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Study: More than 12% of people newly diagnosed with lung cancer never smoked cigarettes

Smoking cigarettes is the biggest risk factor for lung cancer and causes about 80% of deaths from the disease. But people who don’t smoke can develop lung cancer, too. A new study found that out of 100 people in the U.S. who were recently diagnosed with lung cancer, about 12 of them (12%) had never smoked cigarettes. The study was co-led by the U.S. Centers for Disease Control and Prevention (CDC) and the American Cancer Society (ACS). The results were published in a research letter in JAMA Oncology.

While other studies have shown increases in the number of lung cancer patients who had never smoked cigarettes in both the U.S and United Kingdom (UK), this study offers greater insight into the rate at which people are diagnosed with lung cancer. Instead of pulling data from local hospitals as smaller studies have done, this study used a large sample of over 129,000 cases of lung cancer based on data from cancer registries in 7 states.

The data was collected from 2011, when the CDC National Program of Cancer Registries began obtaining cigarette smoking history from patient medical records, to 2016.

New insight into “never smokers” and “ever smokers”

The study offers a more detailed look at recently diagnosed lung cancer patients based on their smoking history.

In “never smokers” (people with a recent diagnosis of lung cancer who never smoked), the researchers found a higher percentage of:

  • Women across all age groups, races/ethnicities, and most types of lung cancer (about 16%) in comparison to men (about 10%).
  • People ages 20 to 49, including women (about 28%) and men (about 19%).
  • People with the adenocarcinoma type of non-small cell lung cancer, compared with other types of lung cancer. This was consistent with previous studies.

In “ever smokers” (people with a recent diagnosis of lung cancer who currently smoke or used to smoke), the researchers found a higher percentage of:

  • Men (90%) than women (84%). About half of men and women ages 20 to 64 were current smokers.
  • Current smokers who are Black compared to whites or Hispanics. 

More research on lung cancer in never smokers needed

Future cancer research focused on people who have never smoked may help researchers improve their understanding about the effect of genetic and other risk factors besides smoking on lung cancer. Risk factors for lung cancer not related to smoking include exposure to secondhand smoke, radon, air pollution, and chemicals and materials at work, such as asbestos.

Smoking still causes most lung cancers

The large percentage of ever smokers who were recently diagnosed reinforces “the need to strengthen and increase smoking cessation,” according to ACS researchers Stacey Fedewa, PhD, and Ahmedin Jemal, DVM, PhD, who were co-authors of the study. Previous ACS research has shown that this can be done with state and federal tobacco control policies that promote smoking cessation and with more doctors advising their patients to quit.

A person’s risk is affected by the number of packs of cigarettes they smoke a day and the number of years they smoke them. People who actively smoke or used to smoke should talk to their doctor about their risk of lung cancer and getting screened with a low-dose CT (LDCT) scan. 

This article first appeared on cancer.org.


  • Pandemic anxiety impacting clinical trials

    ​Nearly 1 in 5 cancer patients less likely to enroll for fear of COVID-19 exposure.

    A significant portion of cancer patients may be less likely to enroll in a clinical trial due to the ongoing coronavirus pandemic. According to an article published this week in JAMA Oncology, nearly 1 in 5 cancer patients surveyed said the pandemic would make them less likely to enroll in a trial. The top reason given for not enrolling is fear of COVID-19 exposure.

    “While most patients would still be willing to take part in a clinical trial during the pandemic, the fear of COVID-19 exposure that would come with participating in a clinical trial is poised to cause many otherwise interested patients from enrolling. This means that trials that already struggled to find enough patients are likely to see reduced enrollment as long as the pandemic continues,” said Mark Fleury, co-author of the article and policy principle for emerging issues at ACS CAN. “The barriers patients already faced pre pandemic made it challenging to take part in clinical trials. Now with the addition of COVID-19, it is even harder and we’re likely to see long-term impacts on the pace of research.”

    The finding was based on a survey ACS CAN conducted of cancer patients and survivors between late May and mid-June. Later surveys showed COVID anxiety remains high among patients and fear of contracting the virus were cited—along with facility closures—as one of the main reasons patients delayed cancer care. Cancer patients are among those most at risk for severe effects of the coronavirus.

    “The pandemic caused many institutions to stop enrolling new patients on clinical trials, and the assumption was that once facilities reopened, they could get enrollment back to normal. What we’ve found is that so long as the pandemic is still underway, fewer patients are going to volunteer for clinical trials,” said Fleury. “The solution is that we need to get the pandemic under control or find innovative ways like telemedicine visits so that patients can take part in clinical trials without feeling exposed to additional COVID-19 risks.”

