Recent studies have revealed a concerning trend: cancers of the appendix are increasing in prevalence, particularly among younger generations. An analysis of the National Cancer Institute database has shown that the rates of appendix cancer have tripled among Generation X and quadrupled among millennials compared to older generations. This alarming finding was published on Monday in the Annals of Internal Medicine.
Lead author of the study, Andreana Holowatyj, an assistant professor of hematology and oncology at the Vanderbilt University Medical Center and the Vanderbilt Ingram Cancer Center, highlights the disproportionate burden of appendix cancer affecting younger individuals. In a phone interview, Holowatyj noted that her previous research was pioneering in showing that one in every three appendix cancers is diagnosed in adults under the age of 50. In stark contrast, only one in eight colorectal cancers occurs in the same age group.
While the increase in diagnosis is noteworthy, it's essential to remember that appendix cancers are still extremely rare. According to the National Cancer Institute, these cancers occur at a rate of just 1 to 2 per million people annually in the United States. Holowatyj utilized data from the Surveillance, Epidemiology, and End Results (SEER) program, which encompasses cancer registries representing approximately 45.9% of the U.S. population, to analyze trends over time. From 1975 to 2019, a total of 4,858 cases of appendix cancer were recorded.
The significant number of patients diagnosed between the ages of 18 and 49, combined with the generational rise among Gen X and millennials, underscores the urgency to investigate the underlying causes of this trend. Holowatyj emphasizes the importance of identifying these factors to potentially reverse the trend and alleviate the disease burden associated with appendix cancer.
Dr. Andrea Cercek, a medical oncologist and co-director of the Center for Early Onset Colorectal and GI Cancers at Memorial Sloan Kettering Cancer Center, supports the study's findings, noting a shift towards younger patients being diagnosed with gastrointestinal cancers. The rise in colorectal cancer rates among younger adults has been documented over the past several decades. However, the specific causes behind the increase in GI cancers, including appendix cancer, require further investigation.
Cercek suggests that the rise in GI cancers may be linked to various environmental factors such as exposure to food, water, and microplastics, alongside lifestyle and dietary changes. She stated, “It’s likely multiple factors causing this rise after 1945,” highlighting the complexity of pinpointing a single cause.
The appendix is a small pouch attached to the large intestine, located on the lower right side of the abdomen. Blockages in the appendix can lead to infections and inflammation, known as appendicitis, which requires emergency treatment. Unlike other GI tract cancers, appendix cancers are difficult to detect because they do not show up well on abdominal scans or during colonoscopies, according to Dr. Deborah Doroshow, an associate professor of medicine at the Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai in New York City.
Doroshow explains that about 95% of appendix cancers are diagnosed only after a person suffers from appendicitis, leading to the removal and examination of the appendix by pathologists. This often results in late-stage diagnoses with poorer long-term prognoses. She stresses the importance of awareness regarding subtle symptoms, advising that changes in energy levels, persistent pain, or unexplained weight loss in young individuals should not be dismissed.
“If a person feels that something is not right, it’s always best to seek a medical opinion,” Doroshow advises, noting that young patients have been misdiagnosed or not taken seriously by healthcare providers. She adds that women and people of color may need to advocate more vigorously for their health. While it’s normal to experience occasional abdominal pain, persistent discomfort should warrant further investigation.
