Cancer is a disease caused by an uncontrolled division of abnormal cells in a part of the body.
It is "a random process that can happen to any of us," says Dr. Nicholas DeVito, an oncologist at Duke Cancer Institute.
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In 2025, more than 2 million new cases of cancer will be diagnosed in the United States and 618,120 people will die from the disease. In North Carolina, cancer is the second leading cause of death, following heart disease.
Between 2010 and 2019, early-onset cases of 14 different cancers -- including colon, breast, uterine and testicular cancers -- increased in at least one younger age group.
An increase in cancer patients under 50
“I would say over the past five to six years … I was really struck by the young age of, particularly, our patients with GI malignancies compared to years prior,” says Dr. Cary Anders, associate director for clinical research at Duke Cancer Institute.
“We do see that over the last 30 years, the numbers across the country have been increasing,” says Dr. Ashwin Somasundrarm, an oncologist specializing in gastrointestinal cancers at UNC School of Medicine. “A lot of us across the country have been looking at why this is happening and what we can do and exactly what the differences are.”
One in five colorectal cancer diagnoses now occur in someone under 55.
More women under 40 are being diagnosed with endometrial or uterine cancer.
DeVito says, "In the past two to three years, I really started taking notice of it. I've seen folks with these types of cancers even in their twenties."
Dr. Angela Alvarez Secord, a gynecologic oncologist with Duke Health, says that a neighbor's cancer diagnosis changed how she approaches her work.
"Seeing patients that I knew being afflicted with this disease who were younger and had young children, it had a profound effect on me. And I actually changed my research trajectory. She inspired what we're doing today," Secord said. "One of the things that went through my mind is why."
An environmental influence
Anders, whose clinical work has specialized in breast cancers, put it this way: "What is the molecular reason for this and what are the environmental or genetic reasons?
Researchers look at diet, environmental factors like air and water, and even habits to try to understand what's changed about the United States population that could be triggering our cells to misfire.
Somasundaram says, “We look for the simplest explanation. We ask ourselves what's really changed over the last 30 to 40 years as a population in the United States, and what, based on the science that we have, could explain what we're seeing.”
“You have to believe that there's an environmental influence,” Anders says, “whether or not it's the air we breathe, the food we eat, the activity that we're engaged in every day, the amount of alcohol that's consumed, smoking. There's so many different components that lead into this.”
One clear trend has been the epidemic of obesity, tied in part to what we eat and how much we move.
Secord explained how bigger bodies and a surge of hormones can trigger uterine cancer.
“Being a higher weight impacts your body in various ways. And one of the ways it can impact your body is by this increase in hormone production. And the uterine lining is exquisitely sensitive to hormones like estrogen. And so when you have a lot of estrogen in your system, and that can happen from when the fatty tissue creates estrogen, you're basically bombarding that uterine lining to grow, grow, grow,” she says. “Then it becomes a pre-cancer to ultimately becoming a cancer.”
"Diabetes, obesity, sedentary lifestyle all play into the convoluted aspect that is ultra-processed foods," DeVito says.
Food manufactured not made
About 75 percent of the American diet is made up of ultra-processed foods, according to the American Journal of Clinical Nutrition. Foods that are manufactured, not made in kitchens, like chips, frozen meals, sugary drinks, are filled with chemicals and very little actual nutrition.
A study done in Norway found a 10 percent increase in ultra-processed food in your diet could raise your overall cancer risk by 13 percent. Another study, done in China, found men who ate the most ultra-processed foods had nearly a 30 percent higher chance of getting colon cancer.
"We've gone from an environment where you used to eat food that came out of your own garden to an environment where now everything's bought at the grocery store," Secord said.
She cautions against expecting research to deliver a single cause for many cancers.
“Just because there's an association doesn't mean that there's a direct link or cause,” she says. “However, I do think further investigation is really warranted, evaluating the environment and how it interacts with our diet and how we move and if there are negative effects on our bodies.”
Anders adds, “I can't say that we have the answer with 100% certainty today, but there certainly are efforts ongoing to help us understand what might be leading to this increased incidence, so then we could change behavior to decrease the incidences in the future.”