    The article, Association of the COVID-19 Outbreak With Patient Willingness to Enroll in Clinical Trials, appears in the November 12 edition of JAMA Oncology.


  • ACS study shows lung cancer screening is still underutilized - especially in states where it's needed most

    The American Cancer Society has published the first population-based study on lung cancer screening rates for all 50 states, and finds that the rates were not aligned with lung cancer burden. The report appears in JNCI: The Journal of the National Cancer Institute.

    Lung cancer continues to be the leading cause of cancer-related death in the U.S., with an estimated 135,720 deaths expected in 2020. 

    Lung cancer screening with low-dose CT (LDCT) has the potential to reduce cancer death and has been recommended for people with a heavy smoking history since 2013. However, previous studies show it is underutilized. 

    For this study, investigators led by Stacey Fedewa, PhD, MPH, and co-authored by members of the National Lung Cancer Roundtable, examined lung cancer screening with LDCT rates and growth in all 50 states, including Washington D.C., from 2016 to 2018. They also looked at how states’ lung cancer screening rates correlated with lung cancer burden, sociodemographic status, and access to lung cancer screening.

    “The increasing but low utilization of lung cancer screening reflects both ongoing efforts to screening eligible adults, and the many challenges to do so,” said Stacey. “Kentucky, which has supported screening implementation efforts, is unique as its screening rates are over twice the national average and four times that of other high lung cancer burden states like West Virginia and Arkansas.”

    Results show that several Northeastern states with lower lung cancer burden (e.g. Massachusetts, Vermont, New Hampshire with <44 lung cancer deaths per 100,000) had the highest screening rates (12.8%-15.2%), and several Southern states with a high lung cancer burden (e.g. Mississippi, West Virginia, Arkansas with >50 lung cancer deaths per 100,000) had lower screening rates (<4%) among eligible adults. A notable exception was Kentucky, which simultaneously holds the nation’s highest lung cancer death rate and one of the highest lung cancer screening rates (13.7%).

    The authors say their finding shows that while overall lung cancer screening rates increased nationally between 2016-2018, the rate was still low in 2018, with only 5-6% eligible adults in the U.S. receiving lung cancer low-dose CT (LDCT). Relative to the national average, screening rate ratios were lower in 8 states, mostly in the West or South and 50% higher in 13 states, mostly in the Northeast or Midwest with Kentucky as the outlier.

    The study also found that compared to the national average, lung cancer screening rates were about 20% lower in states with a high proportion of uninsured adults who smoked and 40% lower in states with a relatively low number of lung cancer screening facilities; suggesting that there may be critical gaps in access to lung cancer screening. According to sociodemographic factors, screening rates were positively correlated with the proportion of smokers who were female and negatively correlated with smokers who were Hispanic. Results showed that states with adults who smoked and are Hispanic had a significantly lower screening rate ratio than the national average.

    “Deliberate effort from various stakeholders such as policy makers, cancer control, health systems, and providers are needed to boost lung cancer screening rates among eligible adults with a heavy smoking history, a group facing multiple barriers to lung cancer screening and cancer care,” said the authors. “If states know what their lung cancer screening rates are, they can set a goal and track progress toward it.”

    Article: Fedewa SA, Kazerooni EA, Studts JL, Smith RA, Bandi P, Goding Sauer A, Cotter M, Sineshaw HM, Jemal A, Silvestri GA. State Variation in Low-Dose CT Scanning for Lung Cancer Screening in the United States. JNCI: The Journal of the National Cancer institute, 2020. DOI:  djaa170.


  • November is Lung Cancer Awareness Month; ACS aims to raise awareness and reduce stigma

    This Lung Cancer Awareness Month, the American Cancer Society is shining the spotlight on something many people may not realize: Anyone can get lung cancer. The fact is, people who have never smoked or who have quit smoking can get lung cancer, too. 

    Lung cancer is the leading cause of death from cancer for both men and women, and accounts for 1 in 4 cancer deaths overall in the U.S. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined.

    And although smoking is by far the leading risk factor for lung cancer – about 80% of lung cancer deaths are estimated to result from smoking – it can be diagnosed in anyone. In fact, about 25,000 lung cancer deaths each year occur in people who never smoked. If counted as a separate category of cancer death, it’s estimated that lung cancers not caused by smoking would rank seventh among the top 10 causes of cancer death. Unfortunately, many lung cancer patients, including those who smoked and those who never smoked, experience stigma around their diagnosis.  

