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Brigid Bergin: It's the Brian Lehrer show on WNYC. Good morning again, everyone. I'm Brigid Bergin, sitting in for Brian today. For the past few years, news articles have covered rising rates of what are considered early-onset cancers, usually meaning cancers that occur in people under 50 years old. In the past decade, a trend has emerged of over a dozen different types of cancer on the rise in younger adults. They include breast, colorectal, kidney, pancreatic, stomach cancers, and more. One example, in 2019, there were 4,800 more early-onset breast cancer cases in the United States than there would have been expected had 2010 rates persisted.

Some of that is due to better technology and an uptick in routine screenings that help catch some cancers early. New research suggests there are a number of factors that can help explain why people are getting certain types of cancer earlier than ever before. Joining us now to explain what scientists have found so far and what's still unknown is Nina Agrawal, health reporter for the New York Times. Nina, welcome back to WNYC.

Nina Agrawal: Hi, thanks so much for having me.

Brigid Bergin: Listeners, have you or a loved one been diagnosed with early-onset cancer? What sorts of conversations did you have with your doctors? Was it hard to get a diagnosis or prioritize screenings or have health insurance cover screening, because you weren't the right age range for the cancer you had, or anything else you'd like to share from your own experience? The number's 212-433-WNYC, that's 212-433-9692. You can also text that number. Nina, you define early onset cancer as those that occur in people under 50. Does that mean that all cancers are just certain types that doctors don't usually see in people under 50?

Nina Agrawal: Any early onset cancer is we're talking about adults here, generally, and the range varies a little bit by cancer, but under 40, 45, or 50, depending on the type of cancer.

Brigid Bergin: As for the causes, you write, "Cancer researchers often point to a historical inflection point, the 1950s. People born in or around that decade started experiencing higher rates of early-onset cancer in the 1990s." What happened with cancer rates following the 1950s?

Nina Agrawal: The reason the 1950s is that inflection point is that the people who were born in that decade, once they got older and they turned into their 30s and 40s, that's when we start to see this rise in cancer, starting in around the 1990s. The reason that that's thought to be an inflection point is because a lot of things changed in our environment. That's when that particular birth cohort, people born in that time period, those are the groups that started seeing rising rates of cancer. Then, successively after that, the next generations have seen successively steeper rises for some cancers.

Brigid Bergin: Are there any major lifestyle changes that scientists think may be behind certain cancers that we're seeing in younger adults now?

Nina Agrawal: Yes, definitely. I mean, these are population-level changes. These are not necessarily individual behavior changes. As a society, a lot about our environment, what we're exposed to physically, and our lifestyle has changed starting in the post-war years. That includes things we're exposed to. More plastics and PFAS, forever chemicals, a more sedentary lifestyle, less physical activity, more ultra-processed foods, and sugar. Our diet overall has changed, and we as a society have become more obese.

Brigid Bergin: I have listeners who are writing in a lot. One text in particular, "A lot is driven by increases in obesity. Also, we do see imaging for lots of good and bad reasons, which means we find some that we wouldn't have found." On that point, you wrote a review of nearly 15 million US cancer cases, found that the incidence of 6 out of 12 obesity related cancers rose in young adults between 1995 and 2014, with steeper rises in successively younger generations. What do scientists say about how obesity can cause early-onset cancer? Are there certain types of cancer more likely in people who are obese?

Nina Agrawal: The data are the strongest for colorectal cancer. That's one of the more common types of early onset, and it's one of the best studied. Obesity is implicated in other cancers as well. Scientists don't really know what is the mechanism that it might be going by to actually cause cancer. There are a few theories that it could be metabolic dysregulation, inflammation, changes to the gut microbiome, those sorts of things.

Brigid Bergin: Listeners, if you're just joining us, my guest is Nina Agrawal, health reporter for the New York Times. We're talking about a recent story she wrote about the increase in early-onset cancer. We want to hear from you. Have you or a loved one been diagnosed with early-onset cancer? Was it hard to get the screenings you needed or to get health insurance to pay for it? Is there anything else you want to share with us about what you learned from that experience that might help somebody else? The number's 212-433-WNYC. That's 212-433-9692. You can also text that number with questions. I have multiple listeners texting in something related to the consumption of plastics. What do scientists know so far about how that is leading to the increase in early-onset cancers?

