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Is early-onset cancer an emerging global epidemic?

227 points| v4dok | 3 years ago |nature.com | reply

255 comments

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[+] photochemsyn|3 years ago|reply
> "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."

What that means is analytical body-burden data collection should be a medical norm, for a variety of substances: polychlorinated biphenyls, triazine herbicides (atrazine), industrial solvents like trichloroethylene, brominated fire retardants, nitrosoamines, plastic-sourced phthalates, perchlorates, hydrazine, hexavalent chromium and so on.

Collecting such individual data via blood & urine samples (possibly fat biopsies & breast milk as well) on a yearly basis should really be part of a standard medical checkup procedure. That would provide a dataset which could be used to address that question.

This is hardly a new proposal, for example see this 2001 PBS report, in which journalist Bill Moyers got his body burden test results:

https://www.pbs.org/tradesecrets/problem/bodyburden.html

The results are not unusual. Each of us has some load of industrial chemicals stored in or passing through our bodies. These chemical residues – termed the "chemical body burden" – can be detected in blood, urine and breast milk.

[+] caeril|3 years ago|reply
Don't hold your breath. One example:

Coronary calcium deposit scans are cheap and extremely effective at giving a probabilistic window of possible future heart attack, but doctors don't order them prior to a CVD event, and insurance doesn't cover them as a pre-CVD elective.

Instead we're told: We have no way of knowing if or when you'll experience infarction, it's one of God's Great Mysteries. Just don't eat eggs and pray.

You're absolutely right, but the entire medical industry has no intention of actually reducing mortality. It's a cash grab from top to bottom, and preventative monitoring of the kind you suggest already has precedent in coronary calcium scanning. It's not going to happen if it reduces the overall predicted revenue per patient.

In the same way that a single triple-bypass surgery is far more lucrative than a hundred coronary calcium scans, a full course of cancer treatment is absurdly more profitable than regular tissue carcinogen testing.

[+] Gatsky|3 years ago|reply
Is this even worth doing when people are still smoking, drinking alcohol, living in polluted areas and eating red meat? These are all known risk factors with large effects on cancer risk in younger people.

I think the effort is better spent as follows:

- ban sale of combustible tobacco products

- ban advertising of alcoholic beverages

[+] haldujai|3 years ago|reply
It would be nice to have this information to see if any trends are discovered (all of this is theoretical, I question whether measuring excreted compounds rather than stores is is relevant but that’s a separate point) however it is unclear what value this information will provide and seems unlikely it will generate anything actionable.

With that in mind, it’s hard to justify the colossal costs that would be involved in administering such a program. Young (< 50) healthy adults shouldn’t even really be getting annual checkups (in my professional opinion and per several guidelines) and annual blood work is definitely not indicated.

Annual urinalysis is not indicated as part of the general work up for patients of any age, so this would be adding a whole extra step in specimen collection and not just adding on a test.

Healthcare is generally a zero sum game and if we divert $ and lab resources to something like this that means other tests and procedures are not being done.

A small prospective study as the authors suggest would be interesting, yet still expensive. It’s a huge stretch to say everyone should be getting this and ignores the harm that this would cause.

[+] BrianOnHN|3 years ago|reply
> Collecting such individual data via blood & urine samples (possibly fat biopsies & breast milk as well) on a yearly basis should really be part of a standard medical checkup procedure

No so long as sickness is so profitable. The incentives aren't there like you would think.

[+] matheusmoreira|3 years ago|reply
Invasive biopsies in common medical screening? Yeah, that just isn't gonna happen. Nobody is going to test for any of those chemicals either due to the huge cost and questionable benefit.
[+] phkahler|3 years ago|reply
>> 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.

How do they separate these two. Early testing is becoming more common so you expect to see more cancer simply due to looking for it.

Doc: Early screening has increased the 5-year survival rate for various cancers.

Patient: Of course it has, but will I live any longer?

[+] pclmulqdq|3 years ago|reply
Early-stage cancer survivorship rates are much higher, and early detection catches cancers at an earlier stage. Studies have been done that show the benefit of early screening, separate from the bias.
[+] Gatsky|3 years ago|reply
The only cancer routinely screened for in people under 50 is cervical cancer. Even then, the test detects precancerous lesions mainly. As such, ascertainment bias is not a major methodological concern.
[+] letsgo39|3 years ago|reply
You should be able to see the 'real' increase from death rates, assuming the cause of death is correctly identified as cancer pre or post mortem.
[+] irrational|3 years ago|reply
I feel like there has been a great increase in mental health issues: anxiety, depression, etc., especially among youth. I don’t recall these being major issues from when I was a youth in the late 80s and early 90s. I’m told that I’m wrong and people just didn’t talk about it so I wasn’t aware of it. But even amongst close family members and friends it wasn’t a thing. Now, I’ve seen some claim it is the post 9/11 world or social media, but I have to wonder if there is some chemical we are exposed to more that might be causing mental disorders in addition to early onset cancers.
[+] gnrlst|3 years ago|reply
> but I have to wonder if there is some chemical we are exposed to more that might be causing mental disorders in addition to early onset cancers.

