Cancer cases are becoming increasingly common among young adults in the United States. This is a troubling trend that stakeholders across the healthcare industry are working to turn around.
Colorectal cancer in particular is particularly manifesting in younger patients, with the diagnosis rate of this disease rising by 15% in people aged 18-50 since 2004.
Data show that cancer is appearing in Americans more than ever before. However, many young people missed the screening, which could lead to late diagnosis with poor outcomes. These low screening rates are primarily due to lack of recognition, cost barriers, or lack of anxiety or discomfort.
To reduce the incidence of cancer among young people, healthcare leaders recommend increasing access to early detection tests and offering a variety of testing options. Some ways to do this include expanding the benefits of a health plan to cover at-home testing, multicancer detection testing, and more diagnostic services.
Why providers are involved
In 2021, the US Preventive Services Task Force (USPSTF) issued a new recommendation that colorectal cancer screening should be started at age 45 rather than at age 50.
The USPSTF is, at least for now, a panel of experts recommending preventive health services such as cancer screening. HHS secretary Robert F. Kennedy is reportedly considering eliminating all 16 members of the USPSTF because they were “awakened too much.”
The panel changed the recommended screening age according to the trend toward an increase in colorectal cancer cases among young adults. Data show that almost 10% of new colorectal cancer cases worldwide occur in people under the age of 50.
Dr. Usmansher, medical director of gastrointestinal oncology at Atlantic Health's Overlook Medical Center in Summit, New Jersey, has observed an increase in colon cancer cases in patients in their 30s and 40s over a two-year career.
Lowering the screening age to 45 is a step in the right direction, but he emphasized that cases will appear more and more among younger people.
These patients are often diagnosed at a later stage due to lack of screening, Dr. Shah added. Identifying colorectal cancer at the late and early stages can make a huge difference. The 5-year survival rate for first-stage colorectal cancer in the United States is approximately 92%, but that percentage is only 12% of stage IV.
Dr. Shah pointed out that most cases of colorectal cancer begin as pre-clear polyps that take seven to ten years to become cancerous.
“What I always want to emphasize to patients is that colonoscopy is not just early detection compared to other forms of early screening and early detection. It's prevention because if it can remove that polyp when it's in a malignant state, you can avoid converting it to malignant,” he explained.
The screening rates for young people are still quite low, but they are rising. According to the survey, the latest share of US adults ages 45 to 49 in colorectal cancer screening has increased from 19.7% in 2021 to 33.7% in 2023. According to the survey.
Dr. Shah recommends that providers provide a variety of testing methods to further increase the speed of screening.
“There's no invasive protection whether it's a DNA-based assay or match, and I think we'll have to meet patients with patients. Some patients are more likely to undergo non-invasive testing and can be done at home.
He also encouraged providers to have honest conversations with patients about lifestyle changes they could adopt to reduce their risk of developing cancer. In the case of colorectal cancer, there are known risk factors such as regular consumption of lean meat, processed foods, and alcohol, and the patient needs greater awareness, Dr. Shah said.
For example, many patients need guidance on how to create diets that are high in fiber, fruit and vegetables, and how to create education to maintain normal physical activity and healthy weight.
Makes testing more convenient
Like Dr. Shah, TealHealth CEO Kara Egan believes it is important for patients to have a variety of screening options. In May, the San Francisco-based startup in Egan was FDA approved for its first home-based neck cancer test.
Cervical cancer is another cancer that is becoming increasingly prevalent among young people. In the US, the incidence of cervical cancer among women aged 30-34 years has increased by 2.5% per year from 2012 to 2019.
Approximately 80% of women take human papillomavirus (HPV) throughout their lifetime. For many people, especially those who have received the HPV vaccine, the virus will disappear on its own within two years. But for others, the infection can lead to cervical cancer. In fact, over 90% of cervical cancers are caused by HPV infection.
Despite these numbers, many women do not take the HPV test. According to CDC guidelines, women should be tested regularly from the age of 21 to 65, but only one in four women of screening age will be screened. Not only do many women struggle to find access to this trial, but many patients find the HPV screening method (most commonly known as PAP tests or Pap smears) unpleasant and invasive.
Teal's screening device, called The Teal Wand, allows patients to self-collect neck samples before sending the samples to the lab. Once the sample is processed, Teal's clinicians review the results and are then shared with the patient via the startup's telehealth platform.
