CLINICAL QUESTION: Does the observed rise in cancer rates reflect a true increase in incidence, or is it primarily attributable to heightened diagnostic scrutiny?
BACKGROUND: In recent years, the rise in early-onset cancer rates has generated considerable media, scientific, and political attention, reinforcing the perception that cancer is emerging more frequently among young adults. It is crucial to determine whether the increase in early-onset cancer reflects a real increase in incidence or is primarily attributable to increased diagnostic detection.
STUDY DESIGN: Descriptive epidemiological analysis and critical commentary
SETTING: Nationwide epidemiological analysis using U.S. cancer registry and mortality data
SYNOPSIS: This study examined population-based mortality trends for cancers with the fastest rising early-onset incidence during the past 30 years in the U.S. (which we defined as those with more than 1% increase per year on average): cancers of the thyroid, anus, kidney, small intestine, colorectum, endometrium, pancreas, and myeloma. The early-onset incidence for these eight cancers has approximately doubled, while their aggregate early mortality has remained remarkably stable, with the rate in 2022 identical to that in 1992 (5.9 deaths per 100,000 in both years). Colorectal mortality increased 0.5% per year, while incidence increased 2% per year; endometrial cancer mortality and incidence have risen in parallel (2% per year). Overdiagnosis of thyroid, small intestine, pancreas, and kidney cancers is well documented and likely explains the increase in incidence and stable mortality. This pattern can be explained by multiple factors, including early diagnosis; however, irrespective of the underlying cause, an increase in the number of diagnoses does not necessarily reflect a rise in clinically significant cancer.
BOTTOM LINE: The lack of a substantial rise in deaths, despite rising incidence, underscores the need to provide context to the early-onset cancer narrative. The challenge is to refine the diagnosis to detect and treat only the cancers that truly matter.
CITATION: Patel VR, et al. The rise in early-onset cancer in the U.S. population-more apparent than real. JAMA Intern Med. 2025;185(11):1370- 1374. doi: 10.1001/jamainternmed.2025.4917.
Dr. Arinovich is a hospitalist in the department of clinical medicine at Hospital Aleman and an instructor of internal medicine at the University of Salvador, both in Buenos Aires, Argentina.