Any link between food or the environment and the development of certain cancers has parallels to the link between tobacco use and lung cancer. Similarly, to reduce the risk will require a concentrated effort that starts with better understanding of what we put in our bodies.
“I would also point out that these cancers in the general population are rare, and for it to come at a younger age is rarer still,” Somasundaram says. He encourages people of every age to consult first with a primary care doctor about necessary screenings and screening guidelines.
“I think being mindful about what you should be doing to screen, what your risks are, especially if you have a family history, a first-degree relative, you should absolutely be thinking about screening earlier,” he says.
“If you have other, general family history of cancer, be mindful of why, what were the environmental exposures that were associated with those cancers? Then be mindful about living an overall generally healthy life,” Somasundaram recommends.
He suggests “avoiding ultra-processed foods, avoiding processed meats, having a high fiber, regular exercise, regular vitamin D exposure.
“These are all things that seem to have more benefits and less risk in terms of general living,” Somasundaram says.
Research, new therapies offer hope
There is groundbreaking research happening in North Carolina to figure out why younger people are hearing a cancer diagnosis, including the group called YOGI (young onset gastrointestinal cancer group) at Duke Health. It is made up of laboratory investigators, practitioners in public health, in primary care, in radiation oncology, surgical oncology and gastroenterology. They share data, lab results and research through a digital biobank to figure out what’s causing patients under 50 to get this disease.
"We're able to follow every patient that is diagnosed with a gastrointestinal cancer going forward and going backwards at Duke," DeVito says.
That work allows DeVito to reassure younger patients that they are not alone and to offer them new therapies that both treat their cancer and ease their side effects.
Secord’s research at the Endometrial Cancer Consortium, inspired by her neighbor’s cancer journey, provides hope for those who get a similar diagnosis in the future.
“At this point, we're 23 sites and growing and almost 4,000 patients. And what it's really helping us do is better understand why these cancers are developing and how we can target treatments for them, but giving us an assessment in the real world how these drugs work,” she says.
Those findings have led treatment for endometrial cancer to the cusp of what Secord calls “a whole new era of individualized personalized therapy … so the right drug to the right patient at the right time will hopefully bring about more cures.”
DeVito is hopeful that his patient, Bianca Harvey, is able to ring the bell later this summer.
Harvey was diagnosed with stage 4 colon cancer at the age of 34. After participating in two clinical trials, she's being treated with immunotherapy, which uses her own immune response to attack her cancer.
Three years after her diagnosis and after two years of immunotherapy, DeVito is encouraged by her prognosis. She has a colonoscopy scheduled for July, and if that scan shows no cancer, DeVito says she could be taken off all treatment.
"For a previously unresectable or stage four colon cancer," he says, "that's a remarkable thing to witness.
"The tumor has continued to shrink over the course of several scans, her blood work looks great, she looks great, she's just continued to feel better the entire time," DeVito says.
Not only is Harvey looking at remission, she's contributing to the YOGI research and helping others.
"I can't see how either of these trials won't contribute to standard of care," DeVito says. "She's not only done this for herself, but she's done this for a lot of other people as well."
Anders concludes, “There's some really innovative research … particularly the role of the environment and how our environment is interfacing with our genes that may or may not be leading to young adult onset cancer. I think that will really be the lock and the key. Ultimately, the goal is prevention. Certainly we want better treatments for cancers once they occur, but we'd love to be able to prevent them completely.”
Diagnosis: Young. The New Face of Cancer in NC
"Diagnosis: Young. The New Face of Cancer in NC" is the latest investigative documentary from the WRAL Doc unit, exploring the alarming trend of cancer striking younger adults in North Carolina and across the nation. The documentary follows three North Carolinians in their 20s and 30s who never expected a cancer diagnosis so early in life. Behind every personal story is the big question: Why is this happening?
Diagnosis: Young is available on WRAL’s streaming platforms and WRAL’s YouTube channel. It will also air on FOX 50 on Sunday, June 29, at 1 p.m. and on WILM on Sunday, June 29, at 6 p.m.