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Cancer in the under 50s, known as early-onset cancer, is on the rise but the reasons behind this are complex. Here, Dr Sharon Tonner from our Cancer Theme Group discusses the increase and outlines the teams work to identify non-invasive tests which could be implemented in primary care to diagnose cancer at an early stage, when the best treatment options are available.

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In September 2023, BMJ Oncology reported that the global incidence of cancer diagnosed in people aged under 50 years increased by 79%, and deaths in this group increased by 28% between 1990 and 2019. With high-profile stories such as that of Dame Deborah James, founder of Bowelbabe, and the knowledge that 1 in 2 of us born after 1960 predicted to develop cancer within our lifetime, the resulting flurry of related media stories is understandable. The issue hit the media again recently following a report at the American Society of Clinical Oncology annual meeting which showed diagnoses in the under 50’s had risen 24% over the past two decades in the UK.

The reasons behind the rise in cancer diagnosis in the under 50’s (often referred to as ‘early onset’) are complex and are not yet fully understood. There is a general consensus that lifestyle factors in high-income countries which have shifted since the second world war have been contributing factors. These include more sedentary behaviour, more boozy and smoky nights indoors, and more ‘convenience’ such as highly processed foods.  We now are all strongly encouraged to move more, cut back on processed foods, give up the ciggies, and if you enjoy an alcoholic beverage to do so in moderation. In the coming decades we will no doubt start to see what effects vaping, air pollution, and record (sunburn creating) heatwaves have on cancer rates.

Cancer Research UK reports that 10% of new cancer diagnoses are in the 25-49 age group. The relative scarcity of early-onset cancer diagnoses leads to delays in diagnosis. Guidelines prioritise older people for urgent investigation, and a younger person’s risk of cancer is low enough that symptoms are rarely initially suspected to be cancer but reliable and cost-effective diagnostic tests in primary care are needed to help identify younger adults at the highest risk of cancer who should be referred.

A cheap, non-invasive test would mean a 33-year-old presenting with persistent abdominal pain, chronic constipation, or fatigue would be much more likely to be tested for cancer earlier ‘just in case’. However, a careful analysis of the potential for false positive results when using any new diagnostic test must first be conducted in this age-group to avoid unintended consequences such as unnecessary investigations.

Identifying these tests and how they can be best implemented within primary care to diagnose cancer at an early stage, when the best treatment options are available, is central to the Cancer Research Team’s work. We continue to build on research we have previously conducted in studies such as SYMPLIFY which explored a blood test that may help early identification of different types of cancer and ultimately improve patient outcomes.

You can keep up to date with our latest projects, including our work on identifying and evaluating diagnostic tests on Cancer theme page.

Opinions expressed are those of the author/s and not of the University of Oxford. Readers' comments will be moderated - see our guidelines for further information.


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