Kate Middleton and millennial cancers: cases on the rise in Italy

It shocked a kingdom, but did not surprise oncologists. The news of British Princess Kate’s cancer at just 42 years old may seem surprising: tumors are associated with advancing age. But the increase in juvenile forms – the so-called millennial cancers – is bad news that has emerged for a few years, for which doctors are still trying to give a reason.

The increase in cancer among young people

The first growing data for so-called young-onset cancers – under the age of 50 – date back to 2019 (no, Covid vaccines have nothing to do with it, as had also been suggested). Magazine Bmj Oncology last year it reported a 79.1% increase in diagnoses and 27.7% in deaths between 1990 and 2019, compared to a decrease in the incidence of cancers over the age of 50.

The statistics of Bmj it includes the whole world, but the most affected countries are those with a higher socioeconomic level. The tumors that are most spreading among young people are stomach and colorectal (we know that Princess Kate’s operation took place on the abdomen), as well as breast, trachea, bronchi and lungs.

Regarding the possible causes, the study remains generic: smoking, alcohol, a lot of red meat, little fruit and vegetables, factors that have long been known to increase the risk of all or almost all cancers.

Data in Italy

Also in 2019, the Milan Health Protection Agency (Ats) published in the magazine Cancer Epidemiology data relating to colorectal cancer in the Lombardy capital.

Here too, between 1999 and 2015 there was a decline in diagnoses in the 50-60 age group (minus 3% every year), but an increase of 0.7% per year under the age of 50. This figure is the combination of the contrasting behavior of rectal cancer (minus 5.3%) and colon cancer (plus 2.6%).

In the United States, again last year, the American Cancer Society confirmed the alarm. One in five cases of colorectal cancer now occurs in people under 55. For this reason, the starting age for screening in the USA has been lowered from 50 to 45 (in Italy it starts at 50).

The search for causes

The reason for the growth in millennial cancers is unclear. The enigma has pushed Airc (Italian Association for Cancer Research) and Ifom (the Airc foundation dedicated to the study of molecular oncology) to try to see more clearly.

“We have created organoids, that is, millimetric models of the colon grown in vitro. We subject them for long periods to substances that we suspect to be dangerous” explains Alberto Bardelli, director of Ifom and professor of oncology at the University of Turin.

“Our analyzes are still ongoing, but in vitro we notice some substances capable of promoting the growth of organoids of the colon mucosa and adenomas: lesions that precede cancer. Among the suspects are microplastics, some molecules present in highly cooked and processed red meat, the added sugars that industrial drinks are rich in, including fruit juices, alcohol and the fine particulate matter that pollutes our cities: we inhale it , of course, but we also swallow it.”

According to Bardelli, the culprit – or more likely the collaboration of several culprits – must be “something to which young people are much more exposed than previous generations, such as sugars in drinks or plastic, which is suspected of having an inflammatory effect and is much more widespread today than in the past, starting from clothes and ending with food containers”.

The heart of the problem

The more you analyze the mystery, however, the more you end up investigating the digestive system, the colorectal in particular. Carlo La Vecchia, an epidemiologist at the University of Milan, published with his group on at the end of January Annals of Oncology cancer spread forecasts for 2024.

In a sequence of positive data (“mortality from cancer has been decreasing for thirty years now” underlines La Vecchia), the black spot of the intestine stands out. Its mortality rate in Great Britain has been increasing since 2021. Since this year it has also increased in other European countries, including Italy.

For 2024, compared to 2018, the study of Annals of Oncology predicts an increase in colorectal cancer mortality in our country of 1.5% in men and 2.6% in women. The growth also concerns men in Spain (plus 5.5%) and Poland (plus 5.9%) and women in Germany (plus 7.2%). However, Great Britain – Kate’s country – still has the most striking data: a 26% increase among men and a 39% increase among women.

Among the causes, the study identifies overweight and obesity (which is often associated with diabetes), together with alcohol consumption. “Italy, compared to other Northern European countries, has better data” explains La Vecchia. “There is a slight increase in colorectal cancer among young people, but not an epidemic. It is no coincidence that next to France we have the best data on alcohol consumption. In the past, wine was often drunk at both lunch and dinner. Today, kids have abandoned both this habit and smoking. Obesity is also less widespread than in Northern Europe and especially the United States.”

Obesity is certainly not the problem of the British princess. But her case could serve to raise awareness among her peers. “One of the problems of youth cases of cancer – explains Bardelli – is the difficulty of diagnosis. Screenings are reserved for older ages and not even cases of bleeding, in thirty and forty year olds, are sometimes enough to raise the alarm bell. The result is that young people often arrive at the diagnosis of cancer at more advanced stages of the disease. And therefore more difficult to treat.”