Young women are almost twice as likely to be diagnosed with cancer as young men: ‘We’re seeing a change’

Charmella Roark remembers the shock that stopped her in her tracks when she learned about her younger sister’s cancer diagnosis.

In 2018, Kiki Roark wrote in their family’s group text that she had been diagnosed with stage I breast cancer – the same disease that had taken their aunt’s life just a few years prior.

“I was in disbelief,” Charmella said of her sister’s diagnosis. “That’s my first best friend.”

The New Jersey sisters never would have guessed that four years later, Charmella would receive the same diagnosis.

The Roark sisters represent an ongoing trend emerging in the United States: More younger women are being diagnosed with cancer.

Cancer rates have generally declined among men in the US early this century before leveling out, yet they appear to be climbing among women – especially young women. Cancer diagnoses are shifting from older to younger adults and from men to women, according to a report released Thursday by the American Cancer Society.

Middle‐age women now have a slightly higher cancer risk than their male counterparts, and young women are nearly twice as likely to be diagnosed with the disease as young men, according to the report, published in CA: A Cancer Journal for Clinicians. It appears that breast and thyroid cancers in women are driving this increasing trend.

“Breast and thyroid cancer account for almost half of all cancer diagnoses in women younger than 50,” said Rebecca Siegel, lead author of the report and senior scientific director of surveillance research at the American Cancer Society.

‘We’re seeing some shifting’

Kiki was 37 when she was diagnosed with breast cancer in August 2018.

Sharp pain in her armpit had radiated to her breast, and she had asked three of her doctors to order a mammogram to check for cancer. But each told her that a mammogram was unnecessary at her age, she said.

“Just because I was younger, I feel like they didn’t take me seriously,” Kiki said. “But I kept pushing the issue, saying, ‘No, something’s not right.’”

It took months, Kiki said, but she eventually got a mammogram. It showed signs of cancer, and a biopsy confirmed the diagnosis.

“I was an early stage,” said Kiki, a mother of three who works from home.

For treatment, she had both breasts removed in a double mastectomy and received the hormone therapy drug tamoxifen.

Charmella stayed by her sister’s side throughout the illness. And in the years after, Charmella said, she was inspired to stay on top of her routine breast cancer screenings by getting mammograms.

In the summer of 2022, one of those mammograms revealed that Charmella, a high school teacher and mother of two, had stage I breast cancer. She was 44 at the time.

After getting her own diagnosis, Charmella immediately called Kiki.

“I was devastated,” Kiki said. “The first thing I thought: not again.”

Charmella quickly started treatment: six rounds of chemotherapy and a month of radiation.

Charmella and Kiki had found themselves among the estimated 1 in 3 women in the US who will be diagnosed with cancer at some point in their lifetime.

Men historically have had a higher overall cancer incidence than women, but in 2021, women younger than 50 in the United States had an 82% higher cancer incidence rate than their male peers, according to the new American Cancer Society report, which involved data from the National Cancer Institute, the US Centers for Disease Control and Prevention and the North American Association of Central Cancer Registries.

“We see for the first time, if you’re a woman under the age of 65, you’re now more likely to develop cancer than men in that same age group,” said Dr. William Dahut, chief scientific officer for the American Cancer Society.

“The other thing is, we’re seeing a change in – at the time of cancer diagnosis – the age of which patients develop cancer,” Dahut said.

“Age remains the number-one greatest risk factor for cancer overall, and that hasn’t changed. But we’re seeing some shifting,” he said. For men and women combined, “the only age group where we’re seeing actually an increase in cancer risk, in incidence going up, is under the age of 50.”

A call to ‘advocate for yourself’

Charmella, now 47, and Kiki, 44, are cancer-free and doing well, but they know that as Black women in the United States, they are part of a community facing significant disparities in cancer outcomes.

Even though Black women in the US have about a 4% lower incidence rate of breast cancer than White women, they are 41% more likely to die from the disease, previous data from the American Cancer Society showed.

The new report shows that these large disparities persist.

“You’re more likely to develop breast cancer as a White woman. You’re more likely to die of it as a Black woman, particularly when you look at the younger populations, where disparity numbers are greatest,” Dahut said.

Black people have a death rate that’s twice as high as White people’s for prostate, stomach and uterine corpus cancers, according to the report. Similarly, death rates for kidney, liver, stomach and cervical cancers among Native Americans are two to three times those seen in White people.

There are geographic differences in cancer occurrence and outcomes, too.

Across the country, the rates of people dying from cancer range from fewer than 150 deaths per 100,000 people in Utah, Hawaii and New York to more than 210 per 100,000 in West Virginia, Kentucky and Mississippi.

But the new report also offers some hopeful news.

Overall cancer survival rates are increasing, and the United States’ cancer mortality rate has continued to fall, averting nearly 4.5 million deaths from 1991 through 2022 – resulting in an overall drop of 34%, the new report said.

“Year after year, we observe a continued decline in cancer-related mortality, and that is very important,” said Dr. Mariana Chavez-MacGregor, a professor at The University of Texas MD Anderson Cancer Center in Houston, who was not involved in the new report.

This decline in cancer deaths has been largely due to reductions in people smoking cigarettes, the earlier detection of some cancer cases and advancements in treatment options, including the development of new immunotherapy medications and targeted therapies.

The Roark sisters want other women to know that it’s important to advocate for access to these medical advancements when it comes to screening and treatment. Screening mammograms are recommended for women every other year starting at age 40, unless the patient meets certain other criteria.

“I always say, advocate for yourself,” Kiki said.

“I had a breast specialist, a [gynecologist] and a family doctor tell me it was nothing,” she said. “If I would have listened to them, we don’t know where I would be right now.”

The American Cancer Society report projects that this year, there will be more than 2 million cancer diagnoses – or about 5,600 new cases each day – and more than 618,000 cancer deaths in the US, corresponding to about 1,700 lives lost per day.

What’s behind the trend?

As the cancer incidence among younger adults continues to rise, physicians are mulling over what could be behind the trend. Is it just that we have gotten better at screening and detecting cancers, or are there real-world factors putting people at risk?

“In my professional opinion, this phenomenon is multifactorial. We cannot point at one specific factor, but it’s possible that changes in fertility patterns play a role,” Chavez-MacGregor said, referring to how pregnancy and breastfeeding have been associated with a reduced risk of breast cancer later in life.

“Obesity and alcohol consumption are likely contributing factors, as is a potential lack of physical activity,” she said. “Other unknown variables may also be at play,” such as environmental risk factors.

A better understanding of the factors driving this increase can help inform ways to reduce the risk among younger adults, said Dr. Neil Iyengar, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York, who was not involved in the new report.

“There is, and there needs to be, a greater shift in scientific research and the resources that are available for the scientific community to better understand how we can be more effective at preventing cancer, or at least reducing the risk of cancer,” Iyengar said.

“We certainly need to understand individual biology and how we can prevent cancer based on individual biology. But we need to expand that to understand a person’s lifestyle, their environmental risks,” he said. “The exposures and the risks of a younger person are likely very different than a traditional older person who’s at risk for cancer.”

The rise in cancer incidence among younger ages also could have major implications for the future of cancer care, as some types of cancer in younger people may need more aggressive therapies, Iyengar said.

“We have to be prepared to support our younger men and women who are undergoing perhaps more aggressive cancer therapies while still dealing with young families and working in careers,” he said. “That ranges from practical considerations – like how we schedule chemotherapy treatments, for example, in a way that needs to be less disruptive to people’s lives and careers and families – to the types of treatments that we’re using.”