Josh Herting was on a business trip in Vermont when he received a phone call from his doctor that would change his life. On that cold winter day — a decade ago this week — his doctor told him that he had colon cancer.
After hanging up the phone, Herting wanted to keep working.
“I was very focused on work, and I was like, ‘I’ve got to finish this work trip, and then I’ll be home,’ ” he said. “I didn’t understand the seriousness of it.”
But moments later, he picked up the phone again and called his girlfriend, Amber. When he told her the news, she said it was time to come home.
Herting drove five hours to Boston. He arrived home at 2 o’clock in the morning and had medical appointments beginning six hours later.
“I was 34 years old, in what I would consider incredible health. I worked out five to six days a week, very low body fat, ate really healthy, and was in no pain or anything, but I noticed some clotted blood in my stool on a few different occasions,” said Herting, who is now 44 and married to Amber. He added that his father was diagnosed with stage I colon cancer in his early 50s but said he had no other known family history of the disease.
Herting’s journey of battling early-onset cancer is an experience shared by a growing proportion of young adults.
Cancer patients are “increasingly shifting from older to middle-aged individuals,” according to a report released Wednesday by the American Cancer Society.
Among adults 65 and older, adults 50 to 64 and those younger than 50, “people aged younger than 50 years were the only one of these three age groups to experience an increase in overall cancer incidence” from 1995 to 2020, says the report, which was published in CA: A Cancer Journal for Clinicians.
Even though the overall US population is aging, “we’re seeing a movement of cancer diagnosis into younger folks, despite the fact that there are more people that are in the older populations,” said Dr. William Dahut, chief scientific officer for the American Cancer Society.
“So cancer diagnoses are shifting earlier,” he said. “There’s something going on here.”
Herting’s diagnosis came after a gastroenterologist recommended that he get a colonoscopy due to the blood in his stool.
Herting had surgery, about a week and a half after his diagnosis, to remove the tumor and a foot of his colon. After the surgery and further testing, he said, his medical team at the Dana-Farber Cancer Institute estimated that the cancer had been in his system for about eight years and was stage IIIA. Stage III colon cancers are likely to have spread to nearby lymph nodes, but they have not yet spread to other parts of the body, according to the American Cancer Society.
Herting then had chemotherapy, and after five years of monitoring his recovery with CAT scans and blood work, his team declared him cancer-free. Amber remained by his side during his cancer treatments.
“But you’re never the same person,” Herting said of his cancer journey. He still has some fatigue and numbness in his fingertips and toes from chemotherapy, and he gets colonoscopies every three years – unless his doctor says otherwise – to make sure the cancer has not returned.
“Colonoscopies – I’ve had way more than I’d like to admit – they’re not fun. But at the same time, colon cancer and chemotherapy are a million times worse,” Herting said.
“There’s this stigma about colonoscopy. For people that have never had cancer, it’s kind of this taboo topic, and you’ve got to go through this process to prep for it, and that’s not fun,” he said. “But I can tell you firsthand, it is definitely worth doing.”
Among adults younger than 50, colorectal cancer has become the leading cause of cancer death in men and the second-leading cause in women, behind breast cancer, the new report says. In the late 1990s, it ranked fourth in both men and women younger than 50.
“It’s just different now than it used to be,” Dahut said. “This young adult trend is the thing that has me scratching my head the most.”
‘A call to arms’
Even though the rising cancer incidence among younger adults has been
“poorly understood” and raises more questions than answers, Dr. Scott Kopetz says he has seen the trend firsthand at MD Anderson Cancer Center in Houston.
“In our clinical practice, we’re seeing patients presenting younger and presenting before ages of screening for many cancers, so it’s certainly a continued concerning trend in the field,” said Kopetz, an associate vice president for translational integration and a professor of gastrointestinal medical oncology at The University of Texas MD Anderson Cancer Center.
For instance, it’s recommended that all adults start screening for colon and rectal cancers at age 45, but more cases are emerging among people at even younger ages.
“When one looks at the totality of the data, it really is a call to arms to really better understand the changing epidemiology of cancer,” Kopetz said.
“Colorectal is the most prominent one, but we’re also seeing that in cancers that don’t have as clear-cut screening guidelines – so things like pancreas, gastric cancer – are also seeing trends towards earlier ages,” he said. “Pancreas cancer, and to some extent gastric cancer as well, are ones that we just don’t have good screening methodologies currently, but we’re seeing a lot of the same trends occurring.”
Kopetz worries that the rising incidence of cancer in young adults will grow into a rising incidence of cancer in older age.