Nina Agrawal: I know it's a question I get asked a lot, and I've reported a fair amount on plastics as well. The thing about environmental exposures is it's really hard to establish a causal link between any environmental exposure and a disease outcome. You can't randomly assign somebody to start ingesting plastics and follow them over time to see which ones develop cancer and don't. It takes a long time and a large body of evidence, which was the case with linking smoking to lung cancer.

It's just that the research on plastics is very new. We know that the production of plastic has increased exponentially since the 1950s and that it's accumulating in our waste and breaking down exponentially. Researchers have found it all over the earth and all over our bodies. There's really not a lot of research. There's a little bit showing some links to health outcomes like heart disease, but there's really not that much research, even though it seems like an obvious potential culprit.

Brigid Bergin: Sure. This question is in a similar vein. Another lifestyle factor is certainly alcohol consumption. I feel like I hear one study one day, another study the next day about how risky alcohol consumption is and what links there are to any number of diseases. Are there links between drinking and certain types of cancers?

Nina Agrawal: Yes, there are links between alcohol and a number of cancers, including colorectal and breast cancer. It is, I think, confusing for a lot of listeners and readers. The evidence, I think, is strongest for heavier consumption of alcohol and binge drinking. What researchers do know is that even though our consumption hasn't necessarily changed over time, our patterns of drinking in terms of heavy drinking and who's drinking more heavily with women, increasingly drinking more heavily has changed over time.

Brigid Bergin: I want to go to some of our listeners. Let's go to Brianne in New Brunswick, New Jersey. Brianne, you're on WNYC.

Brianne: Hi. Thanks for taking my call. My twin sister was diagnosed with colon cancer at 33. She then recently passed away 2 years ago at 37. She started complaining of stomach pains. For like three to five months, they just refused to test her for colon cancer because she was too young. She was complaining, and then, finally, New Year's eve, going into 2020, they did an emergency colonoscopy, and they found out that she had stage three colon cancer, and eventually escalated to stage four. She suffered through that for quite some time.

Her husband, during that time, also was diagnosed with colon cancer at 38 or 39, and he's still with us today. Again, same thing. Listen, your wife has colon cancer. There's no possible way that you have it too, even though you have the same symptoms. You're also under the age of 40 or 45. There's no way. It's been an impossible time. They were both told, listen, it's more expensive for the insurance companies to test you earlier, say at 25, 30 years old, to do pre-screenings than to treat folks with cancer.

Brigid Bergin: Brianne, thank you for sharing. I'm so sorry for your loss. We're definitely pulling for your brother-in-law. It sounds like you and your family are going through a very difficult time, but unfortunately are exactly the type of individuals that you have reported on, Nina. Your reaction to Brianne's story, and how many times have you heard stories like that as you've done this reporting?

Nina Agrawal: Yes, Brianne, I'm so sorry to hear what your family's going through. I have heard a fair amount of people say that, and not just for colon cancer, for lung cancer, for breast cancer, that their symptoms, they had some worry about some symptoms that they took to their doctor, and they were often dismissed because they were thought to be too young to have cancer. I think one thing that doctors have said in this reporting process is really people should pay attention to their symptoms and advocate. Doctors are becoming increasingly aware also and certainly, the screening is not recommended in the general population for younger people. If you have symptoms, that can warrant a test.

Brigid Bergin: I want to read a text from a listener that just speaks to this part of the story that we're dealing with now. A listener wrote, "I learned that you have to be your own advocate. I had a mammogram six months before breast cancer was diagnosed by a sonogram that I advocated for. The mammogram didn't detect it. Thankfully, my doctor believed in my voice. I was 43 and thankfully, I'm now in my 25 year of survivorship." A push for being your own advocate.

Another listener writes, "Ali from Brooklyn. Pathologists working in the Bronx have diagnosed more advanced colorectal cancer in patients under 45 for the past 2 years than ever from stage 4 with no family history. It's very frightening." Nina, I have had conversations on this show with people who've looked at the increase in colorectal cancer, in particular, among young people. What does the science say are some of the drivers of that?

Nina Agrawal: Yes, so we talked a little bit about some of the lifestyle shifts and the rise in obesity. That is really one of the strong hypotheses. Also, alcohol and poor diet quality. There is some research to show that a western diet pattern, including less fresh fruits and vegetables, more processed foods, red meat, sugar, sweetened beverages, have links to colorectal cancer. Then there are some newer findings about the behavior of cancer in younger people and what might be driving it, and the combination between environmental exposures and genetics.

