Cristina G. Lucio Madrid
Madrid
Updated Sunday, February 4, 2024-17:13
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Age is a fundamental risk factor in the development of cancer. As we age, especially from middle age, our chances of suffering from a tumor increase because, over the years, mutations in cell replication become more frequent and our body loses the ability to eliminate those cells that contain errors and the potential to become malignant.
This reality, however, coexists with a global phenomenon that researchers study closely: the
increase in cases of some types of cancer in young adults
. The causes are still not very well known, but evidence that in recent years points to this increase is accumulating in the scientific literature.
This same week, an article published in the journal
Annals of Oncology
estimated that in 2024 there will be an
increase in mortality from colorectal cancer
in those under 50 years of age in several European countries, including Spain.
A few months ago, another work reviewed in
BMJ Oncology
pointed out that in recent decades the incidence of early-onset tumors
has grown by 79.1% on a global scale
. Although there are notable differences between regions and types of cancer, the trend is there, supported by a set of intertwined factors.
Among them are conditions that have to do with our lifestyle, such as a sedentary lifestyle or poor diet; others that are related to what the world we live in is like, such as environmental pollution; and others that are due to technical advances, such as improvements in early diagnosis tools. In addition, possibly other factors that we do not yet know are also playing an important role in triggering the cascade of processes that lead to cancer in young people. Scientists are striving to find out the keys that explain this phenomenon that, in some cases, causes an advance of several decades in the age at which a tumor starts.
An unexpected diagnosis
When she was diagnosed with ovarian cancer,
Irene Roldán
asked herself many times, especially at the beginning, why she had won that unfortunate lottery. In general terms, this tumor is a disease that mainly affects women who have already gone through menopause, with an average age of onset that is around 63 years according to data from the Spanish Society of Medical Oncology (SEOM). However,
she was barely 40 when she was told the news
, cutting short her desire to get pregnant. «At the time of the diagnosis I was considering becoming a mother. And that's where it all ended," she laments.
Roldán had entered the operating room to have what she and her doctors thought was
a minor cyst removed
. During the process, the possibility that it was cancer was not even considered. But a few weeks later, the tumor already had a name and surname and had prompted a second intervention, in which both ovaries, the fallopian tubes, the omentum and 18 lymph nodes in the groin area were removed. «It was a very hard operation, which
left me with significant consequences and from which it took me a long time to recover
. Suddenly being left without a reproductive system means suffering a brutal menopause. "I didn't feel comfortable with my body until two years later," recalls this woman from Jaen living in Madrid.
"You always think about why it happened to you, but I tried to banish that thought from my head because it doesn't help you at all," he emphasizes, seven years after the intervention, completely free of cancer.
Risk factor's
On an individual level, it is not easy to trace the sum of the causes that lead to the development of a tumor. But if we look at the population horizon, epidemiological studies have identified factors that are closely linked to cancer.
"In cancer there is never a single cause, it is always a
multifactorial phenomenon
, but we know different conditions that have a significant influence," summarizes
César Rodríguez
, president of the Spanish Society of Medical Oncology (SEOM). "Among them there are avoidable factors, which have to do with lifestyle habits and which are involved in the global increase in cancer cases," says the head of the Section of the Medical Oncology Service of the University Clinical Hospital of Salamanca.
Obesity, being overweight, having an inadequate diet, physical inactivity, a sedentary lifestyle, alcohol consumption or smoking, among others, are factors that clearly favor the development of various types of tumors, says Rodríguez.
«We know that these factors affect globally.
Tobacco, for example, is responsible for more than 90% of lung cancer cases
, and acts as a fundamental agent in other tumors, such as those of the head and neck, bladder, kidney, esophagus, pancreas, stomach, and colon and rectum. , among others," he points out. Along the same lines, the aforementioned BMJ Oncology study directly cites factors related to diet, such as a diet rich in red meat, low in vegetables, as well as tobacco and alcohol consumption as the main risk factors associated with cancer tumors. early start.
"These modifiable factors are already impacting tumors that develop at an older age and are probably also playing an important role in the diagnoses we see in young adults," says Rodríguez. But, in addition, he adds, this diagnosis count is also significantly influenced by the
early diagnosis strategies
that have been implemented in recent years.
«Detection at an early age also has to do with the implementation of more sensitive screening techniques and diagnostic tools. Only a decade ago, population screening for colon cancer was not carried out. These techniques allow diagnosis at an early age, before these cases are clinically evident, which also
contributes to a better prognosis
», He points out.
Discreet impact
"Exposure to certain environmental factors, together with the fact that we diagnose earlier and diagnose better, is probably contributing to an increase in diagnoses in young adults," emphasizes the oncologist, who, however, recalls that the appearance of cancer before middle age «It remains a discrete phenomenon. It is true that there is evidence, especially in international studies, of a progressive advance in the age of diagnosis in some tumors, but it is a slow trend whose impact is modest. The probability of developing cancer continues to be much higher at older ages,” Rodríguez emphasizes.
Pablo Fernández Navarro, researcher in cancer epidemiology at the National Epidemiology Center (Carlos III Health Institute), adds context. "In the case of Spain, the
Annals of Oncology
study
estimates an increase in mortality from colorectal cancer
in men between 25-49 years of 5.5%
," says the researcher, who recalls that the work uses a model to estimate the trend, which has limitations and does not allow definitive conclusions to be drawn about the impact of these tumors.
Studying the dimension of cancer in young adults and the risk factors involved in its appearance is a complex issue due to the heterogeneity and small number of cases, explains the researcher. «We are embarking on international consortia, with partners from other countries to try to shed some more light and in that sense the size of the sample is essential.
"It is very important that it continues to be monitored by age groups
because it is what may indicate that an increase is occurring and that it is necessary to take preventive measures."
In addition to colorectal cancer, we must also continue to look closely at what is happening with
lung cancer in women
, the incidence of which is probably increasing due to an increase in smoking since the 1970s, as well as gynecological cancers, due to changes in reproductive patterns.
In Spain there is no national database that compiles all cancer cases stratified by age, although the Spanish Network of Cancer Registries provides information on what is happening in part of the country. With these data, estimates are made, such as the one just published by SEOM on cancer figures in Spain.
Their predictions indicate that in 2024
the number of cancers diagnosed in Spain will reach 286,664
, in a growing trend. In 2040, according to these projections, the incidence is expected to reach around 341,000 cases.
The most frequent tumors will be those of the colon and rectum (44,294 new cases), breast (36,395), lung (32,768), prostate (30,316) and urinary bladder (22,097).
Fortunately, cancer survival is getting better and future prospects are also optimistic. According to SEOM, it is estimated to
have doubled in the last 40 years
and is likely to continue to rise, albeit slowly, in the coming years. In some tumors, such as prostate or thyroid, survival rates exceed 90%; in others, such as breast cancer (86%) or cutaneous melanoma (89%), they are very close, although, unfortunately in others, the five-year survival remains very low (this figure does not exceed 10% in the case of pancreatic tumors or 16% in liver and esophageal tumors).
«Before, all cancer care had to focus on curing. The objective was that because unfortunately many people died. But now, fortunately,
there are also many survivors
. And we cannot forget the physical and psychological consequences they suffer, because they are also important," says Irene Roldán, who is a member of the Association of People Affected by Ovarian Cancer (ASACO) and frequently receives questions and doubts, especially from young women. who have overcome the disease but have significant consequences that no one takes care of.
«The treatments leave you touched in many ways. It took me a long time to feel like I was regaining my energy and feeling good again. We must also think about the survivors, their quality of life and their options after the disease," she claims.