    “While lung cancer can affect anyone, people with lung cancer are often made to feel that they are to blame for their disease,” said Robert Smith, PhD, senior vice president, cancer screening and principal investigator of the National Lung Cancer Roundtable. “It’s common for people who provide social support, such as health care professionals, friends, and family, to convey through words and actions a sense that the person with lung cancer brought it on themselves. That needs to stop. People with lung cancer deserve to be treated with compassion and empathy.”

    This stigmatization can greatly affect quality of life and can leave lung cancer survivors feeling isolated. Some lung cancer survivors avoid aspects of self-care because of stigma and guilt, which can affect treatment outcomes. Tobacco control efforts, which have saved millions of lives, have unfortunately contributed to stigma not just against smoking, but against people who smoke, as well. This stigma has direct effects on the timeliness of diagnosis and level of care people seek and receive.  

    Some other important information about lung cancer includes: 

    • There are steps people can take to lower risk, including not smoking, reducing exposure to radon, asbestos, and other known cancer-causing chemicals, and eating a healthy diet.
    • Screening for people at high risk is available. People who smoke or have quit, are age 55 or older, and who are in fairly good health should talk to their health care professionals about whether screening is right for them. 
    • People should report persistent symptoms to their health care professionals. Symptoms can include chronic cough, shortness of breath, wheezing, frequent respiratory infections, chest or rib pain, and fatigue.
    • There is hope for people with lung cancer. Screening for those at high risk can help diagnose cancer early, when successful treatment is more likely. And new biomarker tests, drugs, and therapies that use the body’s own immune system are available and have significantly improved patient outcomes. 

    To learn more about how we’re attacking cancer from every angle, visit our special coverage page on cancer.org. To learn more about screening for cancer amid the COVID-19 pandemic, click here.  


  • Task Force aims to lower colorectal cancer screening age to 45, in line with ACS

    ​The United States Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts in prevention and evidence-based medicine, released a draft recommendation today on screening for colorectal cancer. The taskforce’s new recommendation aligns closely with the American Cancer Society’s guideline, which calls for screening to start at age 45.

    The USPSTF recommends screening for colorectal cancer for all individuals start at age 45 to age 75. It is recommended that the decision to screen individuals aged 76 to 85 years be individualized based on screening history and overall health status.

    The American Cancer Society updated its colorectal cancer screening guideline in 2018, lowering the age to begin screening to 45 (from 50), in an effort to address the rising incidence of colorectal cancer in younger adults.

    Robert Smith, PhD, senior vice president, cancer screening, shares his perspective on the USPSTF’s draft recommendation in a Q&A that can also be found in the ACS pressroom:

    Big picture: what do you think of the draft recommendation statement?

    The major change in the USPSTF’s draft recommendation statement for colorectal cancer screening is an important modification in their 2016 recommendation, specifically to lower the age to begin regular screening for colorectal cancer from age 50 to age 45. We agree with this proposed change, which addresses the rising incidence of colorectal cancer in younger adults.

    How does this draft compare to the current ACS guideline?

    In 2018, ACS updated its colorectal cancer screening guideline by reducing the age to begin screening from age 50 to age 45, so the two guidelines will be essentially the same if the USPSTF retains the proposed change after the comment period. Although there are small differences, the ages to begin screening, the screening test options, and undergoing shared decision about screening from age 76 to 85 are the same. Both organizations do not recommend colorectal cancer screening after age 85.

    How would these changes affect the potential for colorectal cancer screening to reduce colorectal cancer mortality?

    Given the rising risk and the fact that the risk of colorectal cancer at age 45 today is similar to the risk at age 50 about 20 years ago, the opportunity to prevent colorectal cancer or detect it early will improve if adults begin screening at age 45. To date it has been discouraging that most adults do not begin screening at age 50, and on average start screening later in their 50s, meaning that we miss opportunities to prevent colorectal cancer and avert preventable deaths. We hope that the agreement between the ACS and USPSTF guideline will stimulate more health care providers to promote beginning colorectal cancer screening at age 45, so screening begins earlier on average than it has to date.

    How will these guidelines impact health insurance coverage for colorectal cancer screenings?

    These draft guidelines now classify screenings for average-risk individuals ages 45-49 as grade “B” and ages 50-75 as grade “A.” Because colorectal cancer screenings are considered essential health benefits under the Affordable Care Act (ACA) and health insurance plans are required to cover all preventive services that receive an “A” or “B” grade from USPSTF, if this draft is finalized as is, individuals with ACA-compliant plans ages 45-49 who previously were not eligible to get coverage for colorectal screenings will gain access at no cost.

