What’s behind the rise in early onset cancer (and what we can do about it)
Cancer at younger ages is becoming more common in Australia. What do you need to watch out for?
Katie Elson is not yet 30. In early 2022 her partner noticed a small lump in her breast. At first they thought it was an ingrown hair, but she was naturally worried, and went to her GP.
“She said it didn’t feel nasty, and told me that anyway I was too young to have cancer,” Katie says.
“She was saying it was in my head, that I’d been watching too many romantic movies where someone had cancer.
“The doctor said testing for cancer wouldn’t be cheap and that at my age I wouldn’t get any concessional rates.
“But I said I’d rather be sure, even if the costs did come to nearly $2000. A week later I did them (a mammogram, ultrasound and core biopsy) and found that I had stage three breast cancer. From diagnosis to surgery it was six weeks.
“I had a double mastectomy and have had four reconstructions since. It still doesn’t look quite right, but I can’t afford to take any more time off work,” she says.
Katie’s cancer journey doesn’t end there, as you’ll see. She is one of an increasing number of younger Australians diagnosed with cancer, most notably breast, thyroid and colorectal cancers. And there is serious concern that the health system is failing to catch some of these cancers early enough, when there is the best chance for survival and recovery.
Advocates are calling for a change in perception among the medical profession that breast cancer is an older woman’s issue, and for more equitable access for younger women to affordable testing and risk-stratified screening.
As Breast Cancer Network Australia director of policy, advocacy and support services Vicky Durston says, with new Victorian Cancer Council data showing over one-fifth of breast cancer cases in that state are among women 25-49, a number indicative of a national trend, medicos and the primary care sector need to stop telling women they are too young to have breast cancer.
“The data cannot be ignored, but we often hear from women in their twenties, thirties and forties who have had their concerns dismissed because of their age,” Ms Durston says.
So what exactly is going on with early onset cancer, why is it on the rise, and what can be done about it?
Growing cancer rates
Data published by the Australian Institute of Health and Welfare in December shows while almost 90 per cent of cancers diagnosed will occur in people aged 50+, “cancer incidence rates for the young are increasing.”
Around 20,000 cancer cases were estimated to be diagnosed in Australians aged under 50 in 2024, with 84 per cent of those between 30-49.
For those in their 30s, the cancer rate between 2000 and 2024 increased from 121 cases per 100,000 people to an estimated 141 per 100,000, the AIWH report Cancer Data in Australia says. For 40-49 year-olds the increase over the same time frame was from 280 to 323 cases per 100,000 people.
“Cancers strongly contributing to cancer incidence rate increases for people in their thirties are colorectal cancer and thyroid cancer,” the report says. “For the population in their forties (it is) thyroid cancer, breast cancer, prostate cancer, colorectal cancer, and kidney cancer.”
The rise in early onset cancer is not confined to Australia. A report this month by the American Cancer Society found increasing levels of cancer for people aged up to 50 years, driven by higher rates among women.
“Incidence rates for men younger than 50 was generally stable during 1998 to 2021, while incidence rates for women increased,” the report, Cancer Incidence Rate for Women Under 50 Rises Above Men’s, notes.
“By 2021, the cancer incidence rate for females was 82 per cent higher than for males. Those increases were primarily due to increasing trends of breast cancer and thyroid cancer in women, although thyroid cancer has been decreasing in recent years.”
The Victorian Cancer Council’s report for 2023 also finds women are 70 per cent more likely than males to be diagnosed with early onset cancer.
Breast Cancer
Breast cancer prevalence for 25-49 year-old women has risen by 0.6 per cent annually over the last decade, the Victorian Cancer Council report finds.
Oncologist and surgeon Bruce Mann, head of breast cancer services at Royal Melbourne hospital, said a range of factors are correlated with breast cancer risk for under 50s.
“For instance an early pregnancy is protective. So a woman who hasn’t had children or who has children after 35 is associated with some increased risk,” Professor Mann says.
“So too is obesity, with exercise appearing to be a protective factor.”
Ms Durston says the increasing breast cancer prevalence rate, “while not significantly alarming, is a steady rise and something we do need to be cognisant about.”
She says younger women “often have more aggressive forms of breast cancer, and are treated later.
