Cancer
New evidence on obesity and younger cancer diagnosis – study
Obesity may be a key driver of rising rates of 11 cancers in adults under 50, a study has found.
The 11 cancers were thyroid, multiple myeloma, liver, kidney, gallbladder, colorectal, pancreatic, endometrial, oral, breast and ovarian cancers.
All except oral cancer are known to be linked to excess weight, with researchers saying raised insulin levels and inflammation may play a part.
The findings come from researchers at the Institute of Cancer Research, London and Imperial College London, who analysed national cancer registry data for England from 2001 to 2019.
In England, around 31,000 cancers were diagnosed in people aged 20 to 49 in 2023, equal to roughly one in every 1,000 people. This compares with 244,000 cases in the 50 to 79 age group, where the rate is around one in 100.
Concerns have been growing in recent years over rising rates of cancers such as bowel and ovarian in younger adults.
Among the younger group, breast cancer was the most common, with 8,500 cases, followed by bowel cancer at 3,000 and melanoma skin cancer with 2,800 diagnoses.
For nine of the 11 cancers identified, rates are rising in younger adults but also increasing in older adults, who are much more likely to develop the disease. Bowel and ovarian cancer were the exceptions, rising only in younger age groups.
The researchers found that bowel cancer rates in younger women linked to BMI rose faster, from 0.9 to 1.6 per 100,000 people, than those not linked to BMI, which rose from 6.4 to 9.6 per 100,000 people. Similar patterns were recorded for men.
However, the authors noted that the overall number of cases of BMI-linked bowel cancer in younger women remained lower than those not linked to BMI, suggesting other factors must be contributing to the increase.
Several suspected contributors, including ultra-processed foods, antibiotic use and air pollution, have been proposed in recent years. However, many of these factors have also shown stable or declining trends in the UK, the team said.
Despite the rise in several cancer rates among younger adults over the past two decades, most established risk factors, including smoking, alcohol consumption, red or processed meat intake, low fibre diets and lack of exercise, remained stable or even declined in the period leading up to diagnosis.
This suggests these traditional risk factors are unlikely to account for much of the increase in cancer cases.
By contrast, overweight and obesity, which have increased steadily since 1995, could be key factors in the rise in cases. The team suggested that between 2001 and 2019, around 20 per cent of the increase in bowel cancer was explained by increases in BMI over that period.
However, the researchers said rises in BMI alone are not enough to explain the overall increase in cancer among younger adults in England and that there are likely to be other causes.
Data also suggest around 15 per cent of bowel cancer in younger people could be linked to being overweight or obese, with around 40 to 50 per cent in total linked to the combined effect of known risk factors such as obesity, lack of exercise, alcohol and smoking.
Montse García-Closas, professor at the ICR, said more research was needed, but “we cannot wait to act”.
She told a media briefing: “Our main conclusion is that although BMI is our best clue, much of the increase still remains unexplained, and we’ve done some additional analysis that show that most likely what’s missing is not just a single cause unexplained, but it’s likely a combination of multiple factors that act together.”
Amy Berrington, professor at the ICR, said: “Although rates have been increasing, cancer in young people is still a rare disease.”
Marc Gunter, professor at Imperial, said obesity was a known risk factor for around 19 different cancers.
He added: “For some of these cancers, including colorectal (bowel) cancer, we think this could be partly caused by higher levels of hormones such as insulin, which is often elevated in people with obesity, as well as inflammation.
“We know people with obesity have higher levels of insulin, and insulin is a growth factor and has been linked to cancer.
“In a recent study, we actually found that insulin in particular might be playing a role in early onset colorectal (bowel) cancer, and this is actually an area of very active research at the moment.”
The researchers called for large, long-term studies to identify all the biological and environmental factors that could explain rising cancer rates in young adults.
García-Closas added: “Tackling obesity across all ages, particularly in children and young people, through stronger public health policies and wider access to effective interventions, could slow the rise in cancer and prevent many cancers and must become a national priority.”
Michelle Mitchell, Cancer Research UK’s chief executive, said: “Globally, and in the UK, we’re seeing a small increase in cancer rates in adults under 50.
“The picture is complex and we need more research to understand what’s driving the trend, but this study helps to fill in some gaps.
“Overweight and obesity doesn’t explain the rise in full though. Improvements in detection are likely to also be playing a part, meaning that more people are being diagnosed at a younger age.
