2023-09-26 15:06:11
There are many reasons why a human cell can go crazy and begin to multiply uncontrollably until it generates a malignant tumor. Smoking, for example, causes mutations that can lead the cell to reproduce without restraint. Alcohol, excessive exposure to the sun or simply chance can also favor these errors in cell replication. Age has always been, however, the most important variable: the older you are, the greater the risk of these errors occurring because cells degrade, control mechanisms are lost and the defense system deteriorates. However, for some time now, something has been changing in the traditional spread of the disease: age continues to be a determining factor, but there are more and more cases among young adults and the causes are unclear.
A study recently published in the journal BMJ Oncology estimates that the global incidence of tumors among those under 50 years of age has increased by 79% in three decades. Although the interpretation of the data requires caution due to the differences between regions – the more developed the country, the higher the incidence of early-onset cancer -, due to the use of different sources of information and due to the probability of under-reporting in developing countries. development, experts point to unhealthy lifestyle habits, poor diet, sedentary lifestyle, pollution, excessive consumption of antibiotics or reproductive factors, among others, as those responsible for the growth of early-onset cancer. Nor do they rule out the possibility that other, still unknown factors are mediating this script twist.
The researchers consulted, for example, also add the influence of improvements in early detection and refinement of diagnostic techniques. César Rodríguez, president of the Spanish Society of Medical Oncology (SEOM), pointed out in an interview with EL PAÍS that these phenomena are never explained by a single cause and, apart from the impact of the Western lifestyle, also “detection at younger ages.” “Early diagnosis is sometimes related to better diagnostic techniques.” A current digital mammogram, for example, has more precision than those done 30 years ago, the oncologist exemplifies. “The more you refine your diagnostic methods and your ability to perform studies that find a tumor, you will probably diagnose them sooner,” he explains.
Andrea Wizner was barely 30 years old when she was diagnosed with a breast tumor. At the beginning of 2020, she had noticed “a small ball the size of a chickpea” on her chest, she says, and she consulted her doctors. She was nervous and fearful, but they reassured her: at her age, a tumor was unlikely; It would surely be a “lump of fat,” she was assured. But the look on her oncologist’s face when she was given the results of the medical tests cut short her good expectations: “That chickpea went on to become an infiltrating ductal carcinoma. And that’s where the long-distance race began,” says the young woman, who is now 34 years old.
Wizner wondered why. Because she. “She had not had previous symptoms nor had she ever set foot in a hospital in my life. I am an athlete. I live on an island [Ibiza] with fresh air… I wondered how it was possible.” On the other end of the phone, the young woman declares that she felt “fear and uncertainty.” It is not easy, she admits today, to face a cancer diagnosis at that age: “If you have it at that age, you come to think that you have had to do something wrong. But I knew that I had not asked for it in any way,” she explains.
The scientific community is still trying to understand this phenomenon, from its dimension to the causes. It is not always possible to establish a direct causality to cancer, or even what factors may be involved. But there are some points that experts are already clear about, such as that lifestyle plays a determining role. “Changes in diet, lifestyle and the environment since the early 20th century, which have led to increased rates of obesity, physical inactivity, Westernized diets and environmental pollution, may have affected cancer incidence.” early onset. Additionally, alcohol, smoking, and harmful exposures during pregnancy may also have affected,” the researchers state in the article. BMJ Oncology.
We have the perception that we are increasingly serving younger people”
Ana Fernández Montes, oncologist
All those usual suspects in consultations, such as smoking or an unhealthy diet, which are also behind other cardiovascular or metabolic ailments, have been growing in recent decades and may be taking their toll, experts sense. Ana Fernández Montes, who is a member of the Board of Directors of the Spanish Society of Medical Oncology (SEOM) and an oncologist at the Ourense University Hospital Complex, advises paying attention to the exposome. That is, all the environmental exposures — diet, lifestyle, microbiome, obesity, environment… — that a human being comes into contact with throughout their life. “Everything we expose ourselves to will determine the risk,” warns Fernández Montes.
A research published in Nature Reviews Clinical Oncology hypothesizes that, although the reasons for the rise of early-onset cancer are not “completely clear,” “they are probably related to changes in exposure to risk factors in the early stages of life and/or in adulthood.” early from the middle of the 20th century onwards. Still, they admit: “The specific effects of individual exposures remain largely unknown.”
Earlier periods and later motherhood
It influences everything. The good and bad. Improvements in early detection, such as screening, may have contributed to this increase in cases, although their influence will surely be limited because most systematic early diagnosis programs are aimed at the older population. An example is breast cancer, which has screening techniques, but in many countries, such as Spain, it is available from the age of 50. The study of BMJ OncologyIn fact, it warns that the incidence of this early-onset tumor also increased in places where there are no routine screening tests. This suggests, according to the researchers, that, in addition to weight gain and the rise of unhealthy lifestyle habits, “changing reproductive factors” may have contributed. Scientists refer, for example, to the earlier onset of menstruation, the use of oral contraceptives, the older age to become a mother for the first time or not practicing breastfeeding.
