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At age 20, while studying sports management and marketing in college, Sean Kukoleck’s life was disrupted by cancer.
He suffered his first-ever seizure, leading to the discovery of a large mass on the back of his brain. The oncologists at Cincinnati Children’s Hospital Medical Center ran a number of tests and finally made the diagnosis: stage 4 high-grade glioma. Also known as glioblastoma, these brain tumors are fast-growing, aggressive and life-threatening.
“The diagnosis was devastating. My parents, my friends, my teachers — no one could believe this was happening,” Kukoleck recalls.
He underwent surgery, proton radiotherapy and chemotherapy, but he eventually decided to participate in a clinical trial at UPMC in Pittsburgh studying Keytruda (pembrolizumab), an immunotherapy drug that boosts the body’s immune system to fight cancer, in late-stage glioma. For two years, as part of the study, he underwent treatments every three weeks and had regular MRI scans for two years.
Kukoleck and his parents not only listened to the advice of the health care team, but also found online support through the Cancer Research Institute.
“When we discovered the Cancer Research Institute, it changed my outlook, and I became less fearful about the future,” says Sean’s mom, Nicki Kukoleck. “The strides in immunotherapy that they support and the countless patient stories gave Sean and our family hope that he had a good chance to survive.”
After completing two years of treatment with Keytruda, Kukoleck is in full remission and is regularly monitored. He graduated in 2024 and is working in customer service with the professional baseball team, Cleveland Guardians.
Growing Cancer Cases in Young Adults
Kukoleck is part of a growing group of young adults being diagnosed with cancer at younger ages. These early-onset cancers are diagnosed in adults between the ages of 18 and 49.
According to a global study from 1990 to 2019, early-onset cancer cases worldwide increased by 79%, and deaths rose by 27.7%, with breast, lung, stomach and colorectal cancers having the highest death rates in 2019. Nasopharyngeal (head and neck) and prostate cancers saw the fastest rise in incidence, while liver cancer decreased significantly.
“It’s alarming to see the increase in cancer among younger adults,” says Jill O’Donnell-Tormey, CEO and director of scientific affairs of the Cancer Research Institute in New York City.
In a separate 2023 study published in JAMA, of more than half a million U.S. patients under 50, gastrointestinal cancers — including stomach, colon, rectal and pancreatic — had the fastest-growing incidence rates among early-onset cancer patients. Early-onset colorectal cancer was notably high among men and women in both studies.
“Colorectal cancer is now the number one cause of cancer death in people ages 20 to 49,” says Dr. Ian Paquette, chief of the division of colon and rectal surgery at the University of Cincinnati College of Medicine. “There’s a lot of ongoing research in colorectal cancer, especially around the microbiome and the balance of bacteria in the gut, to better understand what’s driving this increase.”
[See: 16 Questions to Ask Your Oncologist at Your First Cancer Appointment.]
Early-Onset Cancer Causes and Risk Factors
While researchers have not yet been able to pinpoint exactly what’s causing the increase in cancer among younger adults, doctors are analyzing data to understand patterns and trends that might raise risk levels.
Risk factors
Based on current research, the following lifestyle factors play a contributing role:
— Lack of exercise or sedentary lifestyle
— Obesity
— Poor diet
— High intake of foods linked to cancer, including processed foods, red meat, sodium and fast food
— Low amounts of fruits, vegetables and milk
— Tobacco use
Other risk factors that may increase early-onset cancer risk include:
— Environmental exposures such as smoke and gasoline
— Exposure to carcinogenic chemicals
“The body mass index of the average American has been slowly increasing which is a factor that increases the risk of early-onset cancer,” Paquette says. “Diets high in red meats, processed foods and the use of alcohol predisposes younger people to cancer.”
However, what confounds doctors is when a young person leads a healthy lifestyle and yet still gets cancer.