“There’s a concern that, as the population ages, that what is currently an increase in young-onset disease will turn into increases in mid-onset and late-onset disease as well. So if the epidemiology of this is changing, this could be the beginning of a wave of increased cancers that may persist or may continue to increase over the next decades,” he said.
The new American Cancer Society report projects that there will be about 2 million new cancer cases in the United States this year, equivalent to more than 5,000 diagnoses each day. It’s also projected that there will be about 600,000 cancer deaths in 2024.
“This is a call to better understand what’s driving these increases,” Kopetz said. “And a call also to accelerate efforts for early detection approaches that may provide screening for multiple different tumor types.”
Herting, who now has a 7-year-old son and a 5-year-old daughter, hopes that when his children are young adults, screening for cancers will be less intrusive, especially for colorectal cancer.
“I hope for the future that it’s made to be less invasive,” Herting said. “If we could find a way to make it less invasive, more and more people would be willing to do it, and most likely insurance might be more apt to cover it for more people.”
Other data has showed that the share of colorectal cancer diagnoses among adults younger than 55 in the US has been rising since the 1990s. Signs and symptoms of colorectal cancer include changes in bowel habits, rectal bleeding or blood in the stool, cramping or abdominal pain, weakness and fatigue, and unexplained weight loss.
A report released last year by the American Cancer Society showed that the proportion of colorectal cancer cases among adults younger than 55 increased from 11% in 1995 to 20% in 2019. Yet the factors driving that rise remain a mystery.
Some of the things known to raise anyone’s risk of colorectal cancer are having a family history of the disease, having a certain genetic mutation, drinking too much alcohol, smoking cigarettes or having obesity.
“People point to exercise, diet, types of food,” Dahut said, but there’s probably more than just one cause — and sometimes, younger people diagnosed with early-onset colorectal cancer are otherwise healthy, with a history of working out and eating healthy diets, and don’t have a family history or genetic mutations.
Some scientists have been looking into whether a woman’s obesity during pregnancy may be associated with an increased risk of colorectal cancer in her offspring and whether that association could contribute to increasing incidence rates in younger adults — but more research is needed.
“The continuous sharp increase in colorectal cancer in younger Americans is alarming,” Dr. Ahmedin Jemal, senior vice president of surveillance and health equity science at the American Cancer Society and senior author of the new report, said in a news release.
“We need to halt and reverse this trend by increasing uptake of screening, including awareness of non-invasive stool tests with follow-up care, in people 45-49 years. Up to one-third of people diagnosed before 50 have a family history or genetic predisposition and should begin screening before age 45 years,” Jemal said. “We also need to increase investment to elucidate the underlying reasons for the rising incidence to uncover additional preventive measures.”
Cases climb as deaths decline
Overall, the number of people dying from cancer in the United States continues to decline, but the incidence rates for several types of cancer — including breast, prostate, uterine corpus, pancreas, oropharynx, liver in women, kidney, melanoma, and colorectal and cervical in young adults — remain on the rise, according to the new American Cancer Society report.
Cancer deaths continued to fall in the United States through 2021, leading to an overall drop of 33% since 1991, the report says, largely due to fewer people smoking, more people detecting cancer early and major improvements in treatments for cancer, such as immunotherapies and targeted therapies.
“We’re encouraged by the steady drop in cancer mortality as a result of less smoking, earlier detection for some cancers, and improved treatment,” Rebecca Siegel, senior scientific director of surveillance research at the American Cancer Society and lead author of the report, said in a news release. “But as a nation, we’ve dropped the ball on cancer prevention as incidence continues to increase for many common cancers — like breast, prostate, and endometrial, as well as colorectal and cervical cancers in some young adults.”
The report adds that “progress is lagging in cancer prevention,” as six of the top 10 cancers in the United States have had increases in incidence.
Among the top 10 cancers, based on cases projected in 2024, those that are increasing are breast, prostate, melanoma of the skin, kidney and renal, uterine corpus and pancreas.
The new report says that incidence rates increased from 2015 through 2019 by about 1% each year for breast, pancreas and uterine cancers and by up to 3% annually for prostate, liver in women, kidney and HPV-associated oral cancers and melanoma. Incidence rates also increased up to 2% annually for cervical cancers in ages 30 to 44 and colorectal cancers in adults younger than 55, according to the report.
The report also highlights that racial disparities in cancer incidence and deaths continue, as people of color still face increased risks, and the report says this has “hampered” progress.
“Progress is also hampered by wide persistent cancer disparities; compared to White people, mortality rates are two‐fold higher for prostate, stomach and uterine corpus cancers in Black people and for liver, stomach, and kidney cancers in Native American people,” according to the report. “Continued national progress will require increased investment in cancer prevention and access to equitable treatment, especially among American Indian and Alaska Native and Black individuals.”