It's always easy to point the finger at a single cause, but the reality is that it's a series of factors that together act like a sophisticated, compound "attack" to the psyche:

- Social media weakens your self-confidence and makes you feel in a constant state of inferiority, i.e. your present self.

- The "post 9/11 world" you mention, is simply a result of a general worsening of Western political relations over time, which are becoming especially evident recently. That state of turmoil weakens your sense of stability and security, making the future look bleak - i.e. your future self.

- Further blows for the knockout: climate change, pollution / micro-plastics / rising costs of living, etc.

I'm actually surprised depression, anxiety and other mental disorders aren't more common...but perhaps they will be.

[+] _yb2s|3 years ago|reply
I don't remember hearing much about anxiety or depression, but do remember hearing about things like alcoholism, domestic violence, and 'laziness.' I'm pretty sure these are largely the same psychological issues- it's just people used to hide it, and deny it even to themselves- so you would only see the resulting dysfunction. Nowadays people are getting a diagnosis and treatment rather than just silently suffering and hiding it.
[+] blablabla123|3 years ago|reply
But I also think "back in the days" life was more fixed. Probably getting a full time job as employee, starting a family, getting a house was not really optional. Now there are much more choices. Add to that all the hyper-connectivity. I don't really think people were better off but were just forced to handle everything more calmly. Growing up in the 90s, what I've found is that things changed a lot when people were starting their jobs.
[+] m_fayer|3 years ago|reply
Puberty coming on ever earlier is my pet theory for what's causing this.

It might come in a way that's uneven. An adult set of sexual characteristics and drives without the corresponding development in executive function must be difficult.

Add to that the sudden arrival of sexual characteristics and attention at an age where our culture has no scripts and rituals with which to handle them. Kids must feel like adrift aliens, within the world and within their own bodies.

[+] dan_quixote|3 years ago|reply
What about constant stimuli fighting for our attention by exploiting our lizard-brain emotions every waking hour?
[+] soundnote|3 years ago|reply
Yeah, especially young people do have it bad. One interesting thing is that as society becomes more and more feminist, it's the young women who fare the worst, and especially the demographics most likely to be intersectional activists.

Maybe not all ideologies are good for us? At a quick glance, a lot of the intersectional feminist/activist modes of thought seem to be the polar opposites of what eg. cognitive behavioral therapy and the stoicism it's inspired by advocate (eg. others are responsible for your emotional reactions/state, so to control your mood you have to control others vs. you are responsible for and in control of your own emotional reactions and mental state and you can improve your mood by honing yourself).

We know CBT is effective for getting rid of dysfunctional thought patterns and lessening mental health symptoms. In that light, these numbers seem unfortunate but entirely predictable.

https://i.imgur.com/uRX0A9u.png

[+] IAmGraydon|3 years ago|reply
1. Toxic social media

2. Toxic mass media

3. Devisive, polarizing politicians

4. Being constantly threatened with nuclear death from a madman half a world away

Humans have to be able to visualize a better tomorrow to be propelled toward it. Do you see a better tomorrow? Maybe people are depressed and anxious because deep down, in the recesses of our collective consciousness, we already know how all of this ends.

[+] TomSwirly|3 years ago|reply
Perhaps knowing that we aren't going to do anything significant about the climate crisis, and thus devastate our environment and the carrying capacity of the planet, might be what's making them a bit touchy.
[+] rtev|3 years ago|reply
The smartphone era directly seems to coincide with elevated mental health problems.

I think porn and social media are responsible. Those two things, heavily changing neurotransmitter and hormone patterns, are significantly amplified when everyone has a smartphone.

[+] alexalx666|3 years ago|reply
There seems to be an empty space that people rush to fill with a newest iPhone and installing FB and Instagram instantly, I guess in 90s you would use McDonalds for that
[+] MonkeyMalarky|3 years ago|reply
If we're going to throw out random theories for the cause like diet and pollution, what about all the volatile chemicals off-gassing from freshly manufactured goods?
[+] rlt|3 years ago|reply
Getting an air quality monitor was enlightening and terrifying. My child’s room (which unfortunately doesn’t have great ventilation) would sometimes hit 4000 ppb VOCs, which I tracked down to some of her stuffed animals…
[+] Fezzik|3 years ago|reply
This is known issue, at least of late. There was a recent article posted here (can’t find it right now on mobile) about how that New Car Smell is caused, to some degree, by known carcinogens.
[+] chiefalchemist|3 years ago|reply
To be fair, I don't think those are random theories. There's plenty of research on the ill effects of (bad) diet, pollution, etc.

But yeah, volatile chemicals are a form of hyper-local pollution. Perhaps less proof ATM, but close enough to regular (?) pollution to want to avoid it. Err to the side of caution, not to the side of cancer.