    When the USPSTF finalizes these updated colorectal screening guidelines, ACS’s advocacy affiliate, the American Cancer Society Cancer Action Network (ACS CAN) will continue to aggressively work to notify relevant state and federal policymakers, insurance commissioners and state Medicaid directors about the evidence in support of screening individuals aged 45-49, and the importance of expanding insurance coverage of screening for this age group. ACS CAN will work with state insurance commissioners to ensure state plans follow the new coverage requirements. ACS CAN will also continue to advocate that all individuals have access to comprehensive health coverage, including for recommended cancer screenings, regardless of where they live.

    The USPSTF’s recommendation is open for public comment until November 23, 2020. The USPSTF is not able to specify a date when they will issue a final recommendation, but generally it is within six months after the comment period ends.

    For more information on screening for colorectal and other cancers, see Cancer Screening Guidelines on cancer.org.


  • Active oldsters fare better: ACS study underscores the importance of exercising and sitting less

    ​Older adults with higher physical activity and lower sitting time have better overall physical and mental health, according to a new American Cancer Society study led by Erika Rees-Punia, PhD, MPH, our resident exercise science expert and cancer survivorship researcher.

    The study, appearing in the journal CANCER, suggests that higher amounts of regular moderate- to vigorous-intensity physical activity (MVPA) and lower duration of sedentary time is associated with higher global mental and physical health for older cancer survivors and older adults, in general.

    With a rapidly aging population and nearly 16.9 million cancer survivors in the U.S. today, there is a need to identify strategies associated with healthy aging and improving quality of life for aging cancer survivors. 

    ACS investigators analyzed self-reported aerobic and muscle-strengthening physical activities, sitting time, and mental and physical health among nearly 78,000 participants in our Cancer Prevention Study II Nutrition Cohort. Participants (with an average age of 78 years) included older cancer survivors up to 10 years post-diagnosis, and cancer-free adults.

    They found that regardless of cancer history, the differences in mental and physical health between the most and least active, and the least and most sedentary, were clinically meaningful. These findings provide evidence for the importance of engaging in regular moderate- to vigorous-intensity physical activity and decreasing sitting time as a reasonable non-pharmacologic strategy to improve quality of life in older men and women, with or without a prior cancer diagnosis. In fact, the recently published ACS physical activity guidelines recommend that adults get 150-300 minutes of moderate-intensity activity or 75-150 minutes of vigorous-intensity activity through the week, and to limit sedentary behaviors such as screen-based entertainment.

    “The findings reinforce the importance of moving more and sitting less for both physical and mental health, no matter your age or history of cancer,” Erika said. “This is especially relevant now as so many of us, particularly cancer survivors, may be staying home to avoid COVID-19 exposure, and may be feeling a little isolated or down. A simple walk or other physical activity that you enjoy may be good for your mind and body.”

    Article: Rees-Punia E, Patel AV, Nocera JR, Chantaprasopsuk S, Demark-Wahnefried W, Leach CR, Smith TG, Cella D, Gapstur SM. Self-Reported Physical Activity, Sitting Time, and Mental and Physical Health Among Older Cancer Survivors Compared to Adults Without a History of Cancer, 2020. CANCER; DOI: 10.1002/cncr.33257.  


  • E-cigarette use up among young non-smokers

    ​Intervention is needed given that long-term consequences of electronic cigarette use are mostly unknown.

    A new ACS study finds that the largest population increase in electronic cigarette users is among younger adults who have never smoked combustible cigarettes. The study appears in the American Journal of Preventive Medicine. 

    Researchers led by Priti Bandi, PhD, principal scientist, Risk Factors Surveillance Research, assessed trends in the prevalence of e-cigarette use and population count of e-cigarette users in younger (18–29 years), middle-aged (30–49 years), and older (≥50 years.) U.S. adults between 2014 and 2018. The most notable finding was a near tripling of e-cigarette use among younger adults who never smoked combustible cigarettes – from 1.3% to 3.3%.

    This increase suggests rising primary nicotine initiation with e-cigarettes. When combined with a large and growing prevalence and population of never-smokers nationally, this increase represents the largest absolute increase in never-smoking e-cigarette users – from 400,000 in 2014 to 1.35 million in 2014. 

