GPs are ignoring cancer warning signs in young people, with too many referred for psychological therapy instead of screening, a leading oncology expert has warned.
The symptoms of young people repeatedly presenting with pain are too often ignored because there is still a lack of awareness among patients and GPs of how early onset cancer has increased, according to Dr Bhawna Sirohi, the president of oncology at the Royal Medical Society. This means that when symptoms are finally picked up, cases are more likely to be terminal, she added.
The latest research suggests that the number of under-50s worldwide being diagnosed with cancer has risen by nearly 80% over three decades to reach 3.26 million in 2019.
“It’s like the black sheep – one has to think about cancer as a differential every time a patient comes,” said Sirohi, adding that GPs were “doing a great job” but needed to be supported by robust NHS data and stronger guidance.
She said that in her breast cancer clinic a lot patients had been referred for psychological counselling because they kept going back to their GP, but then six months later were diagnosed with breast cancer. “She keeps coming back with pain, a niggle, and they say ‘oh no it’s nothing to worry about, it’s pre-period, everybody has pain, don’t worry’.”
Sirohi said she had observed the increase in younger people presenting with cancer first-hand: “I’ve seen 25-year-olds and 28-year-olds in Bart’s health [NHS trust] with breast cancer. I’m seeing people in their 20s and 30s. We never saw that 20, 15 years ago – maybe one every two to three months, but now in every clinic you see quite a few people. In a month you might see 10-15 or maybe more.”
Noting that young people are more likely to present in the later stages of cancer, when it is harder to treat, Sirohi said it was important to have a discussion about lowering the age for screenings in cancers.
This would follow the US, where the American Cancer Society recently recommended lowering the screening age for breast cancer to 40, and for colo-rectal cancer to 45. The equivalent ages are 50 and 60 in England.
Sirohi said: “Decreasing the screening age has a huge implication for countries with universal health coverage, like the UK. It has additional cost, additional tests, additional workload on the NHS which is already overloaded.”
But, she added, it was important that research into its cost-effectiveness was undertaken, and that if it could save a significant number of young lives “it has be done”.
Sirohi said there were specific factors affecting young people, for example the impact of convalescence on their working lives, the effect on their mental health, how treatment affected fertility and the need for genetic testing, which may warrant the creation of specialist clinics.
Research into the demographic breakdown of early onset cancer is also required, since it is known that people from some black, Asian and ethnic minority communities present with later stage cancer as they are more likely to dismiss symptoms. Research in the US has shown that 23% of early onset cancer cases were in African Americans.
In the meantime, Sirohi said it was crucial that awareness was raised among the public of the symptoms of early onset cancer and the lifestyle factors which increase its risk – including poor diet, smoking, alcohol and lack of exercise.
She added that more research was needed into the effects of environmental pollution, which was likely to be another factor, especially given the growing evidence base for a link between climate breakdown and cancer.
It is difficult to pinpoint exactly what the causes of early onset cancer are given the sheer number of carcinogens, said Dean Jones, a professor at the Emory Winship Cancer Institute leading a team shortlisted for Cancer Grand Challenges funding from Cancer Research UK.
As well as lifestyle factors, researchers are considering whether higher temperatures and resultant dehydration; the use and misuse of antibiotics; and industrial pollution, including poor disposal of electronic waste could contribute. They are also drawing on new understanding of how the gut microbiome works, including its relationship with the immune system, to explore its role.
He said that there was evidence that exposure to carcinogens in many cases had “occurred decades before the onset of the cancer” – including in the womb – meaning that research should look at how damage could be reversed rather than just prevented.
Prof Arthur Sun Myint, lead clinician at Clatterbridge Cancer Centre and vice-president of the International Contact Radiotherapy Network, said there was a need to develop cheaper, faster early screening methods, and to train up nurses to deliver them. For example, in his area of rectal cancer, the FIT stool test can be used in the first instance, rather than a colonoscopy.
He added that young people’s quality of life was important to consider as it was more onerous for a 30-year-old to use a colostomy bag for their entire life than someone in old age. This meant it was important to look at how new techniques, such as Papillon radiotherapy, could be used for younger patients.
He recalled one 31-year-old bowel cancer patient he treated: “He said, ‘I don’t care what you do, so long as you don’t give me a bag.’”
A Department of Health and Social Care spokesperson said: “NHS England is supporting GPs to diagnose more cancers early by making funding available for tools to help with clinical decision making, such as whether to refer or request further investigation in patients where they believe there’s a cancer risk and identifying at-risk patients based on their symptoms.”