Name: Brainstorm Health 2024: The rise of cancer in young people
Uploaded: 2024-05-22
Duration: 17 min 6 s
Description: Dr. Thaïs Aliabadi, OB-GYN; Co-host, SHE MD Dr. Kimmie Ng, Founding Director, Young-Onset Colorectal Cancer Center, Dana-Farber Cancer Institute; Associate Professor of Medicine, Harvard Medical School Moderator: Erika Fry, Fortune

Dr. Thaïs Aliabadi, OB-GYN; Co-host, SHE MD Dr. Kimmie Ng, Founding Director, Young-Onset Colorectal Cancer Center, Dana-Farber Cancer Institute; Associate Professor of Medicine, Harvard Medical School Moderator: Erika Fry, Fortune

Brainstorm Health 2024: The rise of cancer in young people

Conferences

Dr. Thaïs Aliabadi, SHE MD Dr. Kimmie Ng, Founding Director, Young-Onset Colorectal Cancer Center, Dana-Farber, Cancer Institute; Harvard Medical School, Erika Fry, Fortune

Thank you all for being here for this conversation. Uh Doctor Ying, I want to begin with you. You're a clinician and a researcher focused on G I cancers and the rise in young onset cases in particular. While there's still a fraction of all cases are increasing. And it's a bit of a, it's a mystery as to why, right? What can you tell us what you're seeing and what we do know about why this is happening. So there is a silver lining about colorectal cancer in that overall and especially in people over the age of 50 there's been a decline in incidents and improvement in survival, largely due to increased compliance with screening guidelines and also improved treatments. But this improvement has not been seen in people under the age of 50 where it has been increasing by about 2% per year ever since since the mid 19 nineties. And in fact, the problem is so severe now that colorectal cancer is actually the leading cause of cancer related death in men under the age of 50 expected to be the leading cause of death in young women by the year 2030. And we do think it's probably some combination of environmental exposures that is causing this uptick, but we don't know exactly which ones. Wow. Um Thank you. We'll come back to that. Uh Doctor Kim, you know, is this something that we're seeing more broadly with all with other cancers? And in terms of, you know, figuring out what's driving this, what are the, the challenges, you know, this is a really concerning pattern that we've all seen someone who's done lung cancer in their past, but now oversee a lot of cancers. This is the epidemic that is smoldering underneath us. We are not noticing it enough and now it's becoming apparent when you walk through our clinics. Now you will see people in their forties and their thirties showing up with new cancer diagnoses. In fact, the American Cancer Society reported that it was the 50 under age group that had the increasing rate of cancer, not the older folks. And uh we did our own study here in Orange County in Southern California where we looked at L A county, riverside San Diego and uh as well as Orange County and Orange County where Newport Beach, Huntington Beach, Irvine is very highly educated uh population. We had the highest rates of cancer in those under the age of 50. So we've got to do something about this. Uh I I've seen patients in my own clinic in lung cancer over 10 years ago who were 4030 years old and it's not because of smoking. So something is happening. Um Doctor Ali Abadi, this is personal for you. You had breast cancer yourself. Olivia Munn, the actress credits you for saving her life for the role you played in her breast cancer diagnosis. In both those cases, they were near misses uh not caught or not detected in mammograms, but caught after you pushed for more thorough testing based on your breast cancer risk assessment score. You know, why was that the case? Why? Um are these things not? Um Like why are we not doing that screening? Well enough? No, first of all, thank you for having me. I've been in women's health for now over, I don't know, 30 years almost. And the first thing I noticed is that women in general get dismissed when they go to the physician, our complaints are dismissed and every time we open our mouth, they tell us we're exaggerating our symptoms. Uh It's P MS, it's anxiety. So that's the starting point of a woman going to a physician when it comes to breast cancer. Uh There's a lot of false information out there. Um I personally had no history, family, history of any cancers and I was still diagnosed with breast cancer. An average American has a 12.5% chance of getting cancer. So if I told you breast cancer, so if I told you this plane had a 12 point 5% chance of crashing. Would you board it? But when you tell a woman that you have a 12.5% chance of getting breast cancer. They're like, it's not a big deal. I don't have it in my family. Even if you don't have it in your family, you start at 12.5. Now, if you add, if you're tall, if you had Children after 30 if you have dense breast, if you've had family history, uh you know, you add these, uh if you're overweight, you add your risk factors and you get a risk score. If that risk score goes above, it's 20% or above. That means you fall into the high risk category and you have to start your imaging as early as 30 not 40. And you have to add MRI to it, which is exactly what I did for myself. And Olivia Munn. Olivia had a negative mammogram, negative ultrasound, but because her lifetime risk was 37%. I added an MRI, all her friends were telling her why is your doctor so paranoid? And you know, with my paranoia, she had three cancer lesions on her right and one on her left breast. And the, you're telling me as we came on stage, the CDC changed their CDC, the US task force because I heard you say it. They, they were talking and they're like the US task force changed their guideline. I'm like, who do you think did it? It's I call it the Olivia task force