    The authors also note substantial increases in e-cigarette use among near-term quitters (i.e. those who quit combustible cigarettes 1-8 years ago, when e-cigarettes proliferated the U.S. retail market) across all age groups. This trend suggests continued use of e-cigarette devices among those who may have switched from cigarettes previously, potentially for nicotine maintenance. 

    “Urgent efforts are needed to address the potential rise in primary nicotine initiation with e-cigarettes among younger adults. It is also important to aid the transition of e-cigarette users—particularly among younger adults—to non-use of all tobacco or nicotine products given that the long-term consequences of e-cigarette use are mostly unknown,” said Priti.


  • ACS Medal of Honor recipients awarded Nobel Prize in Chemistry

    Developers of the tool for gene editing were awarded our highest honor in 2018.

    Congratulations to American biochemist Jennifer A. Doudna, PhD (left in the smaller photo) and French microbiologist Emmanuelle Charpentier, PhD (right) this year's recipients of the Nobel Prize in Chemistry for their 2012 work on the development of Crispr-Cas9, a method for genome editing. The Oct. 7 announcement marks the first time a science Nobel has been awarded to two women.

    Both scientists were among five individuals awarded the American Cancer Society's highest honor in 2018. Read more about those Medal of Honor awards here.

    “The work of these two investigators is arguably one of the great technical advances in the past 50 years akin to DNA sequencing. In the same way that our ability to sequence DNA is essential in biomedical research today, genome editing is quickly becoming a powerful and foundational technology in research,” said William Phelps, PHD, our senior vice president, Extramural Research.

    ACS did not fund either of these women, so the number of ACS-funded Nobel Laureates remains at 49. That number is a tribute to the Society’s Research program and the strength of its peer-review process.

    Dr. Charpentier and Dr. Doudna, only the sixth and seventh women to receive the chemistry prize, pioneered early work on Crispr-Cas9, a kind of genetic scissors that allows researchers to alter the DNA of animals, plants and microorganisms with extremely high precision. Since then, it has been used in numerous scientific applications, from genetically modifying crops to developing cures-in-progress for conditions like sickle cell disease and hereditary blindness, according to The New York Times.

    TOP PHOTO: Flanked by American Cancer CEO Gary Reedy (far left) and 2018 American Cancer Society Board Chair Kevin Cullen, MD (far right) are the 2018 recipients of the Medal of Honor. Their names and their award are, from left to right: Vice President Joe Biden, for Cancer Control; Emmanuelle Charpentier, PhD, for Basic Research; Charis Eng, MD, PhD, for Clinical Research; Jennifer A. Doudna, PhD, for Basic Research; and Michael J. Thun, MD, MS, for Cancer Control Science.


  • Thyroid cancer drives increase in cancer incidence among adolescents and young adults

    ​Cancer mortality rates are highest in non-Hispanic Black AYAs, particularly females

    A new ACS report examining cancer in adolescents and young adults (ages 15 to 39) provides updated estimates of the cancer burden in this age group, predicting that 89,500 cases and 9,270 deaths will occur in 2020 in the U.S. The report appears in the American Cancer Society journal CA: A Cancer Journal for Clinicians, and was co-written by ACS researchers Kim Miller, MPH, Rebecca Siegel, MPH, and others. 

    To watch a slideshow of key findings, visit cancer.org.

    The most common types of adolescents and young adults (AYAs) cancers vary substantially by age

    AYAs with cancer are frequently grouped with older or younger patient populations and/or presented in aggregate, masking the wide difference in cancer occurrence within this population. To address this issue, ACS investigators also examined cancer incidence, survival, and mortality among AYAs by race/ethnicity and for smaller age groups (15-19, 20-29, and 30-39). 

    The bar graph above shows the difference in the most commonly diagnosed cancers by age group:

    • Ages 15 to 19: The 3 most common types are thyroid cancer, Hodgkin lymphoma, and brain tumors. Teens have a higher proportion of childhood cancers compared to the older age groups. 
    • Ages 20 to 29: The most common are thyroid cancer, testicular cancer, and melanoma. 
    • Ages 30 to 39: The most common are breast cancer (in females), thyroid cancer, and melanoma.

    Among these cancers, incidence rates are highest in non-Hispanic whites and lowest in Asian/Pacific Islanders (83 vs 54 per 100,000 people) for both sexes. This reflects higher rates in non-Hispanic white AYAs for thyroid cancer, testicular tumors, and melanoma compared to other major racial/ethnic groups. Unlike adults ages 40 and older, however, female breast cancer incidence rates in non-Hispanic Black AYAs are 14% higher than those in non-Hispanic white AYAs (25.9 vs 22.3 per 100,000 population). 

