Leading Cancer Deaths in People Younger Than 50 Years

Abstract

This study examines changes in cancer mortality in the US for the 5 leading cancer-related deaths among people younger than 50 years over the past 3 decades.

Numerous studies report increasing cancer incidence in young adults,¹ but mortality trends are an important measure of progress against cancer that are less affected by detection bias. This study examined changes in cancer mortality in the US for the 5 leading cancer-related deaths among people younger than 50 years over the past 3 decades.

Methods

Annual numbers of cancer deaths and age-standardized rates per 100 000 males and females younger than 50 years from 1990 through 2023 were obtained from SEER*Stat (version 9.0.41.4; National Cancer Institute) as reported by the National Center for Health Statistics (NCHS). NCHS mortality data are based on underlying cause of death reported on death certificates filed in all 50 US states and the District of Columbia and were classified according to the International Classification of Diseases and Related Health Problems, Tenth Revision. Trends in rates for all cancer deaths combined and for the 5 leading causes of cancer death from 1990 through 2023 were quantified using the Joinpoint Regression Program (version 5.4.0.0; National Cancer Institute), which uses permutation analysis to fit a series of straight lines on a logarithmic scale to observed rates to estimate annual percent change (APC). Mean APC during the past 10 data years (2014-2023) was also calculated. Trends were described as increasing or decreasing when the APC or mean APC was significantly different from zero (P < .05) using a 2-sided test. This study did not require institutional review board approval or informed consent based on guidelines from the National Advisory Committee of Human Research Protections because it involved only deidentified public-use data. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Results

From 1990 through 2023, a total of 1 267 520 people (53% female) died of cancer in the US before 50 years of age, and the age-standardized death rate decreased by 44%, from 25.5 to 14.2 per 100 000. Among the 5 leading causes of cancer death, the mean annual decline from 2014 through 2023 was 0.3% (95% CI, −0.6% to −0.0%) for brain cancer, 1.4% (95% CI, −1.7% to −1.1%) for breast cancer, 2.3% (95% CI, −2.3% to −2.2%) for leukemia, and 5.7% (95% CI, −7.2% to −4.2%) for lung cancer (Table). Only colorectal cancer (CRC) mortality increased, by 1.1% (95% CI, 0.9% to 1.3%) annually since 2005, advancing it from fifth most common from 1990 through 1994 to the most common cancer death in 2023 (Figure). Conversely, lung cancer and leukemia dropped from ranking first to fourth and third to fifth, respectively, whereas breast cancer remained the second-leading cancer death overall and first in females. Cervical cancer ranked third in females in 1990 and 2023, despite a continuous decline throughout the study period. The cancer distribution in males mirrored the overall pattern, with breast cancer replaced by non-Hodgkin lymphoma (fourth) in 1990 and pancreatic cancer (fifth) in 2023.

Table. Trends in Mortality Rates for Leading Cancer Types Among Those Younger Than 50 Years in the US^a.