and I texted her since 2016, the US task force was recommending mammograms at age 50 it was driving me crazy. Olivia comes out with her story mid March on April 30th. I wake up in the morning, they had changed their guideline to 40 every two years and they said average risk this time, meaning if you're high risk, that means you need additional images. I texted Olivia and I said this is an Olivia task force. So thank you for that. Um That's uh that's great to hear. And you know, what are the challenges in detecting these cases early for younger patients, especially since they may not, you know, be entitled to screening at a younger age. Yeah. And the delays in diagnosis for young people presenting with symptoms that we commonly see with colorectal cancer is just a severe problem. There is an average delay of about six months to a year before somebody even goes to seek medical attention for their symptoms. And two thirds report having to see two or more physicians for being correctly diagnosed. And that's because there's a lack of awareness both among people, young people as well as the providers seeing them that colorectal cancer can happen in a young and otherwise healthy person. So there needs to be an increased awareness about what these symptoms are and not a dismissal of symptoms when they happen. Um Either of you have other things to add on what we can do to better prevent. So I have a personal story with my own colonoscopy. I'm 53 years old. I wanted to get my colonoscopy. At age 48. I went to my local gastroenterologist. He said, no, it's not going to get covered. You're going to have to wait. I waited 49 covered, not covered. 49 to 11 months. I get a phone call. We can do you now. Excellent. Had a colonoscopy. It was fine before I turn 51 the guidelines switched to 45. So am I five years late now or did I just get it in time? That's what frustrates me about these guidelines for lung cancer for years. The, the preventive task force recommendation was not to screen for lung cancer. It's because we don't have any evidence or data yet to support it. That doesn't mean we shouldn't do it. We've got to do something proactively through our research, through our clinical trials. Two of the initiatives that we've opened up here in Orange County at City of Hope through philanthropy. Not because the NC I is going to fund it or anything but philanthropic organizations. We opened up a pancreatic cancer screening program where in the 1st 10 patients who came in, we diagnosed a 78 year old sprite lady who's probably going to live to 110. Now, after her cured whipple and we found it. Second is a stomach cancer screening program. If you're of Asian or Latino descent, especially Asians, you come over from Asia, you're getting screened for gastric cancer. You moved to the United States. Now we don't screen it for it. It makes no sense. So we opened up a study now where we're screening our, a API population for this cancer. And the third one I'm going to open this year is a thyroid cancer screening program. Now again, if you go to the task force and it says thyroid cancer screening, they'll say not recommended may be harmful. Well, it's because we just haven't established the level one data or the pilot data that we need to find this. So it shouldn't stop our research and I hate it when people say it's not recommended. Well, no, it just means it hasn't been proven yet. We have to continue to pursue this. And if I may add the age at which to begin, colorectal cancer screening was lowered from 50 to 45. And most young patients getting diagnosed with colorectal cancer are in their forties. But if you look at the statistics, the rate of rise is actually steepest in those in their twenties and thirties who are still not eligible for screening. So a lot of work needs to be done to figure out how to best screen those really young individuals. I want to add one thing which is very important, especially when you talk about cancer in these young patients, make sure if you have family history of any cancers. I don't care what it is. If it's pancreatic, if it's prostate, you're a woman, it doesn't matter. Breast ovary colon, do a genetic test. These genes. I use the myriad my risk test. You can do it at home. You can literally order the box spit in the tube, send it back. They check for 48 cancer causing genes. It's so important because a lot of these younger patients specially have it in their family. They do carry a gene they could carry, I'm not saying all of them, but you don't want to miss at least the ones that carry the gene in my office starting age 25. If anyone has family history of cancer, I do uh order a genetic test on them and you just wanna make sure that's the uh you know, low lying fruit. You don't want to miss those patients, at least in your practice. And you'd be surprised how many people walk around without genetic testing. If you have one family member with pancreatic cancer insurance, we'll pay for it. If you have one family member with prostate, one family member with breasts, under 52 family members above 50 with breasts, two family members above 50 with colon, one under 50 with colon. I mean, almost everyone gets approved. So take advantage of that with appropriate genetic counseling as well. That's very important to have somebody be able explain those results to you and does wanna turn to the audience any questions? Uh just raise your hand? OK. I see you went out there. Um Hi uh Emily Sherbert with Apco worldwide. Um Well, I am the person you speak of. I was diagnosed with breast cancer at 48. Um just had my lumpectomy going through radiation in a few weeks and throughout um I was all did the 86 gene uh genetic testing, it was all negative. My mother had breast cancer though she got it in her mid ff so throughout my whole entire