    The authors also note that despite patterns in overall incidence, cancer mortality rates are highest in non-Hispanic Black AYAs, particularly females (12.6 per 100,000 vs 9.2 in non-Hispanic white persons), reflecting substantial survival disparities compared to those who are non-Hispanic white. The largest 5-year cancer-specific survival disparities occur among those who are non-Hispanic Black compared with non-Hispanic whites for acute lymphocytic leukemia (57% vs 71%, respectively) and female breast cancer (78% vs 89%, respectively).

    Thyroid cancer diagnoses have driven the overall increase in incidence rates—especially for women

    Overall, the researchers found that cancer incidence rates increased across all 3 age groups during the past decade. Notably, thyroid cancer was the only common type among each age group’s top 3 types of cancer. Thyroid cancer incidence rates among women in their 20s are 5 times greater than those in men (15 women vs 3 men per 100,000 people).

    By age group, the cancer incidence rate in AYAs increased during the most recent decade (2007-2016) overall but showed signs of stabilizing among men in their 20s. The rise is largely driven by thyroid cancer incidence rates, which rose by approximately 3% annually among those aged 20 to 39 and 4% among those aged 15 to 19 years. Incidence increased for several cancers linked to obesity, including kidney (3% across all age groups), uterine corpus (3% in group aged 20-39 years), and colorectum (0.9%-1.5% in the group aged 20-39 years).  

    In contrast to incidence, cancer mortality rates among AYAs for all cancers combined declined in the past decade (2008 through 2017) by 1% across sex and age groups except females aged 30 to 39, among whom rates remained stable due to a flattening of declines in breast cancer mortality. Mirroring incidence, mortality rates increased during the most recent 10 data years (2008-2017) for colorectal and uterine corpus cancers.

    Other highlights from the report include:

    • Cancer incidence rates for all types combined are similar for males and females ages 15 to 19. However, 20- to 29-year-old women have rates that are 30% higher than for men of the same age (55 women vs 42 men per 100,000 people). The incidence rate is nearly double in 30- to 39-year-olds (161 women vs 84 men per 100,000 people.) These differences are mainly because of the higher incidence of breast cancer, melanoma, and thyroid cancer in women.
    • Adolescents (aged 15-19 years) are more likely to be diagnosed with cancers associated with childhood, such as Hodgkin lymphoma, while those aged 20 to 39 years are more likely to be diagnosed with adult cancers, such as breast. 
    • Leukemia continues to be the leading cause of cancer death in ages 15 to 29 years. Among ages 30-39 years, breast (women) and colorectal (men) cancers are the leading cancer causes of death.
    • Melanoma incidence rates during 2007-2016 rapidly declined in ages 15 to 29 (4%-6% annually, on average). However, among ages 30-39 years, rates declined only slightly among men and remained flat among women. 
    • The most commonly diagnosed cancer for males aged 20 to 39 is testicular cancer. The incidence rates per 100,000 people are: 13 for non-Hispanic white men;10 for both Hispanic men and American Indians/Alaskan Natives;2.4 for non-Hispanic Black men.
    • Overall 5-year relative survival in AYAs for all cancers combined (83%-86% across age groups) is similar to that in children (84%), but masks lower survival for several cancer types, such as acute lymphocytic leukemia (ALL; 60% vs 91%, respectively).

    The report notes an increasing body of evidence that tumors in AYAs are molecularly distinct from those in younger or older populations, suggesting differences in etiology and in treatment options. In addition, studies have shown that compared to childhood cancer survivors, AYAs have a higher risk of progression and death from their original cancer. Compared to older cancer patients, AYAs have a higher risk of long-term and late effects including infertility, sexual dysfunction, cardiovascular disease, and other future cancers. However, further research in these areas is needed. 

    The authors say that progress in reducing cancer morbidity and mortality among AYAs could be improved with more equitable access to health care, as AYAs are more likely than other age groups in the U.S. to be uninsured. Increased clinical trial enrollment, expanded research, and improved awareness among clinicians and patients of early symptoms and signs of cancer could also accelerate progress. 

    “Although there has been rapid progress in the scientific understanding of cancer in AYAs over the last decade, several research gaps in etiology, basic biology, treatment, and survivorship remain,” write the authors. “AYAs diagnosed with cancer also continue to face challenges in health care access during early life transitions, which can negatively impact treatment.”
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