In particular, there was a big paper earlier this year that showed that a certain pattern of mutations was more common in patients with early-onset colorectal cancer than in patients who had typical onset. That pattern of mutations was associated with a certain infection, an E. Coli infection with an extra weapon system, you might say. Researchers are trying to figure out why would that infection be more prevalent in younger people. It seems that that infection probably happened in these patients in an early time in their life.

Brigid Bergin: Interesting. Something from childhood that now is emerging in their young adulthood. Listeners, if you're just joining us, this is the Brian Lehrer show on WNYC. I'm Brigid Bergin, senior reporter in the WNYC and Gothamist newsroom. We're speaking with Nina Agrawal, health reporter for the New York Times, about the rise of early-onset cancers in people under the age of 50.

Nina, one of the things that can be pretty scary for you and I in this particular case is these shifts seem to be disproportionately affecting women. One of the things you write about is something called reproductive shifts. Girls are getting their periods earlier. Women are having children much later. Can you talk about how that may be leading to some of these increases in breast cancer?

Nina Agrawal: Yes, and I think part of the reason that women are disproportionately affected is because one of the more common cancers is breast cancer. Researchers who are studying this think it has to do in part with these society-wide reproductive shifts that have happened over the past six, seven, eight decades, which is girls are getting their period slightly earlier than they did before and more notably having their first pregnancies later and having fewer pregnancies. That gives them this longer period of time to be exposed to natural processes that can-- every month when you have your menstrual cycle, that is a period of a lot of cell turnover and expansion and proliferation, and contraction.

During that natural period, that is an opportunity for mutations to arise. By contrast, during pregnancy, especially in younger ages, what happens is it remodels the breast in a way that is more protective. Because there's this longer gap when you're subject to the natural process as well as potentially outside exposures like alcohol or metabolic disruption, and then the pregnancy later and fewer of them, you're having less of the protective benefits.

Brigid Bergin: Let's go to Laina in Maplewood, New Jersey. Laina, you're on WNYC.

Laina: Hi, can you hear me?

Brigid Bergin: Loud and clear.

Laina: Okay, great. Sorry. I'm 42 years old and I had been having back pain in various areas for a while. At the beginning of 2025, my chiropractor said I should check out a spine doctor, just to maybe get some imaging. I went to a spine doctor, and he sent me for an MRI. The MRI came back, the spine doctor said that I should eat a more anti-inflammatory diet. My chiropractor, a few weeks later, who happened to have access to my MRIs through her, whatever system they use in their office, she said, "By the way, did anyone mention that you have a node on your thyroid?"

I went to an endocrinologist, and they did some testing, biopsy, and it turned out that I had cancer, thyroid cancer. I just am so grateful for my chiropractor spotting this and telling me, and otherwise I never would have-- I wouldn't have known. I was able to have half of my thyroid removed by the wonderful Dr. Fahey at New York Presbyterian. Now I'm doing great. Recovery was good, and I'm on a small dose of thyroid medicine, but other than that, there's no other treatment required. It's just so strange that the spine doctor didn't really-- he didn't really look at my whole picture, and luckily, my chiropractor did.

Brigid Bergin: Laina, thank you for calling and sharing that. We're so glad you're doing well. Thank you. Our thanks to your chiropractor and your oncologist. Nina, I feel like a theme in these calls that we're hearing involves so much of people having to advocate for themselves. I'm getting a lot of questions from listeners who want to know what do they do about this? Are there screenings they should be pushing for, and are there ways that they can protect themselves?

Nina Agrawal: Yes. I want to remind listeners that early-onset cancer is still very rare. The majority of cases still occur in older patients, and for that reason, screenings generally are in older people 40, 45. You should definitely make sure that you're up to date on your screenings, that are routine, and that's something you can ask your primary care doctor about. Then, if you have symptoms, you certainly should be taking those to your doctor and take them seriously. Doctors say this all the time, that patients know their bodies best.

As awareness is changing, I think-- I will say lots of doctors also are very open and have been advocates for their patients to receive tests and imaging for symptoms that they were concerned about. Certainly, patients can ask for those if they have symptoms that are not going away or that are getting worse.

Brigid Bergin: Part of our conversation, Nina, has been about some of the lifestyle changes that we have seen that people, potentially, there could be some connection to those changes and this increase in early-onset cancer. You also write about changes to our environment. You wrote, "Emerging research suggests that certain exposures, probably early in life or even in the womb, may change our genetic code." You gave an example of gut cells in your reporting. Can you walk us through that a little bit more?