[+] Robotbeat|3 years ago|reply
I actually wonder if viral epidemics are to blame? Increased air travel means rare viruses can become widespread.
[+] Jill_the_Pill|3 years ago|reply
I also wonder about exposure in youth to nuclear weapons testing fallout. That might show an identifiable spatial or temporal pattern, maybe falling off in more recent years and clustered among downwinders worldwide.
[+] nativespecies|3 years ago|reply
My pet theory is plastics/microplastics. We're seeing now just how prevalent they are (and how inside of us they are, too).
[+] TEP_Kim_Il_Sung|3 years ago|reply
Or long-term side-effects of medication, food-trends, or lack of exercise?
[+] swayvil|3 years ago|reply

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[+] notamy|3 years ago|reply
The most disturbing part, to me, is this:

> The early-onset cancer epidemic might be one manifestation of increasing trends in the development of many chronic diseases in young and future generations.

Why are chronic diseases trending upwards? Is it the obvious things (pollution, microplastics, obesity, massive drain on mental health from the modern lifestyle, etc.), or is there something else going on?

[+] mihaic|3 years ago|reply
Anecdotally, I've found out in recent year about many women having serious thyroid issues. I'm sure more people being open about their health increases this, but the sheer frequency seems absurd.

Whatever industrial chemicals we're ingesting need to be drastically controlled, and this poisoning needs to be branded so that the general population knows about it. I don't want years of my life to be an externality to a slightly cheaper industrial process.

[+] jah242|3 years ago|reply
For context, looking at UK data:

1. Yes incidence of cancer in 25-49 year olds has increased 22% from 1993 to 2018 - but that is 22% on a very low number which means it is still a very low number. When you account for increased screening, greater awareness, and better testing, the increase is likely even smaller.

https://www.cancerresearchuk.org/health-professional/cancer-...

2. Better treatment (and more effective screening) means mortality rates per 100k from all cancers in 25-49 has dropped c.40% over the same period (despite higher incidence).

https://www.cancerresearchuk.org/health-professional/cancer-...

So whilst this is obviously important to study. At least the UK data doesn't seem too terrifying but I m no expert.

[+] NhanH|3 years ago|reply
I can't find a source with the full paper at all. And I'm guessing that's why there is no comment here.
[+] dukeofdoom|3 years ago|reply
Sleep deficient seems to be connected to some cancers.

Daily walking a lot seems to really be a key to longevity. Also to be healthy enough that you can ignore the pharmaceutical companies extensive and endless product line. Often you're just trading one problem for another, or just trading short term risk for long term risk or vice versa. And also have the mental strength to want to go on living with health problems. If you're in Canada and you get to old age, and up in an institution. Be prepared to be offered Euthanasia. 3% of Canadian deaths were that way last year.

[+] dev_throw|3 years ago|reply
My bet is on hormonal changes due to modern living and/or it's impact on the gut microbiome. I'm mid thirties with low body fat and somewhat athletic and got diagnosed with stage 4 colon cancer last year with no history in the family. My support groups regularly get new people around my age.

It's scary to think that in the next few years these cancers will no longer be an old person's illness because chemo is absolutely devastating.

[+] synergy20|3 years ago|reply
Could this be related to GMO food? or maybe just the industrialization of food in general?

I also noticed for people born after 1995 there are 18% identify themselves as non-binary these days, I wonder this is also from the same cause, i.e. industrial food related, but I don't have concrete data to back this up.

Longevity is improving slowly, hope one day we can fully catch cancel from onset, I'm aware of quite a few who were taken away by cancers in their 50s or early 60s, sadly.

[+] mlindner|3 years ago|reply
Given that there's no accurate global historical measurements of cancer, anything of this sort is going to be heavily biased by the measurement.

You can only look at this comparative historical thing in certain developed countries with long histories of detecting all cancers.

[+] enviclash|3 years ago|reply
Since when are we using so many chemicals in soap and deodorants? Since when is soap the mainstream thing for washing the body? I am just curious, I remember an ecotoxicologist detailing the interaction of deodorants with hormons, it was pretty scary.
[+] hammock|3 years ago|reply
How much is climate change to blame for this epidemic?
[+] sangnoir|3 years ago|reply
Wouldn't it be awful if unbridled capitalism turns out to be mankind's Great Filter?

We'll be licky to become a Type I civilization after poisoning ourselves and the environment through exposure to chemicals and conditions we do not fully comprehend in return of some convenience, cheaper goods and making some a little richer.

[+] andrenotgiant|3 years ago|reply
Does Betteredge's law of headlines apply to academic papers?
[+] lebuffon|3 years ago|reply
I say this as often as I can. We have a vaccine that prevents cervical cancer with ~83% efficacy. Following the "bread-crumbs" seems like a good strategy to me.

We have this little beasty in wild. Human T-lymphotropic virus type 1, but no vaccine. https://www.who.int/news-room/fact-sheets/detail/human-t-lym...

We have correlation with cancer with other viruses. Hep C for example.

How many more clues do we need to expand research in this direction?

Could the implications for the existing cancer "industry" preclude finding prophylactic methods? Asking for a friend.

[+] uwagar|3 years ago|reply

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