Tackling the rise in early onset cancer: From research to health equity

Hello and welcome to the latest episode of OCTalks, the podcast series from Oncology Central. I’m Jade Parker, Senior Editor of Oncology Central.

Today I am joined by LeeAnn Bailey, who is the Branch Director of the Community Outreach Research and Engagement branch of the NCI’s Center to Reduce Cancer Health Disparities (CRCHD).

In this interview, we will discuss contributing factors to early onset (EO) cancers, how certain groups are disproportionately affected and initiatives seeking to reduce disparities in cancer care. Thank you for joining us, LeeAnn.

What are the key goals of the Early Cancer Initiative and how does it fit within the broader mission of the NCI Centre to reduce cancer health disparities?

That’s a great question. Early onset is not something that’s new or novel. The NCI has been following this for decades. Three areas of focus for the Early Onset Cancer Initiative are the etiology/ causes that contribute to early onset cancers and those are many, including the environment, lifestyle, social determinants of health and geographical risk factors. The research can probe population-wide screening, incorporate AI technology and utilize modeling studies.

The second bucket is what we term molecular pathology. That’s to support research that investigates the mechanistic differences that underlie the biology of early-onset cancer, compared to cancers with later onset. The focus here is on molecular pathogenesis and phenotyping, as well as the distinct characteristics of early-onset cancers that perhaps are not seen in cancers in older populations.

Last but not least, we’re really interested in survivorship; concerns around reproductive health, mental health, especially with financial toxicity, survivorship care. This generation is often termed the sandwich generation because in many instances they’re caring for younger children as well as potentially parents who might have a cancer diagnosis.

Looking at how it ties into CRCHD, I currently serve as the branch director of the Community Outreach and Research Engagement Branch. What we focus on at the Center, is a dedicated effort to reducing the unequal burden of cancer in our society through a multifaceted approach, which encompasses health disparities research, community outreach and engagement and initiatives to ensure workforce excellence. So, by advancing research, building partnerships and fostering a skilled workforce, all of those things culminate to equip and further advance the field, not only with regard to early onset, but also for cancer health disparities as a whole.

How are certain demographic groups disproportionately affected?

Increases in early-onset cancers aren’t experienced equally. For example, there is an increased incidence of specific types of aggressive breast cancers, such as triple-negative breast cancer in African-American women. However, we’re also seeing that those with Hispanic heritage are most likely to be diagnosed with early-onset gastric cancer. Recent data shows an association with the rise in early onset cancer and specific risk factors, including obesity, environmental exposure, sleep patterns, physical inactivity, microbiota and ultra-processed foods.

Currently, there is very little known about how these associated risk factors interact with each other or affect populations from a specificity aspect. Those are all important scientific questions that we’re still following up on.

Taking a closer look at colorectal cancer. The screening age was lowered to 45 in 2021 in the US. What impact do you think that has had?

There are a few things that we can certainly point to. There is an increased screening uptake as a result of lowering the age and studies show significant jumps in screening for 45 to 49-year-olds. So, depending upon the population and the characteristics, there’s some variability but there’s definitely an uptake.

There’s certainly effective polyp cancer detection as a result of these screening guidelines and greater colonoscopy use. This is largely due to Affordable Care Act-associated accommodations that mandate a no co-pay for these services.

In terms of early detection success, more cancers and precancerous polyps are being found and removed in younger individuals, which allows for treatment at earlier stages. As a result of lowering the age, patients aren’t presenting with advanced cancers.

Also, there’s been an improvement in the persistent gaps. Despite the overall increases, screening rates remain low for uninsured, low-income and some minority populations, which highlights an ongoing challenge to traverse these barriers and enable access for all.

How do you think screening guidelines for other cancer types need to evolve to address the rise of early onset malignancies?

Evolving screening guidelines for early-onset cancers are shifting from broad age-based approaches to precision screening methods using genetics, lifestyle data and advanced technology, which target higher-risk younger groups. For example, earlier breast MRIs for BRCA carriers, developing tools that are sensitive to younger biology as well as improving access and awareness.

It’s very important to have patients be empowered and educated to have these conversations with their providers.

Looking at tailoring treatment options to reduce cancer health disparities, what specific NCI initiatives are seeking to ensure treatment effectiveness across different racial and ethnic populations?

One of the great projects to highlight is from March 2024, where the NCI funded a 5-year $25 million project as part of the Cancer Grand Challenges Program. These funds are for interdisciplinary teams to use advanced approaches like precision nutrition to study the biology and physiology involved in the development of early-onset colorectal cancer. The team recently contributed to a Lancet Oncology publication that does a great job of describing the increased rates of early-onset colorectal cancer across 27 countries.

Another example of an NCI project on early-onset breast cancer was launched in 2023. The project really aims to better understand the role adolescent physical activity plays later in life, specifically how it can reduce early-onset breast cancer risk and survivorship. This project really seeks to explore the increase in early-onset breast cancer incidents in the U.S., which has been pronounced in non-Hispanic Black women and underscores the need for an investment in cancer prevention research that’s focused on risk modification beginning in early life.

In addition to examining racial and ethnic disparities in endometrial cancer outcomes, investigators in the Epidemiology of Endometrial Cancer Consortium are looking at risk factors for early-onset endometrial cancer. This is a snapshot of a few of the projects that are specifically tailored.

For oncologists and researchers wanting to better address cancer disparities in their own practice, what key resources or training opportunities would you recommend?

Depending upon the cancer type and what the focus of the study is, clearly any resources that address cancer health disparities.

NCI has a variety of training opportunities. CRCHD has the iCURE program and the R25 YES programs. AACR also has a variety of resources, both scientific as well as funding opportunities and training.

I think critically important to this is, NCI or NIH-funded research on community engagement, tools for health disparities, focusing on cultural competence, community partnerships, policy and workforce excellence. We have key programs here at NCI, and these strategies involve all of those items. Again, NCI seeks to leverage the trust and scientifically valid science that comes out from this research. I think it’s important that be disseminated not only to the scientific community, but also to the lay public to be able to really understand what’s available and better empower patients to make choices about their care and their providers.

Author profile:

LeeAnn Bailey is Branch Director of the Community Outreach Research and Engagement branch of the NCI’s CRCHD. In this role, she manages, develops, and assesses strategies for enhancing the integration and dissemination of community outreach and engagement efforts within and across NCI, as well as within the scientific and lay community through NCI-supported networks. She also identifies and leverages opportunities to address unmet needs in cancer health disparities research. In addition to these responsibilities, she is also the lead of the early-onset cancer initiative for NCI.

Prior to joining NCI, she was a healthcare consultant at Deloitte Consulting LLP. She has also been a principal investigator researching tissue-engineered products and cellular inflammatory responses at the National Institute of Standards and Technology as well as an adjunct professor at Morgan State University.

Dr. Bailey received her M.B.B.S (M.D. equivalent) from the University of Adelaide Medical School with an emphasis on aboriginal health and pediatric oncology. Dr. Bailey also has a Ph.D. in Biochemistry and Molecular Genetics and a M.S. in Biological and Physical Sciences from the University of Virginia School of Medicine.

The opinions expressed in this interview are those of the author and do not necessarily reflect the views of Oncology Central or Taylor & Francis Group.