Cancer in young adults: out of the shadows?
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Published June 27, 2026
DOI: 10.1016/S0140-6736(26)01279-1 External LinkAlso available on ScienceDirect External Link
Copyright: © 2026 Published by Elsevier Ltd.
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Ok“Young adult cancer is a growing crisis hiding in plain sight”, said US Senator Edward Markey. On June 15, he and his colleagues called on the US National Institutes of Health to establish a national strategy to address the rising incidence of cancer among young adults. They are not alone in their concerns. While cancer remains largely a disease of older individuals, a surprising increase in early-onset cancers seems to be occurring. It is a trend that should have the attention of health communities everywhere.
One recent study used data from 42 countries in Asia, Africa, the Americas, and Australasia to assess cancer incidence between 2003 and 2017. It found that incidence rates increased in adults aged 20–49 years in most countries for six of the 13 cancer types analysed: thyroid cancer, breast cancer, colorectal cancer, kidney cancer, endometrial cancer, and leukaemia. Although incidence also increased in older adults, the average annual percentage change was greater in younger than older adults in 69% of countries. Notably, colorectal cancer increased in older adults in only about half the countries. The reason for this increase in cancer incidence among young adults is not clear. The trends are not uniform. For some cancers, the rise in cases might be an artifact due to better diagnostic tools, but many studies also point to a complex interaction of risk factors during early life and young adulthood, including obesity, dietary patterns, alterations in the microbiome, and accelerated biological ageing. While researchers are working to better understand the situation, health-care systems remain underprepared to address cancer in young adults.
Major challenges exist in prevention and diagnosis. Delays in diagnosis are common because doctors easily assume that patients are too young for cancer and overlook unusual and persistent symptoms. The harms and benefits of including younger populations in cancer screening programmes need to be balanced with utmost care—precision approaches are needed to identify those at risk who would benefit from early interventions such as colonoscopy to enable the removal of precancerous lesions and prevent colorectal cancer. Primary care services have a key role in detection and referral, but early-onset disease frequently falls outside existing diagnostic guidelines. Early diagnosis in this setting is particularly important because cancer in young adults often presents more aggressively. Therapy-specific risks are poorly characterised because young adults are often under-represented in cancer studies, and treatment programmes tailored to their needs remain scarce. Survivors of early-onset cancers have a higher risk of long-term health problems such as infertility, cardiovascular disease, and secondary cancers. Furthermore, the emotional and psychosocial impact of cancer, which begins at diagnosis, often persists long after treatment has ended. Managing cancer in this population requires a multidisciplinary approach including specialised genetic counselling, fertility preservation, nutritional support, sexual health services, and integrative oncology. These services need to be not only available but also connected—the lack of clear referral pathways creates extra burdens for health-care systems and for overwhelmed patients.
In the past decade, some countries have developed specialised cancer programmes dedicated to young adults, based on multidisciplinary teams and comprehensive integration of services. For instance, in 2023, the Dana-Farber Cancer Institute (Boston, MA, USA) officially launched its centres for early detection and cancer interception. Such programmes could provide a model for improving care among individuals at increased risk of developing cancer, but they are rare. In terms of research, early-onset cancers present other difficulties. Because they remain uncommon within individual institutions, collaboration is essential to generate sufficiently large datasets and to better understand the complex factors driving their increasing incidence. International research initiatives such as the Cancer Grand Challenges PROSPECT programme—a research effort spanning the USA, India, and several European countries—will be key to accelerating progress in the research and care of cancer in young adults.
The issue of cancer in young adults is generating political attention. Aside from the US Senate's action, G7 leaders released a statement on June 17 identifying cancer in adolescents and young adults as a priority in global cancer care. The requirement now is for concerted multidisciplinary effort in both research and health systems to better understand cancer in young adults and to meet the specific needs of those affected.