Early-Onset Cancer as an Emerging Public Health Challenge

INTRODUCTION

The consistent increase of cancers incidence diagnosed in individuals under the age of 50, known as early-onset cancers, EOCs, has emerged as a global epidemiological phenomenon in the last decades¹-³. Initially recognized in colorectal tumors, now EOCs in breast, stomach, pancreas, liver, thyroid and lymphomas have been detected, affecting populations in low, middle and high income countries. In despite of screening advances justifying part of the increase of certain tumors as in breast and thyroid, the magnitude and reach of the trends observed indicate that it is not just a detection bias, but a structural shift of the epidemiologic profile of cancer¹,⁴.

Similar trends have been recorded in Brazil already. Recent analyzes of hospital-based cancer registries indicate an expressive increase of cases in 19 and 44 years young adults, especially breast, cervix, thyroid and colorectal cancers⁴. This is not only a clinical threatening scenario, but a challenge to public health and to the sustainability of the National Health System (SUS) as individuals in productive age are being affected entailing wide social, economic and psychosocial implications.

DEVELOPMENT

EXPOSOME IN TRANSFORMATION FOR GENERATIONS

Etiologic explanations for the growth of EOCs indicate intertwined multiple factors. Emerging hypothesis point out that the phenomenon reflects deep changes in global exposome encompassing the totality of an individual's environmental, dietary, behavioral and social exposures throughout their lifetime²,³. Among them, stand out high intake of ultra-processed food and sugary drinks, reduction of physical activity, disorders of circadian cycles, abuse of antibiotics, early obesity in addition to chronic infections and human papilloma virus (HPV), the virus of hepatitis B (HBV), and environmental polution¹,⁵. Added to this, there are epigenetic and immunologic alterations, most of the times initiated perinatally and gene-environment interactions which increase the susceptibility to cancer in young adults³,⁶. These cumulative and intergenerational factors justify the necessity of understanding EOCs from a syndemic model which integrates biological, social and environmental dimensions.

The impacts of early-onset cancers go beyond clinical repercussions. Frequently, young adults are diagnosed late at advanced stages due to low clinical suspicion in age-ranges historically little associated with cancer⁴,⁷. In addition, evidences point out that many EOCs are more aggressive and present least favorable responses to the available therapies, which aggravates the burden of intensive treatments and associated costs with modest survival gains⁵. Mostly formed by adolescents and young adults, these patients remain invisible within the context of pediatric and adult care models, which compromises the integrality of the oncologic attention⁸.

IMPLICATIONS FOR HEALTH POLICY

In this context, the National Policy of Cancer Prevention and Control (PNPCC), updated in 2023, emerges as an important landmark for the organization of oncologic prevention and attention actions in Brazil⁹. However, a critical analysis reveals that, regardless of its contributions, the PNPCC still does not address clearly the epidemiologic emergency of EOCs. This strategic gap compromises the country's capacity to respond accordingly to a phenomenon that tends to intensify in the upcoming decades. To tackle this challenge, it is recommended that the national policy incorporates specific guidelines for early-onset cancer, strengthening epidemiologic surveillance, age stratification in cancer registries, creation of specific lines of care for adolescents and young adults and revision of screening protocols for high risk populational groups. Additionally, it is essential to promote intersectoral public health policies that address determinant factors as diet, environment, working conditions and health literacy²,⁶.

Future strategies should include investments in national longitudinal cohorts with biobanks able to investigate early and intergenerational exposures. The use of artificial intelligence and big data can stimulate the integration of clinical, genomic and environmental data for early identification of risk patterns and implementation of predictive medicine actions³,¹⁰. From the perspective of assistance, it is essential that primary health attention is strengthened as gateway for early detection in young adults, integrating screening, diagnosis and fast referral. Concomitantly, cross-sectional health promotion programs should be implemented including schools and working environments targeted to healthy lifestyles and intergenerational prevention.

Early-onset cancers represent not only a new epidemiologic pattern, but an alert to the necessity of rethinking oncologic public health in Brazil. Ignore this phenomenon means to fragilize SUS in face of a rising generation of young adults in productive age affected by chronic diseases¹¹,¹². The incorporation of this emerging problem in PNPCC through strategic surveillance strategies, prevention and care is an essential step to reduce health disparities and ensure sustainability of the Brazilian oncologic system. The response to this challenge needs to be immediate, structured and inter-sectoral to spare not only the health of future generations but also the resilience of the Brazilian health system.

CONCLUSION

The rising incidence of early-onset cancers can be just the tip of the iceberg of a wider and deeper wave of chronic diseases that begin even earlier in life. The biological, environmental and social consequences of accelerated modernization accumulated for generations reflect a delayed, but intense impact of decades of exposures connected to dietary systems, urban environments, occupational conditions and digital lifestyles.

This context in expansion configures a public health crisis demanding urgent and articulated responses. An actual shift paradigm encompassing cancer not only as a condition associated with ageing but as a result of cumulative and intergenerational exposures that begin well before of what it is traditionally recognized is necessary. The complexity of this phenomenon demands interdisciplinary collaboration among investigators of pediatric and adult oncology, molecular epidemiologists, data scientists, health economists and policy formulators to decipher mechanisms, identify risk patterns and propose scalable solutions.

The challenge is generational. Without consistent investments in health promotion since the early days of life, longitudinal surveillance, equalitarian prevention strategies and integrated research infrastructure, the risk of perpetuating health disparities and overload the already fragile system with potentially avoidable diseases is a concrete issue. On the other hand, a timely action opens the opportunity of re-writing this trajectory: anticipate risks, intervene earlier and protect health and the potential of future generations in health systems in the whole world both in high-income countries and low and-middle-income countries as Brazil.

• FUNDING SOURCES
  None.

DATA AVAILABILITY STATEMENT

All the content underlying the text is contained in the manuscript.

References

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Edited by

• Associated-Editor:
  Mario Jorge Sobreira da Silva. Orcid iD: https://orcid.org/0000-0002-0477-8595

• Scientific-Editor:
  Anke Bergmann. Orcid iD: https://orcid.org/0000-0002-1972-8777

Publication Dates

• Publication in this collection
  01 Dec 2025
• Date of issue
  2026

History

• Received
  08 Sept 2025
• Accepted
  17 Sept 2025