Orange County leading a grim trend: Cancer among younger people
By HANNA KANG, The Orange County Register
PUBLISHED: March 12, 2024 at 7:00 a.m. | UPDATED: March 13, 2024 at 9:51 a.m.
Brandon Arbini, 44, at FLDWRK, a flexible workspace he owns, in Costa Mesa, CA, on Monday, March 11, 2024. Arbini, was diagnosed with stage IV colon cancer when he was 41. He is now in remission. (Photo by Jeff Gritchen, Orange County Register/SCNG)
Cancer isn’t just about age.
Yes, it’s still true that older people are more likely than younger people to be diagnosed with cancer. Cells change more frequently, and in different ways, when you’re older. And decades of lifestyle choices and exposures can — and often do — result in some form of cancer.
But according to new data from several health organizations, younger people are starting catch up, cancer-wise.
Though the total number of cancer deaths in the United States has fallen by about 4 million a year since the early 1990s, the American Cancer Society recently reported that the rates of younger people diagnosed with cancer are starting to climb, led by a rise in colorectal and breast cancers.
And that trend is playing out locally, particularly in Orange County.
Over the past five years, youth-cancer rates have jumped in most big counties in California, with Orange County leading the Southern California region in that grim statistic, according to data from the National Cancer Institute.
For people age 50 and younger, cancer is hitting more frequently in Orange County than it is in the rest of the region. What’s more, the rate in Orange County — 98.3 out of every 100,000 people in the same age group — outpaces the other counties (San Diego, 95; San Bernardino 93.1; Riverside, 90.3; Los Angeles, 89.6) by a fairly wide margin.
The good news is the youth cancer diagnosis rate in Orange County — and most of the rest of California — is well below the national average of 105.2 per 100,000.
The bad news is that for every number tabulated in those reports, there’s a human being struggling to stay alive.
In all, each year, about 12,800 people age 50 and younger in the five-county Southern California region are diagnosed with some form of cancer. That includes about 2,000 a year in Orange County.
Or, more specifically, it includes guys like Brandon Arbini.
In 2021, Arbini, a Costa Mesa resident, was diagnosed with stage 4 colon cancer. It was, he said, a surprise. He was experiencing mild discomfort and stomach pain, but no symptoms that were “screaming cancer.” Plus, that year, he was only 41.
“Cancer wasn’t on my radar,” Arbini said. “I didn’t smoke. I didn’t drink. I had no known family history.”
When Arbini told his doctor his symptoms prior to being screened, he said his doctor wasn’t particularly alarmed. Still, to play it safe, the doctor recommended that Arbini get a colonoscopy — something that, at the time, typically didn’t happen doesn’t happen until a person turns 50.
As Arbini was coming out of sedation, his doctor told him, “This isn’t what you want to find.” The screening had detected a large tumor, so significant that the colonoscopy couldn’t be completed without risk of disturbing the tumor.
Worse, Arbini said, the cancer had spread to his liver and lymph nodes.
For the barely-middle-age man, the news changed everything.
Married with three children currently aged 18, 16 and 12, Arbini wondered if he’d be around to see them grow up; he wondered, too, if he’d celebrate another wedding anniversary with his wife, Jill.
“I always had this future orientation about my life thinking about where I am, where I’m headed, what I’m doing to get there,” Arbini said. “And when I got this diagnosis, it threw everything into question… I didn’t know if I would have a future.”
“And I didn’t really know how to deal with that.”
“When we looked at the patients that we’ve seen at City of Hope Orange County, almost 20% of those coming through the door were under the age of 50,” said Ed Kim, City of Hope Orange County’s physician-in-chief. Above, Kim speaks during a White Ribbon Project event at City of Hope in Irvine in 2022. (Photo by Paul Bersebach, Orange County Register/SCNG)
“A younger face”
Because cancer risk increases with age, the disease is still largely associated with old age.
