Cancer cases are becoming increasingly common among younger adults in the U.S. — a troubling trend that stakeholders all over the healthcare industry are working to reverse.
Colorectal cancer in particular is appearing in increasingly younger patients, with the rate of diagnoses for this disease having risen by 15% in people ages 18 to 50 since 2004. The country’s overall five-year survival rate for colorectal cancer is slightly over half.
Data shows us that cancers are appearing in Americans earlier than ever before. However, many younger people are missing out on their screenings, which can lead to later-stage diagnoses with worse outcomes. These low screening rates are mainly due to lack of awareness, cost barriers or feelings of anxiety or discomfort.
To reduce cancer incidence in younger people, healthcare leaders recommend boosting access to early detection tests, as well as offering a variety of testing options. Some ways to do this include at-home testing, multi-cancer detection tests and expanding health plan benefits to cover more diagnostic services.
Why providers are concerned
In 2021, the U.S. Preventive Services Task Force (USPSTF) issued a new recommendation that colorectal cancer screening should start at age 45 instead of 50.
The USPSTF is a panel of experts who make recommendations on preventive health services like cancer screenings — at least for now. HHS Secretary Robert F. Kennedy is reportedly considering eliminating all 16 members of the USPSTF for being “too woke.”
The panel changed the recommended screening age in response to the trend of increasing colorectal cancer cases among younger adults. Data shows that nearly 10% of new colorectal cancer cases around the globe occur in people younger than 50.
Over his two-decade-long career, Dr. Usman Shah — medical director of gastrointestinal oncology at Atlantic Health’s Overlook Medical Center in Summit, New Jersey — has observed a growing number of colorectal cancer cases in patients in their 30s and 40s.
While lowering the screening age to 45 is a step in the right direction, he emphasized that cases are increasingly appearing in even younger people.
These patients often receive their diagnoses at later stages due to lack of screening, Dr. Shah added. Identifying colorectal cancer at a late stage versus an early stage can make a major difference — the five-year survival rate for stage I colorectal cancer in the U.S. is about 92%, whereas that percentage is just 12% for stage IV.
Dr. Shah pointed out that most colorectal cancer cases begin as premalignant polyps, which typically take seven to 10 years to become cancerous.
“One of the things I always like to stress to my patients is that colonoscopies, in comparison to other forms of early screening and early detection, are not just early detection — it’s prevention. Because if you can remove that polyp when it’s in a pre-malignant state, you can avoid having it transform into malignancy,” he explained.
While screening rates among young people are still pretty low, they are going up. Research shows that the share of U.S. adults ages 45 to 49 who are up to date on their colorectal cancer screening rose from 19.7% in 2021 to 33.7% in 2023.
To increase the rate of screening even more, Dr. Shah recommends that providers offer a variety of testing methods.
“There are also less invasive methods of protection, whether that’s DNA-based assays or FIT tests. And I think you have to meet patients where they are — some patients are going to be much more amenable to a noninvasive test, one that can be done at home and then sent in. Other patients are going to want the more comprehensive evaluation, including that early prevention with polypectomies, with a colonoscopy,” he remarked.
He also encouraged providers to have honest conversations with their patients about lifestyle changes they can adopt to lower their risk of developing cancer. In the case of colorectal cancer, there are known risk factors — such as regular consumption of red meat, processed food and alcohol — of which patients need greater awareness, Dr. Shah stated.
For example, many patients need guidance on how to create a diet that is high in fiber, fruits and vegetables, as well as education about regular physical activity and maintaining a healthy weight can help reduce risk.
Making testing more convenient
Like Dr. Shah, Teal Health CEO Kara Egan also thinks it is important that patients have a variety of screening options. In May, Egan’s San Francisco-based startup received FDA approval for the first-ever at-home cervical cancer test, which gives patients an alternative to the in-office pap smear.
Cervical cancer is another cancer that is increasingly prevalent in younger people. In the U.S., cervical cancer incidence among women ages 30 to 34 has grown by 2.5% per year from 2012 to 2019.
Roughly 80% of women will get human papillomavirus (HPV) in their lifetime. For many, especially those who have gotten an HPV vaccine, the virus will go away on its own within two years. But for others, the infection could lead to cervical cancer. In fact, more than 90% of cervical cancer cases are caused by an HPV infection.
Despite these figures, many women don’t get tested for HPV. CDC guidelines say that women should be tested regularly from ages 21-65 — yet only 1 in 4 women of screening age get screened. Not only do many women struggle to find access to this exam, but many patients find the method for HPV screening — most commonly known as a pap test or pap smear — to be uncomfortable and invasive.
Teal’s screening device, called the Teal Wand, allows patients to self-collect a cervical sample and then send the sample to the lab. Once the sample is processed, Teal’s clinicians review the results, which are then shared with the patient via the startup’s telehealth platform.