All of these factors also contribute to increasing the risk of cancer. Each variable can add points to the individual risk, although, to begin with, this is low, agrees Xavier Castells, head of Epidemiology and Evaluation at the Hospital del Mar in Barcelona. “When we look at five-year risk, the most important factor remains age. The average risk of having breast cancer here in Europe is 1.3%. One that has a high risk is 2% or 5%. We are talking about these dimensions,” reassures the doctor, who belongs to the team of experts that draws up the recommendations for breast cancer screening in the EU.
Everything we expose ourselves to [en la vida] “will determine the risk of cancer”
Ana Fernández Montes, oncologist
Wizner had to undergo six cycles of chemotherapy, an operation and as many sessions of radiotherapy to kill the tumor. During treatment, she says, she met girls like her. Even younger: “There was a 24-year-old. It is a time when no one is safe,” she reflects now. The study of BMJ Oncology estimates that, in this decade, the incidence of early-onset cancer will grow by around 31%, especially among people aged 40 to 49 years.
At the consultation, the feeling also goes along these lines, accepts Ana Fernández Montes: “We all have the perception that we are increasingly serving younger people. Before, the profile of patients with colon cancer that I had in the consultation was people over 65 years old and it was very rare to see patients of 48. Now I have a patient of 36, 40 or 43. Those cases before were a rara avis”. The oncologist regrets, however, the lack of a registry of cases in Spain that stratifies by age: “We don’t know how it is increasing. “It is an unmet need.”
Regarding colon cancer, a study published in the journal Science, points out, precisely, that this type of early-onset tumor “is increasing worldwide and is expected to become the main cause of death from cancer in people between 20 and 49 years of age in the United States by 2030.” The authors admit that “the exact reasons are still unknown.”
Colorectal cancer has always been a tumor associated with aging — which is why screening with a fecal occult blood test is usually done after the age of 50. But obesity, diabetes or a sedentary lifestyle, for example, are also risk factors traditionally linked to this disease. Elena Elez, oncologist at the Vall d’Hebron Hospital and principal investigator of the VHIO colorectal cancer group, points out that 25% of colorectal cancer “has a hereditary component” and in patients under 40 years of age, that was what used to happen. : “They had a family history.” But not now, warns the scientist, who also highlights the role of all human exposures, from the prenatal stage, even.
The role of the microbiome
In this sense, experts look closely at the microbiome, which is the entire ecosystem of microbes that populate the intestine and participate in key functions of the body, such as its own defense against foreign agents. No two microbiomes are the same, everything varies depending on exposure to certain circumstances: for example, if a baby is born by cesarean section or natural birth; depending on the type of diet or the consumption of antibiotics. “Humans are the invading organism of bacteria. The microbiome is modulated with antibiotics, for example, and the use of these drugs is now greater and may be having an effect,” explains Fernández Montes.
Elez is part of an international project to study the role of the microbiome, to know if it is a risk factor and, if applicable, how to modulate it: “There is a type of bacteria, the Fusobacterium nucleatum, which has been seen most frequently in a type of colorectal cancer. The existence of this bacteria has been demonstrated in the tumor and in liver metastases,” exemplifies the oncologist from Vall d’Hebron. It is not known whether these bacteria or others are transient or cause the disease, but the scientific community continues to investigate their potential in the genesis or prognosis of cancer. “Certain bacteria make immunotherapy treatment more effective or have fewer side effects,” emphasizes Elez.
“Certain bacteria make immunotherapy treatment more effective or have fewer side effects.”
Elena Elez, researcher in colorectal cancer at the VHIO
Although the average individual risk is low, both for suffering from breast cancer and other tumors, the rise of early-onset neoplasms has opened the debate on whether or not it is appropriate to advance screening or refine these early detection tests to higher risk profiles. The EU advisory group in which Castells participates, for example, has recommended extending the age for breast cancer screening in front and behind: “For women with medium risk, it is being proposed to advance it to 45 and delay it until 74, which would increase the target population by 50%. We lowered the age because we believe that there have already been enough studies that show a mortality benefit that outweighs the risks. [como los falsos positivos o el sobrediagnóstico]. Between 40 and 45 it is recommended not to [se haga el cribado], but we are doing studies to see if it makes sense to start earlier in a subgroup of women,” explains Castells. This refers to those with high breast density—with this type of breast, potential lesions on mammography are not well appreciated—a family history of breast cancer, a personal history of benign lesions, or those with a genetic predisposition.
Scientists recognize that there are still many “gaps” in the research. In fact, Harvard researchers note that this “epidemic” of early-onset cancer could be just one part of something larger, they say: “The tip of the iceberg or an example of a growing trend toward higher incidence of many chronic diseases.” in young and/or future generations.”
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