“The more we age, the more chances you have of getting cancer,” said Ed Kim, City of Hope Orange County’s physician-in-chief. “Whether that’s within your own body because your cells are reproducing and there are different mutations occurring that can’t be cleared by our immune system, or whether it’s because the longer you are alive, the more exposures you have to different things in the environment.”
But according to the American Cancer Society’s report, the nationwide death rate from colorectal, or colon, cancer has gone up among men younger than 50, as has the incidence rate of breast cancer among younger women.
The rise of cancer among younger people is changing the way cancer is treated.
In 2021, the U.S. Preventive Services Task Force, an independent group of medical experts affiliated with the Agency for Healthcare Research and Quality in the Department of Health and Human Services, lowered the recommended initial age of screening for colon cancer from 50 to 45, and in 2023, it lowered the recommended initial age for mammograms from 50 to 40.
“When we looked at the patients that we’ve seen at City of Hope Orange County, almost 20% of those coming through the door were under the age of 50,” said Kim.
Such numbers beg a question: Why?
Kim said at this point it’s a guess.
“Is it lifestyle exposures that we have? Is it genetics? Is it environmental factors? We know that it can definitely be diet and other things, like alcohol. But we clearly don’t have all the answers here,” Kim said.
Kim suspects that there may be cancer-causing genetic variants, locally, that have not yet been identified, but he said it’s why clinical trials and research in a healthier population is needed.
“I wish I could tell you there were some patterns of presentation, symptoms or lifestyle tendencies. And we just haven’t seen that. Most people who present to us have some nonspecific symptoms.”
Those symptoms could be unexplained weight loss, low-grade pain or discomfort.
“We don’t have a pattern there yet, but the pattern that we are seeing for sure is that there are definitely younger people showing up into our cancer clinics,” he said.
Annette Walker, president of City of Hope Orange County, said over the past 18 months or so she’s received more referrals from people ages 40 to 50 than from people in her own age group, 60 and up.
“This is an age group that is often getting to their mid-career, they might have children and (are) taking their kids’ health more seriously than theirs,” she said, referring to the younger patients.
“People typically characterize cancer as a disease associated with aging. But cancer has a younger face.”
Cancer prevention
Eating healthy, exercising, not smoking, being moderate in alcohol consumption; all are choices that can help reduce cancer risk.
But they can’t eliminate it.
“We now know they’re not the entire solution,” Kim said. “We will hear people say, ‘I live a healthy lifestyle. I do all of those things.’”
County Health Officer Dr. Regina Chinsio-Kwong did those things. In 2022, at age 43, a routine mammogram revealed she had an early form of breast cancer.
“As a physician, I should have known better, right? Yes, I was up to date with my screening. But at the same time, I fell into the myth of, ‘Oh, I’m low risk. I’m healthy, I exercise, I live a very active lifestyle; I didn’t have any family history of breast cancer of cancer at all. I think I’m on top of it,’” she said.
Chinsio-Kwong, who’s now cancer-free, said when she shared her story with friends, all in their 30s and 40s, she found out many had not had regular breast exams.
Such testing could save lives. Others note that such testing could lead to answers about why rates are rising among younger people.
“This speaks to the need of trials in cancer detection and screening, so we can start gathering that important medical and genomic information of people,” Kim said.
Kim added that City of Hope has opened several research trials, including one that examines whether a simple blood test could detect cancer early.
“We’re trying to look at screening programs that are more inclusive,” he said.
To give a broader population access to screening, City of Hope also launched a mobile cancer prevention and screening program, set to serve its first patients on March 19 in Antelope Valley. The program will assess the risk and screen for at least 15 different types of cancer, including using state-of-the-art mammography technology.
The clinic will also serve patients in Orange and Los Angeles counties, Kim said.
A second mobile clinic is slated to open later this year.
Arbini, now 44, is on the path to being cancer-free after surgery and 12 rounds of chemotherapy.
“If I had been screened earlier, they would have caught this before it turned into cancer, and certainly before stage 4 cancer,” he said. “My hope is that by sharing my story, more people that are of my age or younger, will understand the risks and get that screening.”