I had always put health as a priority. I exercised all the time, and we were the kind of people, you know, my husband and I grew our own kale and got engaged backpacking, so I don't know what about my lifestyle I could have changed. Her husband I think said she was the fittest cancer patient he'd ever known. So obesity may be part of it.
But then there are other issues, particularly, I suppose, what you might call about modern life. It's different things to what we've previously thought of. And one idea, for example, is artificial light. Could artificial light exposure be a new carcinogen, which we haven't really contemplated in the past? Because if you think about it, you know, compared to 50 years ago, a hundred years ago, our bodies are getting exposed to so much more artificial light than they ever were. We're watching tablets in bed. We're bombarded with light pretty much at all hours of the day. You know, if you live in a major city, you're going to have artificial lighting outside. And all of this is disrupting our sleep cycle. And this is quite interesting because we do know that the sleep hormone melatonin, which regulates our daily sleep-wake cycle that has a really strong anti-cancer protective effect. So perhaps we're messing with our melatonin levels. And in some people that is driving this greater cancer risk. So that's one idea.
And sleep is another one in and of itself, not just as a result of too much light, but because of the lifestyles that a fair number of people now have. They get a lot less sleep or they get a lot more interrupted sleep.
Exactly. It's maybe less sleep and also poorer quality sleep. And a lot of that is perhaps because we're on our smartphones until one a.m. or, we're not giving our body the right breaks before we start to drop off to sleep. So that's one possible idea, but it's just one of many theories, you know?
Another very interesting one, which often floats beneath the radar is antibiotic exposure. There's a lot of talk at the moment about ultra processed foods. But the interesting thing is if you look at antibiotic rates, they've really gone up a lot in the last few decades. And the impact of that is it's wiping out the bacteria and in our gut microbiomes. And then given the fact that we're eating this Western diet with high amounts of saturated fat, all the different additives and the ultra processed foods, it's perhaps then repopulating our guts with more harmful bacteria such as E.coli, which then produce toxins which then predispose us to colorectal and other cancers. So that's another theory which has really taken traction. I've spoken to quite a few oncologists who've mentioned that one.
One of the alarming figures within the alarming figure about young people in cancer seemed to be that for women in particular, there seems to be a higher emerging risk. And I spoke with a woman called Victoria, who was diagnosed with breast cancer when she was in her early 30s.
I was active, seemingly healthy and had no family history, so it was a surprise to me to hear that I had cancer. It was something that was surreal and overwhelming to just have so many unknowns at such a early stage in my life. Something that was just so unexpected for me.
Is there a reason that young women may be particularly vulnerable to getting cancer?
It's an interesting question, and it's something I've actually been exploring in some of my recent articles. So I did a piece about this for The Telegraph about a month ago, and I interviewed an oncologist at Addenbrooke's Hospital in Cambridge, who particularly specialises in breast cancer. And he was telling me that, yes, you know, just like you found that his whole team is seeing increasing numbers of patients who are either pregnant or have just had children, and they're developing these very aggressive breast cancers. And in the past, we've perhaps put that down to genetics, you know, the BRCA mutations. You know, those were very strongly linked to to more aggressive breast cancer. But actually often we find that lots of some of these patients, they don't have notable genetic mutations. And so one of the ideas is related to oestrogen the female sex hormone. So obviously now we have a trend of like women are having children later, or maybe not even having children at all. And a lot of this means that they're perhaps exposed to estrogen for longer. So childbirth and breastfeeding basically kind of act as a sort of natural estrogen break. And why that's important in the context of cancer is because estrogen, what it does, it actually encourages cells to divide, which we need that for our bodies to be able to repair themselves. But if that gets out of control, that leads to cancer. So that's that's the whole idea. Perhaps women are being exposed to more estrogen for longer, and then that's creating this increased cancer risk.
Have we seen a response from the scientific community and from government to these figures to this rise in cancer amongst younger people?
From government? Not at all. At the moment, I think policymakers around the world are just waiting for more evidence, you know, because as I've said, unfortunately it's very still very unclear. We need a lot more evidence, really. All the data we have is just from these big population studies which have looked at the records of people over 30 years. And scientists have a few theories. But for governments to really be able to step in and be like, okay, we're going to introduce this new policy, they need more data, they need more evidence. And that's the stage we're moving forwards towards now.
And looking at the data, do we see that younger people have better, well, to be blunt, survival rates, because they are younger, they are healthier, they have fewer comorbidities, other diseases along the way?
This is the unfortunate challenge because on the one hand, these younger people, they're much more capable of dealing with really intense chemotherapies and treatments or in a better physical condition. But at the same time, they're being picked up too late. Often we're seeing people, you know, like Natalie who had been diagnosed at stage four when there really is often very little that you can do.
It took me a long time to get diagnosed. I had to advocate very hard because my primary care doctor, first of all, I don't think was very educated about cancer and young people and just didn't really think it was going to be an option. So I would have pushed harder to get that colonoscopy sooner. In lieu of that, there are more and more screening tools becoming available that if I had been educated about, I could have done. So like, you can go now, at least for colon cancer, you can go to a pharmacy in the United States and buy a fit kit, which is sort of a it's like a pregnancy kit, except you can dip a little strip in some stool and it's not perfect. but I have friends all the time, and they're too young for a colonoscopy. In America, you have to be 45 or older to have insurance cover it unless you're having symptoms or, you know, have a family genetic history.
Actually, one of the big steps which many of the main cancer authorities think we need to have next is to educate doctors to look out for these warning signs, because typically, you know, the warning signs of colorectal cancer are things like difficulty passing stool, fatigue. If a doctor sees a patient in their 30s with that, they might think, okay, they're a bit stressed at work. Maybe they've got irritable bowel syndrome. They don't automatically think cancer. And I think that's one of a big awareness pushes we've got now. It's exactly what happened with with Natalie when she went to her doctor who gave her a pelvic examination. And clearly it never crossed his or her mind that it could be cancer.
What else can be done then to try and tackle the issue of younger people getting cancer?
I think it's a combination of just raising awareness among people themselves as well. Oncologists are quite keen to encourage people to check their family history. If colorectal cancer does run a little bit like in your family, then you might have a genetic risk which were not aware of yet. You know, so things like that. So I think that's the main thing people can do themselves, check their family history. We need more awareness amongst the medical community and we just need more funding. The government needs to fund more research projects actually like sort of looking into this trend.
David, thank you very much indeed.
Thank you. And thanks so much to you for watching. If you want to hear more episodes, you can go to wherever you get your podcasts and subscribe. If you never want to miss an episode every day we do one big international story. Thank you so much for watching and if you want to leave a comment, just do so below.