Cancer is becoming increasingly common among young people, with cases slowly and steadily rising every year for the past decade.
Colorectal cancer is now the leading cause of cancer death in people under 50 in the US, with cases increasing from 8.6 cases per 100,000 people in 1999 to 13 cases per 100,000 people in 2018.
A recent report from the American Cancer Society (ACS) found incidence among adults under 50 – which is considered early-onset – has gone up by about three percent yearly. In fact, 45 percent of CRC diagnoses are in people under 65 years old, according to ACS.
The rate of lung cancer diagnoses in young people has also gradually increased over the past two decades, particularly in those who have never smoked, which experts have blamed on environmental pollutants like radon gas.
And new diagnoses of breast cancer that have spread to other parts of the body are increasing most rapidly among young women. From 2004 to 2021, cases in patients ages 20 to 39 rose nearly three percent, a rate more than double the increase seen in women age 75 and older.
Young people are often diagnosed at later stages, which studies suggest could be due to insurance woes that compromise their chances of survival.
Health experts from the University of Texas at Arlington have examined the social and systemic factors that shape who survives a cancer diagnosis in an analysis that included nearly 470,000 Americans between the ages of 15 and 39 who had been diagnosed with cancer, finding insurance status is one of the clearest and most consequential factors.
Mariana Tata (pictured above) was just 26 years old when she was diagnosed with Stage 4 colorectal cancer that had spread to her ovaries and abdominal wall. She had bloating and rectal bleeding prior to her diagnosis
Young people with private health insurance lived longer than those on Medicaid or without insurance.
Depending on the cancer, this survival advantage ranged from a modest eight percent lower risk of death for lymphoma to a drastic 2 to 2.5 times lower risk of death for melanoma and multiple other cancer types.
Young people are especially at risk
People between the ages of 15 and 39 have especially unstable access to health coverage in the US.
Young people in this age group are often finishing school or starting new jobs, including positions that don’t offer benefits. They’re also aging off a parent’s insurance plan, which happens when you turn 26 under current US law.
This instability leaves many young people uninsured or underinsured, making them more likely to avoid doctor visits for red flag warning signs such as rectal bleeding, abdominal pain and unexplained weight loss.
The long-term consequences of no or insufficient health coverage go beyond inconvenience. Adolescents and young adults already tend to see smaller improvements in cancer survival over time compared to children and older adults.
This gap has puzzled researchers for years. Insurance instability appears to make this gap even wider.
Insurance shapes the entire cancer experience
Katie Rich (pictured at right with her husband and daughter) was diagnosed with Stage 4 colon cancer in 2012 after suffering just one symptom: abdominal pain
Health insurance does far more than cover hospital bills. It determines whether a patient can access a specialist, how quickly treatment begins and whether they are eligible to enroll in a clinical trial.
Strikingly, the new study showed patients on Medicaid and uninsured patients often had similar cancer outcomes – and both did worse than those with private insurance.
This suggests that simply having some form of coverage isn’t enough if that coverage doesn’t actually open doors to quality care.
One underdiscussed consequence of insurance status is access to clinical trials. These studies are often the pathway to the most advanced treatments available.
Yet research has found that the type of insurance a young cancer patient has is a significant predictor of whether they enroll in a clinical trial, with higher enrollment rates for those with private insurance.
For cancers such as early-stage Hodgkin lymphoma – a disease most common in young adults – treatment decisions and access to newer approaches can vary significantly based on where and how a patient receives care, which is often tied to their insurance status.
Clarifying cause and effect
Steven Kopacz, drummer for alternative band Go Radio, was just 33 when he was diagnosed with stomach cancer for the first time. He is pictured above with his wife and their five-year-old daughter, Saige
The body of research analyzed primarily tracked patterns in existing data rather than through controlled experiments. That makes it difficult to say with certainty that insurance status directly causes differences in survival.
However, the pattern observed was consistent across many studies. Moreover, most studies recorded insurance status only at the time of diagnosis, which misses changes that happen during treatment. Patients may lose or gain coverage in the middle of their care.
Future research that tracks insurance continuously throughout treatment, standardizes how coverage is categorized and examines specific cancer types and age subgroups in greater depth could clarify the picture further.
What can be done to help young cancer patients
The good news is that insurance is something society can change. Based on the findings from the University of Texas at Arlington team, a few key areas stand out.
Expanding coverage could help keep more young cancer patients insured. This might look like policies allowing young adults to stay on a parent’s plan longer, expanding Medicaid and reducing gaps in coverage after diagnosis.
Improving what Medicaid actually covers could make it easier for patients to access top cancer centers. Many doctors and cancer centers limit how many Medicaid patients they see because reimbursement rates are low.
Holly Shawyer of North Carolina was diagnosed with pancreatic cancer in her 30s despite being a marathon runner. Her main symptom was a stomach ache
Connecting with financial counselors, patient navigators and care coordinators could help young patients on public insurance or those who lack insurance navigate the system. This support could enable them to get timely access to the right treatments and clinical trials.
Early screening for financial barriers can prompt timely referrals to financial counseling, assistance programs or social work before patients experience treatment delays.
Financial support can help patients complete treatment, make their appointments and improve their outcomes.
This article is adapted from The Conversation, a nonprofit news organization dedicated to sharing the knowledge of experts. It was written by the following University of Texas at Arlington experts: Tara Martin, clinical assistant professor of nursing; Rhonda Winegar, assistant professor of nursing; and Zhaoli Liu, assistant professor of nursing. It was edited by Emily Joshu Sterne, the US Assistant Health Editor at Daily Mail.