Matt Stenger, 37, never smoked and ran a half-dozen marathons and an Ironman competition in the Cincinnati area. A few months before Stenger and his wife were expecting their third baby in 2022, he was diagnosed with colorectal cancer after experiencing stomach pains while on vacation.
“I thought maybe I was allergic to some foods or developed a gluten intolerance, but I never thought it was cancer,” Stenger says.
He started a multi-week course of immunotherapy, then underwent surgery to resect his colon. Now, his doctors continue to monitor his health, but he is optimistic about his prognosis.
“At my last review my blood work looked good, so I’m hopeful and back to running,” Stenger adds.
Diagnostic and screening advances
Advances in diagnostics and screenings are also detecting cancers at an earlier age. Modern techniques, like machine learning and artificial intelligence, enhance cancer detection, subtype tumor classification and treatment options through analysis of medical imaging and molecular data from biopsies.
“These technologies enable earlier and more accurate identification of cancer biomarkers and small tumors,” O’Donnell-Tormey says. “Additionally, liquid biopsies, which use blood samples to detect tumor DNA, are emerging as a powerful tool for identifying otherwise undetectable cancers.”
[READ: Best Diet for Breast Cancer.]
Ways to Prevent Early-Onset Cancer
While there is no magic bullet to preventing early-onset cancer, there are lifestyle changes and healthy habits you can adopt to reduce your risk.
Effective strategies include:
— Avoid tobacco. Stop smoking and using other tobacco products. Research shows that eliminating tobacco use lowers the risk of many cancers, including lung, mouth, throat, pancreas and bladder cancers.
— Exercise regularly. Adopting routine physical activity helps maintain a healthy weight, which is associated with a lower risk of various cancers.
— Get screened. Cancer screenings are becoming more widespread, and screening ages have lowered to reflect the latest incidence rise in younger people. For instance, the colorectal cancer screening advised people who turned 50 to get a colonoscopy. However, with the increasing number of early-onset cancers, the American Cancer Society and other cancer groups recommend that people at average risk of colorectal cancer start regular screenings at age 45.
— Limit alcohol consumption. Drinking alcohol increases the risk of cancers, such as breast, liver, and colon cancer. Limiting alcohol intake can reduce these risks.
— Maintain healthy weight. Eating a diet rich in fruits, vegetables, whole grains and lean proteins, while reducing red and processed meats and sugary foods, can help maintain a healthy weight and reduce cancer risk.
[Read: Where to Go for Cancer Treatment.]
Special Care Needs for Early-Onset Cancer
How a younger adult is treated for cancer may be similar to an older adult, but doctors acknowledge that there are distinct care needs between the two age groups. Younger people face higher risk of long-term effects, such as infertility, sexual dysfunction, cardiovascular disease and future cancers.
“Psychological support is crucial for younger people, especially after active therapy,” O’Donnell-Tormey says. “Fertility preservation and navigating multiple cancer journey transitions are also important.”
Younger patients may also require individualized care because of higher likelihood of long-term survivorship. They are more likely to endure the long-term side effects of intense cancer treatments, such as “chemo brain” and lifestyle changes post-surgery. Managing these effects is vital for maintaining their quality of life and life expectancy.
Bottom Line
Early-onset cancer is increasing across younger generations, with colorectal cancer being the No. 1 cause of cancer death in people ages 20 to 49. Direct causes linked to early-onset cancer have not been identified, but the average American’s BMI has been gradually rising, which has been shown to be a major driver of early-onset cancer.
Diets rich in red meats, processed foods, and alcohol consumption increase the likelihood of cancer in younger individuals, so it’s important to focus on consuming a healthy, well-balanced diet rich in fruits, vegetables, whole grains and lean proteins to reduce your cancer risk.
Other ways to prevent early-onset cancer include exercising regularly, limiting alcohol consumption, maintaining a healthy weight and, most importantly, following cancer screening guidelines.
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Why Are Younger People Getting Cancer? originally appeared on usnews.com
