Gen X and Millennials in U.S. Face Higher Risk of 17 Cancers Than Older Generations

A new study investigates trends in 34 types of cancer in the United States. For 17 cancer types, Generation X and Millennials have a higher risk than previous generations. Similarly, for five cancer types, mortality risk is also higher in younger generations. Many factors may be involved, but obesity likely plays a substantial role.

Published August 1 in The Lancet Public Health, the study takes an in-depth look at cancer rates in the United States, measuring incidence rates and cancer mortality in different generations. The researchers found that 17 cancer types were more common in recent generations, with some forms being 2–3 times higher in people born in 1990 than in 1955. The authors cite obesity, diet, and environmental toxins as major contributing factors.

Higher Cancer Rates in Younger Generations
A previous study in 2019 by the same authors found that the incidence of eight types of cancer increased in younger generations compared with older generations. The latest study examines both cancer incidence — the number of new cases — and cancer mortality by birth year. Trends in cancer incidence in people aged 50 or younger mostly reflect increased exposure to carcinogenic factors in early life or young adulthood. This suggests a future disease burden as these young cohorts carry their increased risk into older age when cancers most frequently occur.

Increases in Cancer Incidence and Mortality
The scientists used information from 23,654,000 people diagnosed with 34 types of cancer and 7,348,137 deaths from 25 cancers from 2000–2019. They found an increased incidence in 17 of the 34 cancers in progressively younger generations:

• Cardia gastric
• Small intestine
• Estrogen receptor-positive breast
• Ovary
• Liver and intrahepatic bile duct (in females)
• Non-HPV-associated oral and pharynx (in females)
• Anus (in males)
• Kaposi sarcoma (in males)
• Colorectal cancer
• Endometrial cancer
• Gallbladder and other biliary
• Kidney and renal pelvis
• Pancreas
• Myeloma
• Non-cardia gastric
• Testis
• Leukemia

The increase in incidence was particularly pronounced in cancers of the small intestine, thyroid, kidney and renal pelvis, and pancreas. Compared with people born in 1955, the incidence in those born in 1990 was two- to three-fold greater. Additionally, in five cancer types, mortality rates also increased: liver and intrahepatic bile duct in females, endometrial cancer, gallbladder and other biliary, testicular, and colorectal cancers.

Why the Sharp Increase in Cancer Rates?
While this study was not designed to explain why these cancers increased, the researchers suggest that obesity likely plays a substantial role. Ten of the 17 cancers listed are associated with obesity. Since the 1970s, obesity has increased in all age groups, but the swiftest increase has been in younger people, aged 2–19 years. This is supported by other research demonstrating that excess weight and obesity at a younger age are associated with an increased risk of 18 forms of cancer.

Beyond overweight and obesity, other factors such as an increase in sedentary lifestyles, altered sleep patterns, and chemicals in the environment may also play a role, although much less is known about these factors.

How Diet and the Gut Microbiome May Affect Cancer Rates
The Western diet, high in saturated fats, sugar, refined grains, and ultra-processed foods, is linked to increased cancer risk. Emerging evidence suggests that ultra-processed food increases body weight and is independently associated with the risk of some cancers, such as breast and colorectal. Changes in the gut microbiome may also be a factor. With the rise of the Western diet and antibiotic use, the gut microbiome has been severely impacted.

How is Epigenetics Related to Cancer?
Epigenetic changes — changes to the expression of proteins from DNA without changes to the DNA itself — usually result from environmental factors. These changes can be passed on to offspring, affecting gene expression and potentially contributing to cancer risk. This suggests that behaviors and exposures of parents and even grandparents can impact the health of future generations.

Exposure to Toxins May Affect Cancer Rates
Certain environmental toxins may contribute to increasing cancer rates. Some of the most harmful include aflatoxins, benzene, soot, arsenic, aristolochic acids, nickel compounds, radon, thorium, trichloroethylene, vinyl chloride, and wood dust.

Rates of Some Forms of Cancer Are Declining
Despite the concerning implications of increasing cancer rates in younger generations, there are some positive trends. The incidence of cervical cancer has decreased due to the effectiveness of HPV vaccination, and cancers of the lung, larynx, and esophagus have declined with the drop in smoking rates. Mortality rates are also declining for many cancer types, likely due to early detection and advances in treatment. For example, the five-year survival rate for pancreatic cancer in young adults increased significantly from 16.5% in 2000 to 37.2% in 2016.

Takeaway
The incidence rate of 17 cancers and the mortality rate of five cancers is higher in Gen Xers and Millennials than in older generations. These increases are likely due to overweight, obesity, the Western diet, changes in the gut microbiome, and environmental toxins.

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