“Preventing cancer cases must be a priority for the UK government. Smoking remains a leading cause of cancer in adults under 50, which is why the Tobacco and Vapes Bill receiving royal assent this week is such a historic moment.
“Measures to restrict the advertising and promotion of junk food, introducing mandatory reporting and targets on healthy food sales, and making nutritious food more accessible to everyone would all help people keep a healthy weight.”
A vaccine trial will test whether an mRNA jab can help stop precancerous cells developing into bowel and ovarian cancer in people with Lynch syndrome.
The first stage is due to launch this summer and will assess whether the jab can train the immune system to recognise and eliminate precancerous cells before cancer develops.
Around 175,000 people in England have Lynch syndrome, but only five per cent, or around 10,000 people, know they have it.
The inherited condition increases the risk of developing bowel cancer by 80 per cent and is linked to around 1,100 bowel cancer cases each year.
Lynch syndrome is also linked to a far higher risk of bowel, womb and ovarian cancer, alongside other types including stomach, pancreatic, kidney and skin cancer.
While the syndrome does not directly cause cancer, the genetic changes can lead to more abnormal cells developing, which then multiply and increase the risk of cancers such as bowel, prostate and endometrial cancer.
It is caused by an alteration in a mismatch repair gene. Carriers do not have any symptoms.
The new Intercept-Lynch trial is part of a scientific collaboration between the University of Oxford and Moderna, while Cancer Research UK has backed the vaccine’s development.
Once patients receive the new mRNA-4194 jab, experts will analyse their immune responses, assess the best dose and check whether the jab is safe.
The second phase of the study will include multiple centres across the UK, including Oxford, and is expected to begin in 2027.
The aim of the trial is to train the immune system with a vaccine to recognise abnormalities and stop them developing into cancer.
Professor David Church, Cancer Research UK senior cancer research fellow in the University of Oxford’s centre for human genetics and lead investigator of the trial, said: “People with Lynch syndrome are at risk of cancers over their entire lives.
“So, it’s very common, for instance, a woman to have a first cancer of her womb, and then some years later have a bowel cancer, or vice versa.
“The targets we’ve chosen for the vaccine were chosen based on their sharedness across multiple cancer types in Lynch syndrome, so we think they should provide broad protection, if the vaccine works.”
In people with Lynch syndrome, mutations can build up, making the cells containing them more likely to turn into cancerous cells.
However, those mutations can be made visible to the immune system and, with enough stimulation, the immune system can attack the abnormal cells and stop cancer from forming.
Professor Church said the mRNA jab acts as “an instruction manual” for the body to attack precancerous cells.
He added that, as with many vaccines, patients may need a booster jab at some stage.
On whether similar approaches could help prevent cancers not caused by Lynch syndrome, Professor Church said: “In terms of proof of principle that we can train the immune system to recognise these cancer-associated alterations and enhance the immune response against them to prevent these pre-cancers or prevent the progression of pre-cancer to cancer, that proof of principle should give us insights that are generalisable.”
David Berman, chief development officer at Moderna, said: “By applying mRNA technology earlier in the patient journey, we aim to harness the immune system when it can have the greatest impact.
“We are proud to bring this innovation to the UK, building on our long-standing collaboration with leading UK institutions to advance mRNA research and development.”
Changes in lymph nodes may help show which breast cancer patients face higher or lower risk of the disease spreading, researchers have found.
The findings could support more tailored care, new treatments and help more people avoid unnecessary treatment.
Dr Simon Vincent is chief scientific officer at Breast Cancer Now, which funded the research:
He said: “These findings suggest that changes to the structure of the lymph nodes are more than just a consequence of the cancer. They can also play an active role in helping breast cancer progress.
“With one person tragically dying from breast cancer every 45 minutes in the UK, we urgently need research like this so that we can better understand who is most at risk of their cancer progressing and becoming incurable. Only then we can find ways to stop it.
“With a better understanding of how lymph nodes change as breast cancer spreads, we could find new targets for future treatments for types of breast cancer that are harder to treat.”
Lymph nodes, a key part of the immune system, help the body fight infections and cancer. In breast cancer, the lymph nodes in the armpit are often the first place the disease spreads to.
At the moment, everyone with invasive breast cancer has to undergo surgery to remove lymph nodes so doctors can check for cancer cells.
Invasive breast cancer means cancer that has spread beyond where it first developed in the breast into nearby tissue.