“They are at a stage of life where they are working on their career, planning a family. We need to give them support.’
Her organisation is pushing for increased access to affordable genetic testing, and is looking forward to the outcomes of a BreastScreen Australia review into risk-stratified screening approaches.
“(Younger onset breast cancer) is not something on the radar of GPs or primary care,” Ms Durston says. “We want GPs to be aware and be able to give accurate advice, so all women are taken seriously and given good advice when they present.”
Professor Mann says while across the board screening for all women is likely to be too expensive from a public health perspective, he agrees there needs to be work done to find ways to deliver targeted screening for at-risk under 50 women.
Colorectal Cancer
The AIHW data shows colorectal cancer has increased rapidly since the turn of the century among 30-39 year-olds. In 2000 the rate was 6.3 per 100,000 population, rising to 17.2 per 100,000 in 2024.
For 40-49 year-olds the rate increased from 24.9 per 100,000 in 2000 to 29.9 per 100,000 in 2024.
Consultant colorectal surgeon and director of cancer surgery at Peter MacCallum Cancer Centre Sandy Heriot says a recent international oncology paper found Australia has the highest rates of early onset bowel cancer in the world.
“Colorectal cancer is still predominantly an older person’s cancer, with around 11.7 per cent of these cancers being in people under 50,” Professor Heriot says.
“The incidence among older people is going down, perhaps due to increased screening, but for younger people it is going up.”
He said while there was as yet no hard evidence as to what lies behind the increase, he suggests it is likely to be a range of reasons.
“It is likely to be multifactorial, unlike smoking and lung cancer, where there is a high causality.”
“At the moment there’s talk about dietary changes, changes to fibre intake, but no one really knows. It’s being looked at. Obesity may also be a factor, but the challenge is getting hard data to prove it,” Professor Heriot says.
Asked what his advice would be to minimise the risk of colorectal cancer, he said it would be the same for most forms of tumorous cancer.
“Stay physically active, maybe reduce the amount of red meat and processed meat in your diet, though that’s not to say vegetarians won’t get bowel cancer. Avoid smoking, eat more vegetables. This is applicable to all forms of tumours,” he says.
Mortality
It’s worth remembering that although cancer incidence rates have been increasing, improved treatment has seen cancer mortality rates have been falling for people in their 30s and 40s.
“For people in their forties age-specific mortality rates have been steadily decreasing between 2000 and 2024 (60 deaths per 100,000 people to an estimated 37 deaths per 100,000 people),” the AIHW report finds.
“The cancer mortality rate also decreased for people aged in their thirties over this time (18 deaths per 100,000 people to an estimated 12 deaths per 100,000 people).
“The most notable exception was colorectal cancer for people in their 30s where the mortality rate increased by 1 death per 100,000 people (1.8 to an estimated 2.8 deaths per 100,000 people).
Katie’s story
Behind every number and percentage above there are tens of thousands of very human stories.
Katie’s is not over. Two years after her initial diagnosis, in May last year, new tests revealed her breast cancer is metastatic and has spread to her pelvis. She has just finished another six month block of chemotherapy, 37 rounds of treatment altogether.
The diagnosis means she is unable to have children.
“It’s a hormone positive form of cancer, I’ve been placed in medical menopause. If I fell pregnant the hormones would spread. The doctors said I have to make peace with not having a biological child. That was almost more devastating than the cancer itself.”
The recommended drug for her condition is Olaparib, but she said she was unable to afford it last year, as it would have cost her around $70,000 a year.
As of January it is now listed on the PBS, with Katie now likely to be eligible, but it has been valuable treatment time lost.
“It really was heartbreaking that there was a treatment out there but I just couldn’t quite reach it. You’d think in Australia we have a health system that could cover it, and we’re not like the US where you have big health bills just to go to hospital.”
Katie says she decided to undergo the initial testing in 2022 despite the high cost because she didn’t want the uncertainty of not knowing, but said she worried this was not an option for some women.
Katie, a federal public servant, has a good job and a supportive partner and has hopes for the future. She will need medication for the rest of her life.
“They’ve said what I have is treatable but not curable. They haven’t given me months or years, we’re not at that point yet.”
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