journey, nobody talked to me about my diet. Nobody talks to me about my alcohol consumption or my exercise or any of my lifestyle factors. And I'm convinced that that was a big part of what led to me developing cancer at 48. Um So talk to me about or talk to all of us really about, you know, why is that? Why isn't that diet and lifestyle and exercise? You know, I mean, I saw a surgical oncologist, I saw an oncologist, you know, at all these doctors part of my care, not one of them mentioned diet. I think, I think part of the problem is when we go to medical school and I'll completely be honest with you. I think we can all speak to that. No one sends us to a nutrition class. They don't teach us about diet lifestyle, right? We just learn to treat the disease and we forget about everything else that surrounds it. I agree with you. I mean, processed food, uh, lack of exercise, obesity alone is linked to 13 cancers. So, you're right. And until, you know, we, I mean, more and more we're learning about diet and health and, uh, not smoking and, um, uh, obviously avoiding alcohol but it's a, we don't know, I mean, there's so many factors I don't smoke, I don't drink. I don't, I've never done drugs. I've never been overweight. I don't have family history. I don't have a gene mutation. I got breast cancer. So I think as she was saying there, I was the poster child of an American woman who was not supposed to get any cancers. I got it when I was 48. So there's so much more to it. I think. So when I, when I moved, I was recruited to City of Hope. Just 3.5 years ago, we're building, we just built our second campus in Orange County. Orange County has got the sixth largest county in the country, 3.2 million people. My very first recruit to come to the center is a guy named Richard Lee. He is an integrative oncologist. He's internationally known. He has spent time as on a Fulbright scholarship over in Taiwan, learning about holistic lifestyle, therapies. I recruited him. We started an acupuncture clinic, a massage therapy clinic. We had other programs ready. And we were fortunate enough to meet some donors who were ready to join our mission in just what you say to treat the mind, body, soul and not just the disease, treat the person. And so uh the Churn Family uh Andrew and Peggy Chung gave us $100 million to set up the Churn Family Center for integrative oncology at City of Hope. And what we're going to do with this is basically a drug development institute. But for naturopathic compounds, we're going to test aromatherapy, art therapy, music therapy, tai chi, you know, white button mushrooms. Uh cannabis, actually, he's the first person in the country to get an NC I grant to study cannabis in patients who have neuropathy afterwards. So all of these things you've mentioned is so important. That's what we're going to integrate, not into just those who are diagnosed but also in the survival and cured patient population, but also in the preventative population as well. So I hear you loud and clear. It's the mission of what we're doing. We're armed with resources and brain and smart people who are coming to join us. And we're going to make this a nationwide program. So I salute you there. And I don't think it's a coincidence that breast cancer and colorectal cancer, the two most common cancers in young people are the most strongly linked to diet and lifestyle. We started our young onset colorectal cancer center with the goal to really guide patients after their cancer diagnosis about what they can do in survivorship to decrease the risk of recurrence and have them live healthier lives. And that does include exercise and avoiding red meat and avoiding alcohol and not smoking and all those things that are often too often overlooked. Unfortunately, when survivors are being counseled, uh real quick, we have one question in the back and then Alicia Bazzano from Hopkins Venison. Uh I don't want us to just throw the US Preventative Services task force down the river. There was a reason that they didn't originally do that and it's because of false positives as well. So a lot of these conditions, for example, uh cervical cancer, we've done tons of pap smears on women and subsequently a lot of procedures and a lot of money spent on all those procedures um for women to get their cervixes cut out. And now they don't actually need them cut out as much because we know the, the natural history a little bit more. And there are a lot of false positives. Similarly with breast cancer, there are questions about that as well. So I wonder what your response is in terms of how do you address false positives and um in the future you mentioned MRI. But how does A I play into this as well? I think let's start backwards. Thank you. I think A I plays a huge role, one of the centers that I refer my patients to uh basically as um last year, they implemented A I to read their mammograms. And I was speaking to the CEO of the company and he was telling me that in the past six months, a I picked up 500 lesions that the radiologist missed. So, and even in my case, when my mammogram, ultrasounds and MRI were all negative, I had no cancer but because my lifetime risk was high, I asked for a double mastectomy. And after I did it, they found cancer in the, in my breast tissue, not the uh not this um not on the left where we they were doing all the biopsies but on the right when you know, and it was read as completely benign on all three images. So I think a I will bring a huge value. I think our false positive rates will go down and when it comes to the US task force, you know, when sorry, I'm really sorry. We are completely out of time. I'm sorry, we couldn't get to more questions. But thank you all for being here and for not very much. I think you can connect in the hall, but thank you.