In addition to the issues of access and comfort, there are also some issues with understanding the procedures of the average woman, Egan noted.
“The Pap smear is not a mammogram with breast cervical cancer. Most people don't fully understand Pap smears. They don't know what they are actually testing. The correct term – the more you can use cervical cancer screening, the more important it can be to complete your visit,” she said.
Egan also said that most patients are not aware that cervical cancer is almost completely preventable if caught early in HPV screening.
Teal began rolling out its products to consumers last month. As the company continues to implement consumer outreach, its main goal is to remove patient fear and confusion. And she explained that regular cervical cancer screening is less worrying in the long run.
For broader early detection
Colorectal and cervical cancer rates are not the only ones that are increasing. Other cancers such as the breast, pancreas, kidneys, prostate and uterus are also becoming increasingly common among Americans under the age of 50.
This has replaced multicancer detection tests such as Grail's Galleri test and Exact Sciences' CancerSeek test.
Spotitearly is an early cancer detection startup in Israel, launched in the US in May. The test aims to use AI and trained dogs to analyze patient breathing samples and detect multiple types of cancer in the early stages.
Startup testing requires patients to breathe for 3 minutes into what appears to be an N95 mask. After samples are collected, Spotitearly dogs use their noses to sniff and detect the odor signature of the cancer found in the patient's volatile organic compounds. If the dog has identified a cancer signature in the sample, sit next to it and inform the lab of this.
This test costs $250 for a single type of cancer and $500 for spotietearly screens for all four types of breast, colorectal, prostate and lung.
Madhar pointed out that in the US, patients' cancer screening intake rates are usually surprisingly low, sometimes single-digit rates. This is unfortunate because there is a positive trend towards therapeutic innovation, such as immunotherapy and treatments that target the cancer microenvironment.
He believes that early detection is more valuable than ever, as advances in cancer treatments have led to effective treatments for many early stages of cancer.
Madhar also pointed out that most people are not looking for all the recommended individual cancer screenings due to hurdles such as cost, time, intrusion, and anxiety. He argued that a single multicancer test is a more accessible option that could lead to better adoption.
There are several multicancer detection tests ordered by US doctors, but no one has been approved by the FDA yet, Madar pointed out.
In the US, companies selling early cancer detection tests for multiple types of cancer are permitted to do so based on clinical laboratory improvement amendments (CLIA) certification rather than FDA approval.
FDA approval means that the agency has reviewed clinical trial data from a test and confirmed it is safe and accurate for its intended use. CLIA certification, on the other hand, regulates the lab process, not the diagnosis itself.
Madhar said he hopes that initial FDA approval will come soon, as this will increase the uptake of multicancer detection diagnostics.
How payers reduce barriers to screening
Rhonda Randall, chief medical officer of Commercial Business at UnitedHealthcare, believes payers will also play a key role when it comes to dealing with rising cancer rates among Americans.
Last month, UnitedHealthcare announced new benefits in the detection of breast and colorectal cancer in commercial plan members. These benefits are expected to take effect on January 1st, and will fully cover the initial diagnostic imaging tests of breast cancer and the initial diagnostic tests of colorectal cancer, regardless of the age of the patient.
Prophylactic screenings such as mammograms and colonoscopy are usually performed when no symptoms are present, and these are usually already covered by insurance. However, the UnitedHealthCare announcement is related to diagnostic testing. Providers use these to arrive at a specific diagnosis if the patient has symptoms or abnormal screening results.
“We know that with breast cancer, for example, there will be additional diagnostic images for about 11% of people who take part in mammograms,” Randall said. “So when (the provider) sees something, they'll want to get an additional image, and it's often billed as a diagnostic image – it has brought additional costs for that member in the past.”
Similarly, Randall noted that nearly half of colonoscopy results in polyp identification. This could change the classification of procedures from preventive screening to diagnostic tests.
By eliminating these costs of diagnostic testing, UnitedHealthcare aims to reduce barriers to care and enable more timely diagnosis, Randall said.
“Early stage cancer is much more treatable, with fewer side effects, fewer recovery times and fewer time to get away from work. When you catch something early, you can go through that checklist,” she said.
There is a real possibility that the trend towards advances in diagnostic technology and early screening will reverse the increasing trend in cancer incidence in young populations. The experts interviewed in this article agreed that this purpose would require continued cooperation between payers, providers and diagnostic companies.
Photo: St. Art, Getty Images