In addition to issues with access and comfort, there are also some problems regarding the average woman’s understanding of the procedure, Egan pointed out.
“Pap smear is not to cervical cancer the way mammogram is to breast. Most people don’t really totally understand the pap smear — they don’t know what it’s really testing for. I think the more we can use the correct term — a cervical cancer screening — the more we elevate the importance of getting those visits done,” she stated.
Egan also noted that most patients don’t realize that cervical cancer is almost entirely preventable when caught early through HPV screening.
Teal began rolling out its product to consumers last month. As the company continues to conduct consumer outreach, its main goal is to remove patients’ fear and confusion — and to highlight that regular cervical cancer screenings equal less worry in the long term, she explained.
The case for broader early detection
It’s not just colorectal and cervical cancer rates that are increasing — other cancers, such as breast, pancreatic, kidney, prostate and uterine are also becoming more and more common among Americans under age 50.
This has given way to multi-cancer detection tests, such as Grail’s Galleri test and Exact Sciences’ CancerSEEK test, noted SpotitEarly CEO Shlomi Madar.
SpotitEarly is an Israeli early cancer detection startup that launched in the U.S. in May. Its test uses AI and trained dogs to analyze patients’ breath samples, with the goal of detecting multiple types of cancer at their earliest stages.
The startup’s test requires patients to breathe into what looks like an N95 mask for three minutes. After the sample is collected, SpotitEarly’s dogs use their snouts to sniff and detect cancer odor signatures found in a patient’s volatile organic compounds, which Madar described as “biological information from the blood in our lungs that travels into the air we exhale.” If a dog identifies cancer signatures in a sample, it will signal this to the lab by sitting next to it.
The test costs $250 for a single type of cancer and $500 for all four types SpotitEarly screens for: breast, colorectal, prostate and lung.
Madar pointed out that in the U.S., patients’ rates of cancer screening uptake are usually alarmingly low, sometimes just a single-digit percentage. This is a shame because there is a positive trend in treatment innovations, such as immunotherapies and therapies that target the cancer microenvironment, he said.
He believes that advances in cancer treatment have made early detection more valuable than ever, since effective therapies now exist for many cancers in their earliest stages.
Madar also pointed out that most people don’t seek out all their recommended individual cancer screenings due to hurdles like cost, time, invasiveness and anxiety. A single, multi-cancer test is a more accessible option that could lead to better adoption, he argued.
While there are some multi-cancer detection tests being ordered by doctors in the U.S., none have been approved by the FDA yet, Madar noted.
The companies selling early cancer detection tests for multiple types of cancer in the U.S. are allowed to do so under Clinical Laboratory Improvement Amendments (CLIA) certification, not through FDA approval.
FDA approval means the agency has reviewed a test’s clinical trial data and confirmed it is safe and accurate for its intended use. CLIA certification, on the other hand, regulates the laboratory’s processes rather than the diagnostic itself.
Madar said he hopes the first FDA approval comes soon, as this will increase uptake of multi-cancer detection diagnostics.
How payers can reduce barriers to screening
Rhonda Randall, chief medical officer of UnitedHealthcare’s commercial business, thinks payers also play an important role when it comes to addressing Americans’ rising cancer rates.
Last month, UnitedHealthcare announced new benefits for breast cancer and colorectal cancer detection for its commercial plan members. These benefits, which are slated to go into effect on January 1, will fully cover members’ first diagnostic imaging test for breast cancer, as well as their first colorectal cancer diagnostic test, no matter the patient’s age.
Preventive screenings like mammograms and colonoscopies are typically done when no symptoms are present, and these are already usually covered by insurance. UnitedHealthcare’s announcement has to do with diagnostic tests, though. Providers use these to arrive at a specific diagnosis when patients have symptoms or abnormal screening results — and these often come with out-of-pocket costs for the member.
“For breast cancer, for example, we know that for about 11% of people who go in for a mammogram, it results in an additional diagnostic image,” Randall said. “So when [the provider] sees something, they will want to get an additional image, and that is often billed as a diagnostic image — which, in the past, has resulted in additional costs for that member.”
Similarly, Randall noted that nearly half of colonoscopies result in the identification of a polyp — which can cause the procedure’s classification to change from a preventive screening to a diagnostic test.
By eliminating those costs for diagnostic tests, UnitedHealthcare is aiming to reduce care barriers and enable more timely diagnoses, Randall said.
“Early stage cancers are much more treatable, and they have fewer side effects, a faster time to recovery and less time away from work. You can go through that checklist of good news when you catch something early,” she stated.
With advances in diagnostic technology and greater attention being paid to early screening, there is real potential to reverse the trend of rising cancer incidence in younger populations. The experts interviewed for this article agreed that this objective will require ongoing collaboration between payers, providers and diagnostic companies.
Photo: ST.art, Getty Images
