In October 2017, twenty-nine-year-old Meagan Schwenk-Gattey was living her dream life near Coronation, a small town in central Alberta. She loved working with animals on her family farm, had recently finished building her first home with her husband, and was trying for a baby. But she was concerned about her deteriorating health; she had difficulty breathing, was losing weight, and often felt extremely fatigued and cold. She’d had some blood work done the year before when her symptoms were milder, but the tests hadn’t revealed anything. Her doctor recommended a CT scan.
The results were life changing: Schwenk-Gattey had stage 4 Hodgkin’s lymphoma, the most advanced form of this type of blood cancer. Her prognosis wasn’t good—about one in three people with the diagnosis she had die within five years—and she would have to undergo chemotherapy and radiation to try to overcome the disease. Suddenly, none of her plans mattered; the next few years would be all about fighting to survive.
Schwenk-Gattey’s experience is part of a wider trend being seen in developed Western countries—of an increasing number of adults below the age of fifty being diagnosed with cancer. The issue was in the spotlight last year because of public figures such as princess Kate Middleton and actor Olivia Munn, both in their forties, sharing their stories. But even before that, several international and Canadian studies had been sounding the alarm.
Globally, new cancer cases in younger adults jumped by 79 percent between 1990 and 2019, according to a study published in the journal BMJ Oncology in 2023. Deaths have also risen, by over 28 percent, in the under-fifty age group during the same period. In Canada, a review published in 2020 revealed that the incidence of thirteen types of cancers has been increasing in younger adults—especially in the twenty-to-forty-nine-year-old cohort—over a thirty-year period. Another study, published in the Canadian Medical Association Journal in 2019, found that colorectal, breast, uterine, kidney, and pancreatic cancers have been rising most significantly in under-fifties.
Canadian doctors have also been reporting a rise in cases on an anecdotal basis. Christine Brezden-Masley, an oncologist and medical director of the cancer program at Sinai Health in Toronto, says that, in the past decade or so, she’s been seeing more patients in their twenties, thirties, and forties with colorectal, gastric, and breast cancers. Similarly, her colleagues have noticed a higher number of younger men getting diagnosed with prostate and lung cancer, she says. “We don’t truly understand why this is happening,” she adds, explaining that the typical age range for these cancers is fifty-five to sixty-five.
Darren Brenner, a cancer epidemiologist and head of the Brenner Research Group at the University of Calgary, who has been studying colorectal and breast cancers in younger adults since 2015, says research shows a strong association between diet changes in the past thirty years and some cancers. This includes increased consumption of ultra-processed, high-fat foods like frozen pizzas and store-bought muffins. In addition to contributing to poor nutrition, excessive intake without adequate exercise can lead to obesity, a known risk factor for certain cancers. Other studies link diets high in red meat and sugar, as well as overuse of antibiotics, which destroy healthy gut bacteria, to cancer.
A 2022 study found that, in addition to people having more Westernized diets over the past three decades, today’s adults were exposed to other risk factors—such as environmental hazards and more sedentary lifestyles—at younger ages compared to the generations before them. Researchers, including Brenner, believe that may be why cancer has started to show up earlier in patients’ lives now when compared to the 1970s and ’80s. And while more screening does play a role—the authors acknowledged that enhanced testing could explain some of the diagnoses—it doesn’t account for the spike in cases we’ve seen in recent years.
Still, researchers are hoping for more definitive answers about which factors are playing a leading role in the rise in early-onset cancer. More conclusive results would inform better decision making around prevention and screening policies. (Currently, in Canada, screening for colorectal cancer is recommended only to those fifty and up, but advocates are pushing to lower that threshold, as the US did in the past few years.)
Brezden-Masley says she would like to see the federal government invest in more research. In Canada, the proportion of research funds invested in cancer biology and causes in the period between 2017 and 2021 actually decreased as compared to the period between 2007 and 2011 (from a combined 49 percent of funds to just 35 percent). Meanwhile, the proportion spent on prevention strategies, such as the creation of public health policies and educational programs, remained largely the same, at 3 percent, while the highest share of funds was directed toward treatment. Very little of the money pays for studies specifically focused on younger adults as compared to other age groups.
