In addition, a recent study by the American Cancer Society and the National Cancer Institute investigating lung cancer incidence across 40 countries found that women between the ages of 30 and 49 are being diagnosed with lung cancer at higher rates than men of the same age, even though the rates of smoking were similar in both genders11. What is driving these increased incidences of lung cancer in younger adults?
One possibility may be greater awareness of the cancer in this age group. “There may be an actual increase in incidence of young-onset lung cancer, but the other possibility is there is an increased awareness and appreciation of this phenomenon, and I’m not sure which is true,” said Dr. Oxnard. “About 10 or 20 years ago, the dominant narrative about lung cancer was that it was caused by smoking, and I wonder whether young individuals diagnosed with lung cancer were blended into that dominant narrative. What has happened since then is that we’ve discovered the incredible variety of lung cancer biology and the various clinical factors that impact lung cancer biology. So, it is also possible that we are now able to see young-onset lung cancer in a new light.”
Genomic Differences in Early-Onset Lung Cancer
What is indisputable, said Dr. Oxnard, is these lung carcinomas are genetically different from those found in older adults and are more aggressive. However, it is not clear whether the cancer has more aggressive biology in younger patients or is found at more advanced stages, when a cure is more difficult.
“It doesn’t cross the mind of young patients that they could have lung cancer, and early symptoms can often be dismissed as a respiratory infection, so the cancer is often diagnosed at a later stage. Also, younger people tend to have poor or no health insurance compared with older patients and may have a more difficult time accessing medical advances.”
16
Continued on page next page ...
A genetic predisposition to the cancer may also be playing a much larger role in the development of lung cancer in younger vs older adults than previously thought. “As environmental lung cancer decreases in prevalence, we need to better understand the genes that may predispose young people to develop this cancer because inherited lung cancer risk might be growing,” continued Dr. Oxnard. “The persistent problem with young-onset lung cancer is not going away and requires us to revisit the epidemiology of why lung cancer happens in folks who do not fit the dominate narrative for the disease. With modern genomic technology, we now have an opportunity to figure out the inherited genetics of young-onset lung cancer and also to identify other causes of the cancer in younger adults.”
What Influences Outcomes in Young-Onset Multiple Myeloma?
Although a rare hematologic malignancy, multiple myeloma is the second most commonly diagnosed blood cancer, after non-Hodgkin lymphoma, in the United States. Despite treatment advances over the past 2 decades, which have extended survival for patients with multiple myeloma, the cancer remains incurable. This year, about 32,270 new cases of multiple myeloma will be diagnosed, and nearly 13,000 people will die of the disease.12 Although the cancer is largely a disease found in people aged 70 and older—about 37% of patients are younger than age 65 and approximately 2% are younger than age 40—the overall incidence of the cancer appears to be increasing among all age groups, especially in young adults between the ages of 40 and 49 and in young adult women.13
Some studies have suggested that multiple myeloma in young adult patients is also associated with high-risk features and worse outcomes, possibly because the cancer is usually found at a more advanced stage in these patients. However, other studies have shown that younger patients have as good a prognosis or better than older patients.