The New York Times reports today on the unique issues faced by people who are diagnosed with cancer in their young adult years. The number of people with cancer in their young adult years is trending upward and nobody really knows why or whether or not the treatments that are available for children and older adults with cancer are best for this population. Researchers and care providers suspect that both genetics and environmental factors are involved, but nobody knows for sure. Many of the young people who are diagnosed with cancer do not have a family history, but some do and this may be one important clue that would be a red flag, at least in some cases. Also, since no one expects cancer to occur in younger people, when the diagnosis is made, it is often at a later stage. In addition, it is not clear that cancer that occurs in young adults is the same disease as the cancer that is diagnosed in older patients. Whatever the particular situation might be, everyone agrees that we need to fill the gaps in our knowledge, there needs to be greater awareness amongst care providers and the public about this trend, and there needs to be more and better services and systems in place to meet the particular needs--many of which are psychosocial--of this group of cancer survivors.
So, what is the role for public health in this? Clearly, public health has a role in identify and characterize cases, do the population-based surveillance that may help identify the factors in the genome and in the environment are involved. Also, those who are looking at genes and those who are looking at environmental factors need to be talking to each other and integrating the knowledge that comes from both approaches because it is likely that it is at the point of interaction between the two that is responsible for this worrisome trend.
Public Health also has a role to educate the public and providers about this growing trend, encouraging doctors to consider placing cancer higher in the list of differential diagnoses. Even though a diagnosis of cancer may be the least likely situation, the consequences for the patient may be so grave that it may be appropriate to definitively rule out this situation, if at all possible. Public Health can have a role in collecting the perspectives of stakeholders in the medical and cancer survivor communities, along with data on the true prevalence of cancer in young adults and the cost / benefit ratios of such approaches to assure that our systems and providers have the evidence and tools they need to address this for the better health of their patients and the population as a whole.