According to a 2017 Canadian Partnership Against Cancer report, from 2005 to 2013, only 0.4 percent of national funds were allocated to research on cancer among adolescents and young adults between the ages of fifteen and thirty-nine. Since cancers in the below-fifty age group grow more aggressively and result in more deaths—partially due to more advanced-stage diagnoses—as compared to the elderly population, research focused on the young adult population should be a priority, Brezden-Masley argues.
“As a cohort, we struggle from two things: we’re not as cute as the kids, and we’re not as wealthy as our parents,” says Geoff Eaton, founder and executive director of Young Adult Cancer Canada. “When it comes to fundraising, these factors make the world go round—not just in the YACC world but also when it comes to the priorities of the government and cancer system.”
The Institute of Cancer Research—part of the Canadian Institutes of Health Research, which directs about $230 million annually in federal funding toward cancer research—launched a new five-year strategy this year. Among its top priorities, it lists cancer prevention, early detection and risk reduction, as well as an improvement in the ongoing care of cancer survivors. Currently, there are only a few CIHR-funded studies specifically focused on early-onset cancers that are underway, including one on improving survivorship outcomes for breast cancer and another on treatment options for colorectal cancer.
In 2023, CIHR funded several projects aimed at improving the development and implementation of clinical trials across Canada, including increasing access for underrepresented communities, says Fei-Fei Liu, scientific director of ICR. But she admits there were no projects focusing specifically on treating cancers in young adults, although younger adults did participate in some trials. “CIHR invests in research projects proposed by researchers in all areas of health, so we are dependent on researchers to submit applications for early-onset cancers,” she says.
Beyond research, there is a need for more government funding that provides support and resources for young adult survivors, says Eaton. Treatments, surgeries, and the disease itself often affect cancer patients in several ways—including emotionally, socially, mentally, and financially—in the short and long terms. For younger adults who may live for another fifty years after their diagnoses, ongoing medical and psychosocial care, to improve quality of life, is important.
Some nonprofits, such as Eaton’s, help with this, as do a handful of young adult survivorship programs offered through hospital clinics. The programs connect cancer patients and survivors to specialists who provide tailored services, such as individual and family therapy, diet and exercise plans to manage chronic symptoms, and reproductive and sexual health care. They also often run peer support groups and provide counselling around finances and careers.
Eaton says younger adults are particularly vulnerable, because they haven’t accumulated as much wealth as older generations have—which means getting sick has a bigger impact on their careers and finances. In many provinces, unless patients have third-party health insurance to help cover costs, cancer medications have to be paid for out of pocket, which can add up to thousands of dollars, Brezden-Masley says.
For Schwenk-Gattey, learning that her eggs were no longer viable for conception was the most devastating effect of cancer treatment. “It was really hard. My husband and I were building a life around having . . . a house full of kids, and it was just taken away with the snap of a finger,” she says. Schwenk-Gattey met with fertility specialists and had counselling to navigate the issue. She and her husband considered adoption or buying eggs to conceive through in vitro fertilization, but they faced several barriers with both options. Ultimately, they decided to give themselves more time to make a decision. Luckily for them, during that period, Schwenk-Gattey unexpectedly conceived naturally. She gave birth to a healthy son in 2022.
But even today—seven years after her treatments began—she still deals with other physical side effects, such as fatigue, joint pain, numbness in her toes, and cognitive challenges. These include sometimes writing letters backward or being unable to find the right words to express herself.
There is also the emotional toll. “It’s a challenge every day, because I know what my statistics are. Is the cancer coming back? Or when is it coming back? How much time do I have?” Schwenk-Gattey says. She also worries how long she’ll stay healthy enough to raise her son.
“The reality is that it takes longer to recover from cancer than it does to be treated for it,” Eaton says. A Canada-wide study published by YACC in 2018 found that there were significant physical and mental health gaps even six years after diagnosis. That’s why establishing more supportive networks that provide an outlet for social connection with other young survivors is also crucial, he argues.
“We have lots of stories in our community where survivors were so isolated, depressed, and having suicidal thoughts. And then they found connections through YACC that normalized the struggles they’d been through, which is really important for healing,” Eaton says.
Survivorship programs are also needed to help young adults navigate issues such as how to best live after a diagnosis and improve energy and cognition, Brezden-Masley says. Since cancer patients typically stop seeing their oncologists for follow-ups after the five-year mark, she believes more family doctors should be trained in oncology survivorship care. For many young adults like Schwenk-Gattey, receiving this support could mean the difference between simply surviving and thriving in the decades that lie ahead.
