Between 2010 and 2019, incidence rates of 14 cancers increased among individuals younger than 50, with “concerning increases” reported in colorectal and uterine cancer mortality.

While the statistics may raise alarm, one oncology expert is encouraging healthcare leaders to understand the full picture.

Mary Gemignani, MD, is chief of the breast surgery division at New York City-based NYU Langone’s Perlmutter Cancer Center and director of the system’s Early Onset Cancer Program.

She spoke to Becker’s about the opportunities hospital and health system leaders have to invest in care models and education initiatives that can shift the rate of early-onset cancers in a different direction.

Editor’s note: Responses have been lightly edited for clarity and length.

Question: Some of the data coming out about early-onset cancers can be startling, particularly when not presented with context. What are the most urgent data points that hospital and health system leaders should be paying attention to now?

Dr. Mary Gemignani: There are basically three or four cancers that are the most prevalent. Sometimes the media homes in on one specific aspect, leading patients to come in with the perspective that this is an epidemic.

The overall numbers may be shifting to a younger onset, but the percentage is still relatively uncommon. Although there might be a perspective of an epidemic — when you’re thinking from a population perspective — the median age of those cancers are still in the group you’d expect them to be, except the younger cohort is slightly younger.

That’s the crux of this. Screening and care guidelines are geared towards an older onset, meaning younger patients are more reliant on symptoms that they often ignore, because there are no real guidelines to screen them. This is leading younger patients to present at more advanced stages and with more aggressive tumors.

Q: Can you share some of the gaps in current cancer care models that make them ill-suited for younger adults facing a cancer diagnosis?

MG: Most cancer care models are based on median patient age, and cancers are still more prevalent in older patients. For breast cancer, the median age is around 60, so a lot of our care models and research are geared towards that age. We don’t have a lot of evidence-based studies to treat younger patients.

From that perspective, we have to think about what we are missing. When patients present at an early onset in a more advanced stage, they end up getting all three care modalities — chemotherapy, surgery and radiation — leading to more disruption to their lives.

A lot of the things that are an important part of the care for younger adults may not necessarily be as important in older adults, such as job or education loss, health insurance changes, fertility concerns and financial toxicity.

Financial toxicity is huge. It affects outcomes when patients delay care or ration medication because they can’t afford it. Cancer drugs are very expensive and the treatments are very prolonged.

Q: If one accepts that increasing early-onset cancer rates are not an anomaly but a generational shift, what should forward-thinking health systems be doing to make a difference five, 10, 20 years from now?

MG: Warren Buffett always says, someone is sitting in the shade because somebody thought of planting a tree. That’s exactly what we’re thinking at NYU Langone.

We’ve decided to invest in an Early Onset Cancer Program. We basically focus on four components: the adolescent and young adult component, breast, colon and gynecologic cancers. Our program offers young folks a more comprehensive, holistic approach to their cancer.

Offerings include peer-to-peer support groups and access to social services. We are building those programs to focus on education, psychosocial services and financial toxicity, but also on research.

For example, about a third of breast cancer patients have triple-negative breast cancer, one of the most aggressive breast cancers you can get. Why are patients getting this particular type of breast cancer at a young age compared to when they’re 50 when the risk of getting that cancer is significantly lower?

We will be looking at tumors, biology, environmental factors, etc., to help us understand why the shift is occurring and discern where healthcare systems need to invest.

Q: While there are many contributing factors to the rise in early-onset cancers, what is the one driver you find most concerning or most under-recognized?

MG: Particularly as we talk about young adults, a lack of investment in education for both clinicians and for young adult patients.

I can’t tell you the number of times where I’ve seen a young woman who felt a breast mass and went to her doctor, and her doctor sort of said, “Oh, it’s nothing. It’s a cyst.” Didn’t order any imaging, didn’t order any follow-up. And the patient comes back in two years with advanced cancer.

Most healthcare systems are really good at treatment. There needs to be education that there is no such thing as too young to have cancer.

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