Exploring current cancer screening practices and guidelines for adults under age 50 in the United States

There has been a concerning 79.1% global rise in incidence between 1990 and 2019 of early onset cancer (EOC), defined as cancers diagnosed under age 50. EOC diagnoses now account for 12% of all cancer diagnoses. The largest increased incidence of EOCs has been noted in breast, colorectal, kidney, and uterine cancers, with early onset colorectal cancer rates rising the fastest. Women under age 50 represent 67% of all EOC diagnoses, attributed primarily to early onset breast cancer. Early onset colorectal cancer (CRC) has been rapidly rising and is often diagnosed at advanced stages. Despite the general decline of overall cancer mortality over the last 20 years, EOC mortality rates have risen 27.7%, driven by increased mortality in colorectal, uterine, and testicular cancers. The drivers of rising EOC incidence and mortality rates are likely multifactorial (e.g., exposome changes, microbiome disruptions, lifestyle and environmental exposures, comorbidities), including genomic and hereditary factors. Approximately 10–20% of EOCs are attributable to germline pathogenic variants (inherited mutations in cancer genes), with higher estimates observed in certain tumor types such as colorectal cancer. Many EOCs also display more aggressive biology and worse clinical outcomes compared to average and later onset cancer diagnoses. To address these gaps, public health campaigns and national screening programs are essential strategies in cancer control. These efforts include raising awareness of specific cancer risk factors and potential signs and symptoms, dispelling misconceptions, and promoting equitable access to screening services

Family history can also be crucial to considering hereditary cancer genetic testing to identify hereditary cancer syndromes. Key indications for genetic testing include strong family history of cancers, young age at cancer diagnosis, specific cancer pathologic or molecular subtypes, and precision therapy eligibility. Many younger adults do not receive recommended early screening due to a range of access issues, including a lack of insurance coverage for screening before the standard recommended ages. Even with access to screening, many may still face inadequate coverage for follow-up diagnostics, required monitoring, or treatment. These barriers are further amplified for those who experience other sociocultural challenges, such as limited financial stability, employment challenges, or differences in language and cultural norms. Given the rise in early onset cancers, a compelling need exists for enhanced awareness, public empowerment, patient-centered healthcare and policy systems, and innovative research. With continued research, digital and social innovation, diverse stakeholder collaboration, and public campaigns targeting younger adults, there is significant potential to more effectively address the needs of this growing population.