The announcement that the Princess of Wales, Kate Middleton, 42, suffers from cancer, has once again put the spotlight on the rise of this pathology, traditionally associated with aging, in young adults. Age has always been the main risk factor for the development of a tumor, which begins with a cell that begins to grow uncontrolled: the older you are, the greater the risk that the body’s control systems will fail and these errors will occur. However, in recent years, the scientific community has identified a new phenomenon in the spread of the disease: “In young people, there are published series in which it seems to be increasing discreetly. It is not known why, but it is speculated that it may be due to environmental factors, nutrition or exposure to substances that we do not know since the embryonic period,” explains Martín Lázaro, oncologist at the Vigo University Hospital Complex and president of the Oncological Society of Galicia. . A study 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. “Dietary risk factors, alcohol and tobacco consumption were the main risk factors for the main early-onset cancers in 2019,” the authors warn.

Cancer is the main cause of death in the world and, according to the World Health Organization, around 10 million people died due to this disease in 2020. The scientific community is investigating the new dynamics of the incidence of this disease and, purpose of the boom in increasingly younger people, the experts consulted agree that the evidence is still incipient and limited. Above all, when explaining the causes. We must be “cautious,” recommends Mariano Provencio, oncologist at the Puerta del Hierro Hospital in Madrid, in evaluating all hypotheses. “There is an increase in cancer in young people, but each person will have an explanation. It is clear that there are habits with a direct relationship with cancer, but we have also seen lung tumors in young patients who did not have time for tobacco, for example, to impact them. And this is cause for alarm because we think that there may be something genetic in these people, but with the detection methods we have now, we do not find it,” he reflects.

Experts are still trying to measure a phenomenon that is just beginning to come to light. Various tumors are in the spotlight, from breast to colon, although scientists have identified a greater growth rate of gastrointestinal tumors. American research published last year in Jama Network Open revealed that, between 2010 and 2019, the highest incidence of tumors at an early age occurred in breast cancer, but the most accelerated expansion was seen in gastrointestinal cancer (such as colon, pancreas or stomach), followed by cancers of the urinary system and the female reproductive system. Another study published in the journal Science, also notes that early-onset colon cancer “is increasing globally and is expected to become the leading cause of cancer death in people ages 20 to 49 in the United States by 2030.” However, the authors admit that “the exact reasons are still unknown.”

Research published last year in the journal Cancer Discovery, elaborates on the rise of gastrointestinal tumors and warns of a “worrying trend of a growing incidence of early-onset gastrointestinal cancers”, which seems to be correlated, they point out, with non-hereditary conditions “in which behavioral factors, lifestyle life, nutritional, microbial and environmental” can play a key role. “The relatively low proportion of hereditary cases among the population with early-onset gastrointestinal cancer indicates a potential key role of environmental and behavioral factors in pathogenesis. De novo genetic alterations, environmental factors, lifestyle changes, including obesity, diet rich in red or processed meat, and lack of physical activity, are possible causes of the change in the burden of disease in the population. younger,” they maintain. Everything may have taken its toll. From the first years of life.

Another variable that comes into play to explain this phenomenon of the rise of tumors in young people is the improvement of diagnoses and early detection. However, Lázaro shows his misgivings with this hypothesis: “There is speculation about the influence of the diagnostic improvement, but the tumors end up manifesting in some way, if not at 42, then at 43.” In fact, the oncologist points out, in young people there may even be a delay in diagnosis because when faced with a non-specific symptom, precisely due to age, this pathology is not considered: “It has been seen that it can be diagnosed in a more advanced stage because in Young people do not think that there is a tumor and this may imply a worse prognosis,” he warns.

The Princess of Wales has not revealed the type of tumor she suffers from or her prognosis. The only thing she has specified is that she was undergoing “preventive chemotherapy,” a therapeutic approach usually indicated to prevent cancer from recurring. “Preventive chemotherapy (also called adjuvant therapy) is often used after primary therapy, such as surgery, to reduce the chances of the cancer coming back and spreading. Even after successful removal of all visible cancer by surgery, microscopic cancer cells can remain lurking in the body and cannot be detected with current tests. The type of chemotherapy and the duration of treatment depend on the type and stage of the cancer, as confirmed by examining the cancer removed during surgery,” explained Professor Lawrence Young, Professor of Molecular Oncology at the University of Warwick (UK). , in statements to Science Media Center.

Psychological impact

The appearance of cancer at younger ages also implies a great impact in psychological terms for patients. Tania Estapé, president of the Spanish Society of Psycho-oncology and coordinator of the FEFOC Foundation, points out that this diagnosis is, at any age, a shock for the patient, but among young adults, the impact is greater. “It breaks the common sense of the life cycle of a young person, who may have small children, is working… There is more hostility, more anxiety and a feeling of injustice. In young women, if there are small children, studies show that the first thing they think about is them,” says the expert. Precisely, Middleton has explained that the silence with which they have carried out the diagnostic process was related to trying to find how to explain the situation to their three children in the “most appropriate” way possible.

However, Paco Gil, head of Psycho-Oncology at the Catalan Institute of Oncology, adds that the case of the Princess of Wales is exceptional in every sense: “In this person there is no parallel with reality. People usually talk to their family about what is happening to them.” Gil points out, on the other hand, that “when someone famous, like the situation of the Princess of Wales, faces this diagnosis and tells it, it normalizes it” and, in some way, helps to make it visible and break stigmas.

In any case, how a cancer patient copes with the disease depends on numerous variables, experts point out. From age – older people tend to show more “serenity”, Estapé agrees – to the prognosis of the tumor or the individual life context. Gil agrees that in young people, the impact is usually “greater”: “A cancer diagnosis is always like a rupture of your basic beliefs. And under 50 years old it is something more unexpected. There is a fear that your life project will come to a standstill.”

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