While this is effective, it can lead to long-term side effects such as swelling of the arm, known as lymphoedema, and may be unnecessary for some patients, particularly those with early-stage disease or those whose cancer responds well to treatment.
The study analysed 331 lymph node samples from people with different types of breast cancer and compared them with healthy lymph nodes from people free from the disease.
It found that breast cancer could change the structure of a network that supports the lymph nodes.
Crucially, some of these changes could occur before doctors were able to spot any cancer cells in the network.
Some changes were linked to a better chance of survival, while others were associated with a poorer prognosis.
Dr Amy Llewellyn and Dr Kalnisha Naidoo from King’s College London, together with professor Sophie Acton at University College London, compared the 331 samples with healthy lymph nodes in people free from the disease.
They looked at fibroblastic reticular cells, known as FRCs, a group of cells in lymph nodes that provide their structure, control fluid flow and activate different immune cells.
The study showed that the structure of this FRC network could change before the cancer had spread and differed depending on the type of breast cancer, any spread and whether someone had received chemotherapy.
Chemotherapy uses medicines to kill cancer cells or slow their growth.
The researchers said the findings could help doctors better understand who is most at risk of breast cancer spreading.
Dr Llewellyn said the first large-scale analysis of FRC in human lymph node tissue from breast cancer patients was addressing the “urgent need” for a better understanding of the area’s biology.
A new ovarian cancer drug has been approved for NHS use in England, offering hundreds of women with hard-to-treat disease a life-prolonging treatment.
Elahere is the first new drug for chemotherapy-resistant ovarian cancer to be approved by the NHS for more than 20 years.
Ovarian cancer is the 18th most common type of cancer globally, affecting more than 300,000 women a year.
More than three-quarters of patients are diagnosed at an advanced stage, making the disease harder to treat.
Prof Ruth Plummer, national clinical lead for cancer drugs at NHS England, said: “This represents the most significant breakthrough in NHS treatment for these hard-to-treat ovarian cancers in over two decades – and we’re delighted it will now offer hundreds of women much-needed hope of precious extra time with their loved ones.”
Standard treatment for ovarian cancer usually involves surgery and chemotherapy, but about 80 per cent of patients with advanced disease relapse and most eventually develop resistance to chemotherapy.
According to the National Institute for Health and Care Excellence, patients with folate receptor-alpha-positive platinum-resistant epithelial cancers have until now had limited options when their tumours stop responding to standard chemotherapy.
Now NICE has approved mirvetuximab soravtansine, also known as Elahere, for patients with epithelial ovarian, peritoneal or fallopian tube cancer that has become resistant to platinum-based chemotherapy and whose tumours contain the FRα protein that the drug targets.
FRα is a protein found on the surface of some cancer cells.
NHS England said up to 400 women a year in England could benefit, in what it described as a major milestone for treatment.
Mirvetuximab soravtansine is given through a drip once every three weeks.
A global clinical trial involving eight NHS hospitals found that the treatment delayed cancer progression and prolonged survival by an average of four months, compared with chemotherapy alone, with more manageable side-effects.
Cancer progression means the disease is growing, spreading or worsening.
In 37 per cent of patients, tumours shrank by at least 30 per cent, compared with 16 per cent of those given chemotherapy.
The drug, made by AbbVie, combines a “homing” antibody, which seeks out the FRα protein on the surface of cancer cells, with a cancer-killing molecule that destroys the cell from within.
Experts said the decision was a seminal moment and could significantly improve the quality of life of affected patients.
Rachel Downing, head of policy and external affairs at Target Ovarian Cancer, said: “This is a hugely important moment for women with platinum-resistant ovarian cancer and their families, who have faced limited effective treatment options for far too long. Today’s announcement offers real hope of improved quality of life.”
Victoria Clare, chief executive of the charity Ovacome, said: “Today marks a landmark moment. Being told that platinum-based chemotherapy is no longer working can bring anxiety and uncertainty, particularly when the disease is at an advanced stage, where time and options are limited.
“This recommendation is the first in over 20 years to offer the ovarian cancer community an additional choice at a critical stage, with the potential to make a real difference to patients and their families.”
Helen Knight, director of medicines evaluation at NICE, said: “We heard clearly from patients and clinicians about the very limited options available at this stage of the disease and the substantial burden that chemotherapy places on women’s lives.
“We are pleased that, following a robust process and a new commercial arrangement with AbbVie, we are now able to recommend this treatment for NHS use.”
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