When it comes to early-onset cancer, The Princess of Wales is unfortunately not alone
As published in The Globe and Mail – Opinion: March 26, 2024
Dr. Sharlene Gill is a professor medicine at the University of British Columbia, a medical oncologist practising in Vancouver and the President of the Canadian Association of Medical Oncologists.
Last week, the 42-year old Catherine, Princess of Wales, shared the surprising news that she is on preventative (adjuvant) chemotherapy after a diagnosis of cancer found during abdominal surgery for what was believed to be a benign condition. Surrounded by what appear to be daffodils, a flower associated with the fight against cancer, she said “For everyone facing this disease, in whatever form, please do not lose faith or hope. You are not alone”. On March 22nd, Princess Catherine, aged 42 years, shared the surprising news that she is on preventative (adjuvant) chemotherapy after a diagnosis of cancer found during abdominal surgery for what was believed to be a benign condition.
Speculation remains on the type and stage of her cancer but what is clear is that it took tremendous courage to publicly disclose the private and difficult reality of a cancer diagnosis. I commend Princess Catherine for sharing her personal story and using her platform to remind us that cancer affects us all and does not discriminate by race, gender, religion, social status…or age.
We have heard this statistic often – an estimated 2 in 5 Canadians will be diagnosed with cancer and 1 in 4 will die of cancer. While cancer is, of course, hard at any age, it is particularly hard to accept in a young person. This, however, is no longer rare. The majority of cancers still occur in an older population, but early-onset cancers – diagnosed under the age of 50 – are increasing at a rapid and alarming rate. I find myself having difficult cancer conversations with young families on a daily basis, and this was certainly not the case when I started my practice 20 years ago. The cancer community is calling this an early-onset cancer epidemic.
While it is not known if Princess Catherine’s early-onset abdominal cancer is a colorectal cancer, March is Colorectal Cancer Awareness Month and this cancer well illustrates the changing epidemiology of early-onset cancers. Colorectal cancer is the third leading cause of cancer in men and women. While rates are declining in people over the age of 50, Canadians born after 1980 are 2 to 2.5 times more likely to be diagnosed with colorectal cancer than previous generations at the same age.
The reasons for this age shift are uncertain. Many theories abound relating to heavily processed diets, lack of exercise, early obesity, our gut microbiome and our environment. What we do know is that we can no longer dismiss symptoms with ‘you are too young to get cancer’ and we need to re-examine our cancer screening guidelines to reflect the changing demographic of cancer. To remind you, cancer screening means looking for cancer before symptoms appear. We know there have been tremendous recent advances in cancer treatment, but it remains true that prevention and early detection is our best chance for cure. In 2021, the US Preventative Task Force revised their guidelines for colorectal cancer screening in average-risk individuals from age 50 to now include younger individuals between age 45 to 49 years. Canada still recommends screening at age 50 and there are widespread calls to lower our age threshold as well. This goes hand-in hand with a need for greater public and primary care awareness to encourage screening and recognize symptoms early.
As individuals, we can also reflect upon our personal risk examining our family history and seeking medical guidance to identify preventative strategies that may help address this risk. Cancer can also be influenced through lifestyle choices including factors such as diet, physical activity and our exposure to smoking, alcohol and UV radiation. To be clear, there is no lifestyle ‘magic bullet’ for cancer prevention but risk matters and we need to exercise our personal agency and control what is in our control.
Our governments must increase targeted funding to support research in early-onset cancers and how we can turn this tide for future generations. We need a cancer care system that is sufficiently resourced to not only provide essential chemotherapy, radiation and surgical treatments but also provide the unique supports needed for young adults living with cancer including age-appropriate psychosocial support, fertility counselling, genetic testing, cancer rehabilitation and survivorship.
Like countless Canadians, I wish Princess Catherine a full recovery. As an oncologist, I know the months ahead for her and her family will not be easy, and I hope they receive the grace and support to do so privately. Let’s use her brave message of “you are not alone” to remind us that we are all in this together and it is time to think differently about the changing face of cancer.