Nina Agrawal: Yes. This is really about the interplay between our environment, our genes, and actually our immune system as well. I referenced that a little bit with that discussion of the E. Coli finding that this particular toxin, that certain strains of E. Coli produce, this pattern of mutations, was imprinted on these patients more commonly in early-onset colorectal cancer than in typical onset. There are other examples of where this interaction between something we're exposed to is affecting how our cells and our immune cells and our-- in breast cells, how our genes are expressed.

Scientists, really, are using this as an example to point to mutations are not enough. It's not just mutations. Most of us have these mutations, sometimes even from birth, even though they're not inherited. You need some other factor to turn those mutations on or to accelerate them to actually lead to cancer. That actually is a little bit of a hopeful point because that gives us time. It takes decades for these mutations to turn into cancer. It gives us those decades to intervene because a lot of cancer is preventable through lifestyle factors.

Brigid Bergin: Nina, when we hear about something like E. Coli, I think of it most in connection to foodborne outbreaks. Can you say a little bit more about how it could create this change that could potentially cause the early-onset cancers?

Nina Agrawal: It's a little bit technical, and it's not all E. Coli infections. Scientists don't really know if everybody who gets the infection-- not everybody who gets the infection is going to get cancer, but they believe that children, even probably in their early years, like first two or three years of life, who get this infection with this particular strain that produces a toxin called colobactin, that they are at an increased risk for colorectal cancer, basically because they're getting these mutations to their genome really early on in life. They're on a fast track to cancer if they have other changes that promote the cancer development.

Brigid Bergin: Let's go to one more caller. We'll try Kitty in Huntington, New York. Kitty, you're on WNYC.

Kitty: Hi. Wow. Thank you for taking my call. I was having issues with my gut for three and a half years. I don't want to get too graphic, but let's just say it was coming out of me all the time. Conventional doctors did not know what to do, so I went to functional doctors, and the functional doctors diagnosed all these kinds of things going on in my gut. They found a precursor to breast cancer in the testing that they did, and because of that, they'll be able to treat me preventatively.

If I hadn't gone to functional medicine, I would have never discovered that I had even a precursor for cancer. I don't have the BRCA gene. It just showed up in my hormones as high 4-hydroxy. I would have never have discovered that if I had continued with conventional doctors.

Brigid Bergin: Kitty, thanks for your call and your experience. Nina, for those-- I don't know if you do a lot of reporting on the difference between functional doctors or traditional medicine, but any reaction to that? I think people seeking lots of ways to treat themselves in these times when it's hard to get doctors to necessarily give you the screenings you need.

Kitty: People can also go to places online where they can get their own blood work done, like through Function Health, they can get their own blood work done, and then they can bring it to a doctor to evaluate those results.

Brigid Bergin: Kitty, thank you so much for that. Nina, before we let you go, I wonder if you could talk just briefly, how do you think this research can play a role in potentially reversing this trend of early onset cancers? An optimistic note, we have several listeners who have written in feeling a little bit like-- particularly women in this case, we're talking about you're drinking, it's you're eating, it's feeling like they're being blamed for this rise in early onset cancers when certainly some of this research suggests there are factors outside of their control, that it's not women's behavior, per se, that is causing these things, but it's this combination of these factors. What, to you, gives you the most hope when you look at this research about how this trend could be reversed?

Nina Agrawal: I think scientists are really optimistic that there's attention being paid now that they have data, and they can show, actually, what are the trends. Then they can go from there to look into what is behind the trends. Will that mean that we need to change screening and detection procedures? Do we need to shift to some ways of looking earlier? I think the awareness and the rallying in the scientific community around this topic is really hopeful. I would just add on one point you mentioned, researchers, oncologists, basic scientists really make this point that it is not about blaming any one individual for their cancer. Lots of very healthy people end up with cancer.

A lot of these are not inherent, that's not genetic. These are society-wide population-level shifts. When they talk about reproductive trends, or alcohol or obesity, these are things that have happened in our society collectively across a full population and not just in the US, and they correlate those to these shifts. It really is not about any one individual's behavior, but looking at what are some shifts across big numbers that we can relate to these changes.

Brigid Bergin: Sure. I want to thank you so much. Nina Agrawal is a health reporter for the New York Times. Her latest asks why are more young people getting cancer? Nina, thanks so much for coming in.

Nina Agrawal: Thank you for having me.

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