Catherine, Princess of Wales, announced in a video released March 22 that she is undergoing preventative chemotherapy after cancer was found to have been present, following her abdominal surgery in January.BBC Studios/Reuters
Dr. Sharlene Gill is a professor of medicine at the University of British Columbia, a medical oncologist practising in Vancouver and the President of the Canadian Association of Medical Oncologists.
Last week, the 42-year-old Catherine, Princess of Wales, shared the surprising news that she is on preventative (adjuvant) chemotherapy after a diagnosis of cancer found during abdominal surgery for what was believed to be a benign condition. Surrounded by what appear to be daffodils, a flower associated with the fight against cancer, she said: “For everyone facing this disease, in whatever form, please do not lose faith or hope. You are not alone.”
Speculation remains about the type and stage of her cancer, but what is clear is that it took tremendous courage to publicly disclose the private and difficult reality of a cancer diagnosis. I commend Catherine for sharing her personal story and using her platform to remind us that cancer affects us all – that it does not discriminate by race, gender, religion, social status or, notably, age.
We have heard this statistic often: an estimated two in five Canadians will be diagnosed with cancer in their lifetimes, and one in four will die of it. But while cancer is, of course, hard at any age, it is particularly hard to accept in a young person. This, however, is no longer rare. The majority of cancers still occur in an older population, but early-onset cancers – diagnosed in patients under the age of 50 – are increasing at a rapid and alarming rate. I find myself having difficult cancer conversations with young families on a daily basis, and this was certainly not the case when I started my practice 20 years ago. The cancer community is calling this an early-onset-cancer epidemic.
A timeline of Catherine, Princess of Wales’s abdominal surgery and cancer treatment
March is Colorectal Cancer Awareness Month, and this cancer well illustrates the changing epidemiology of early-onset cancers. The cancer is the third leading cause of cancer-related deaths among men and women. While rates are declining in people older than 50, Canadians born after 1980 are now 2 to 2.5 times more likely to be diagnosed with it than previous generations at the same age.
The reasons for this age shift are uncertain, though theories abound, including heavily processed diets, lack of exercise, early obesity, our gut microbiome and our environment. But we do know this: we can no longer afford to dismiss potential symptoms by saying “you are too young to get cancer.” Instead, we need to re-examine our screening guidelines to look for cancer before symptoms appear amid a changing demographic for cancer.
We know there have been tremendous recent advances in cancer treatment, but it remains true that prevention and early detection are our best chances for a cure. In 2021, the U.S. Preventive Services Task Force revised its guidelines for colorectal cancer screening in average-risk individuals from the age of 50 to now include younger individuals between the ages of 45 to 49 years. Canada still recommends screening at the age of 50, however, and there are widespread calls to lower our age threshold as well. This goes hand in hand with a need for greater public and primary-care awareness to encourage screening and recognize symptoms early.
As individuals, we can also reflect upon our personal risk by examining our family history and seeking medical guidance to identify preventative strategies that may help address this risk. Cancer can also be affected by lifestyle choices, including factors such as diet, physical activity and our exposure to smoking, alcohol and UV radiation. To be clear, there is no lifestyle “magic bullet” for cancer prevention – but risk matters, and we need to exercise our personal agency and control what is in our control.
Our governments must increase their targeted funding to support research into early-onset cancers and how we can turn this tide for future generations. We need a cancer-care system that is sufficiently resourced to not only provide essential chemotherapy, radiation and surgical treatments, but also to offer the unique supports needed for young adults living with cancer, including age-appropriate psychosocial support, fertility counselling, genetic testing, cancer rehabilitation and survivorship.
Like countless Canadians, I wish Catherine a full recovery. As an oncologist, I know the months ahead for her and her family will not be easy, and I hope they receive the grace and support to do so privately. Let’s use her brave message – “you are not alone” – to remind us that we are all in this together, and that we need to think differently about the changing face of cancer.