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Review
. 2022 Oct;19(10):656-673.
doi: 10.1038/s41571-022-00672-8. Epub 2022 Sep 6.

Is early-onset cancer an emerging global epidemic? Current evidence and future implications

Tomotaka Ugai #  1   2 , Naoko Sasamoto #  3   4 , Hwa-Young Lee #  5   6 , Mariko Ando #  7 , Mingyang Song  8   9   10   11 , Rulla M Tamimi  12 , Ichiro Kawachi  7 , Peter T Campbell  13 , Edward L Giovannucci  8   9 , Elisabete Weiderpass  14 , Timothy R Rebbeck  8   15   16 , Shuji Ogino  17   18   19   20
Affiliations
Review

Is early-onset cancer an emerging global epidemic? Current evidence and future implications

Tomotaka Ugai et al. Nat Rev Clin Oncol. 2022 Oct.

Abstract

Over the past several decades, the incidence of early-onset cancers, often defined as cancers diagnosed in adults <50 years of age, in the breast, colorectum, endometrium, oesophagus, extrahepatic bile duct, gallbladder, head and neck, kidney, liver, bone marrow, pancreas, prostate, stomach and thyroid has increased in multiple countries. Increased use of screening programmes has contributed to this phenomenon to a certain extent, although a genuine increase in the incidence of early-onset forms of several cancer types also seems to have emerged. Evidence suggests an aetiological role of risk factor exposures in early life and young adulthood. Since the mid-20th century, substantial multigenerational changes in the exposome have occurred (including changes in diet, lifestyle, obesity, environment and the microbiome, all of which might interact with genomic and/or genetic susceptibilities). However, the effects of individual exposures remain largely unknown. To study early-life exposures and their implications for multiple cancer types will require prospective cohort studies with dedicated biobanking and data collection technologies. Raising awareness among both the public and health-care professionals will also be critical. In this Review, we describe changes in the incidence of early-onset cancers globally and suggest measures that are likely to reduce the burden of cancers and other chronic non-communicable diseases.

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Figures

Figure 1.
Figure 1.. Trends in incidence of selected early-onset cancers.
Trends in the incidence of 14 cancer types with increasing incidences among 20–49 year-old adults during the period of 2002–2012, by country and region. Age-standardized cancer incidence data were obtained from the Global Cancer Observatory (GLOBOCAN; https://gco.iarc.fr/). Horizontal bars indicate 95% confidence interval (CIs). Larger 95% CIs that do not fit onto the graph scale are indicated by arrows. Data were obtained from 44 countries that provided age-standardized data on cancer incidence during 2002–2012. Among these, we selected 10 countries that are indicative of trends in specific geographical regions. The full dataset, including data from all 44 countries is shown in Supplementary Table 1. Average annual percentage changes (AAPCs) with 95% confidence intervals (shown as horizontal bars) in incidence were calculated using the Joinpoint Regression Program (version 4.9.0.1) for data obtained for 2002–2012, except for Slovakia (2000–2010) owing to differences in data availability. A maximum of two joinpoints were permitted in this analysis. Although extrahepatic bile duct cancer and gallbladder cancer (EBDC & GC) are distinct cancer types, making precise classifications is often difficult, hence, these cancer types are often recorded and data calculated together. Data were not available on the incidence of thyroid cancer among women in Slovakia. AAPC, annual average percent increase; EBDC & GC, extrahepatic bile duct cancer and gallbladder cancer.
Figure 2.
Figure 2.. Individual life-course exposures and their relationship with the development of early-onset cancers.
An individual will encounter various exposures throughout life, from conception (or even the germ cell period before conception), some of which might also be cancer risk factors. Considering the long latency periods of neoplastic development, risk factor exposures in early life (from conception to adolescence) and during young adulthood are considered to have pathogenic roles in the development of early-onset cancer (defined here as cancer diagnosed in adults ≤50 years of age). Genetic susceptibility results from germline genetic variants with a spectrum from low to high penetrance. Gene–environment interactions can occur at any time throughout the lifetime of an individual. This figure also implies considerable challenges in studying the aetiology of early-onset cancers.
Figure 3.
Figure 3.. Broad implications and benefits of prevention efforts for early-onset cancers.
Collaborative interventions at multiple levels (such as those delivered by health-care professionals, general communities, public health authorities, and policy makers) promoting the early identification of hereditary cancer syndromes, healthy diet and lifestyle behaviours, behavioural education of children, and increasing cancer awareness will lead to not only prevention of early-onset cancers (defined here as cancer diagnosed in adults ≤50 years of age) and many other diseases including later-onset cancers (defined as cancers diagnosed at >50 years of age), but also ultimately more sustainable health-care practices.
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References

    1. Shah RR, et al., Trends in the incidence of early-onset colorectal cancer in all 50 United States from 2001 through 2017. Cancer 2021. - PubMed
    1. Islami F, et al., Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics. J Natl Cancer Inst 2021. - PMC - PubMed
    1. Gupta S, et al., International Trends in the Incidence of Cancer Among Adolescents and Young Adults. J Natl Cancer Inst 2020, 112 (11), 1105–1117. - PMC - PubMed
    1. Heer E, et al., Global burden and trends in premenopausal and postmenopausal breast cancer: a population-based study. Lancet Glob Health 2020, 8 (8), e1027–e1037. - PubMed
    1. Lortet-Tieulent J; Ferlay J; Bray F; Jemal A, International Patterns and Trends in Endometrial Cancer Incidence, 1978–2013. J Natl Cancer Inst 2018, 110 (4), 354–361. - PubMed

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