Cancer type	Trend 1		Trend 2		Trend 3		Trend 4		Mean APC 2014 to 2023 (95% CI)
	Years	APC (95% CI)	Years	APC (95% CI)	Years	APC (95% CI)	Years	APC (95% CI)
All cancers	1990 to 2019	−2.0 (−2.0 to −1.9)b	2019 to 2023	−0.3 (−1.1 to 0.5)					−1.2 (−1.6 to −0.9)b
Male	1990 to 2003	−1.9 (−2.0 to −1.8)b	2003 to 2019	−2.4 (−2.5 to −2.3)b	2019 to 2023	0.3 (−0.5 to 1.0)			−1.2 (−1.5 to −0.9)b
Female	1990 to 2018	−1.8 (−1.8 to 1.7)b	2018 to 2023	−0.7 (−1.5 to 0.1)					−1.2 (−1.6 to −0.7)b
Female breast	1990 to 2007	−3.2 (−3.4 to −2.9)b	2007 to 2023	−1.4 (−1.7 to −1.1)b					−1.4 (−1.7 to −1.1)b
Colon and rectum	1990 to 2005	−0.4 (−0.7 to −0.1)b	2005 to 2023	1.1 (0.9 to 1.3)b					1.1 (0.9 to 1.3)b
Male	1990 to 1998	−1.1 (−1.8 to −0.4)b	1998 to 2001	3.0 (−3.0 to 9.4)	2001 to 2004	−3.0 (−8.5 to 2.8)	2004 to 2023	1.3 (1.1 to 1.5)b	1.3 (1.1 to 1.5)b
Female	1990 to 2004	−0.5 (−0.9 to −0.1)b	2004 to 2023	0.8 (0.5 to 1.0)b					0.8 (0.5 to 1.0)b
Lung and bronchus	1990 to 1996	−4.0 (−4.9 to −3.1)b	1996 to 2006	−1.2 (−1.7 to −0.7)b	2006 to 2020	−7.2 (−7.5 to −6.8)b	2020 to 2023	−2.7 (−7.5 to 2.4)	−5.7 (−7.2 to −4.2)b
Male	1990 to 1995	−5.2 (−6.4 to −3.9)b	1995 to 2005	−2.2 (−2.7 to −1.7)b	2005 to 2019	−7.2 (−7.6 to −6.8)b	2019 to 2023	−2.4 (−5.8 to 1.1)	−5.1 (−6.5 to −3.7)b
Female	1990 to 1996	−3.2 (−4.3 to −2.0)b	1996 to 2005	0.2 (−0.6 to 0.9)	2005 to 2009	−3.9 (−7.2 to −0.5)b	2009 to 2023	−7.5 (−7.9 to −7.0)b	−7.5 (−7.9 to −7.0)b
Brainc	1990 to 2007	−1.5 (−1.7 to −1.2)b	2007 to 2023	−0.3 (−0.6 to −0.0)b					−0.3 (−0.6 to −0.0)b
Male	1990 to 2007	−1.4 (−1.7 to −1.2)b	2007 to 2023	−0.4 (−0.7 to −0.1)b					−0.4 (−0.7 to −0.1)b
Female	1990 to 2007	−1.5 (−1.8 to −1.2)b	2007 to 2023	−0.1 (−0.6 to 0.3)					−0.1 (−0.6 to 0.3)
Leukemia	1990 to 2023	−2.3 (−2.3 to −2.2)b							−2.3 (−2.3 to −2.2)b
Male	1990 to 2023	−2.3 (−2.4 to −2.2)b							−2.3 (−2.4 to −2.2)b
Female	1990 to 2023	−2.2 (−2.3 to −2.1)b							−2.2 (−2.3 to −2.1)b
Non-Hodgkin lymphoma	1990 to 1996	−0.3 (−2.0 to 1.4)	1996 to 2004	−7.4 (−8.7 to −6.0)b	2004 to 2023	−3.6 (−4.0 to −3.1)b			−3.6 (−4.0 to −3.1)b
Male	1990 to 1997	−0.9 (−2.0 to 0.2)	1997 to 2000	−13.2 (−21.0 to −4.7)b	2000 to 2020	−4.3 (−4.6 to −3.9)b	2020 to 2023	2.4 (−5.0 to 10.4)	−2.1 (−4.4 to 0.3)
Female	1990 to 1996	0.5 (−1.5 to 2.5)	1996 to 2005	−5.8 (−7.1 to −4.5)b	2005 to 2023	−3.6 (−4.2 to −3.1)b			−3.6 (−4.2 to −3.1)b
Pancreas	1990 to 2023	−0.5 (−0.6 to −0.4)b							−0.5 (−0.6 to −0.4)b
Male	1990 to 2023	−0.7 (−0.8 to −0.5)b							−0.7 (−0.8 to −0.5)b
Female	1990 to 2006	0.4 (−0.2 to 1.0)	2006 to 2023	−0.8 (−1.3 to −0.2)b					−0.8 (−1.3 to −0.2)b
Uterine cervix	1990 to 1997	−1.7 (−2.9 to −0.4)b	1997 to 2003	−3.9 (−5.9 to −1.8)b	2003 to 2023	−0.4 (−0.6 to −0.1)b			−0.4 (−0.6 to −0.1)b

Abbreviation: APC, annual percent change (based on mortality rates age adjusted to the 2000 US standard population).

^a Trends analyzed by Joinpoint Regression Program (National Cancer Institute), version 5.4.0.0, allowing up to 3 joinpoints (ie, 4 line segments). Joinpoints occur where the APC changes in magnitude or direction; the number of line segments, identified by a year range, increases with the variability of the trend. Statistical significance was determined by the parametric method.

^b The APC or mean APC is significantly different from zero (P < .05).

^c Includes other nervous system.

Figure. Temporal Changes in the 5 Leading Cancer-Related Deaths in People Younger Than 50 Years in the US, 1990-2023.

Panel C includes 6 cancer types instead of 5 because pancreatic cancer replaced non-Hodgkin lymphoma in the top 5 cancer deaths among males during the study period.

Discussion

Mortality has decreased for every leading cancer-related death in people younger than 50 years in the US except CRC, which is now the leading cancer death in females and males combined, up from the fifth-leading cancer death in the early 1990s. Breast cancer and leukemia mortality decreased despite increasing incidence.¹ These findings are consistent with reports of increased CRC mortality among adults younger than 50 years overall¹ and in most racial and ethnic groups,² and preempt projections that CRC would lead cancer deaths in those younger than 50 years by 2040.³

Increasing mortality underscores the critical need for ongoing etiologic research to identify causes for increasing early-onset CRC. Meanwhile, given that 3 in 4 patients younger than 50 years are diagnosed with advanced CRC,² educating clinicians and the public about unique red flag symptoms, including hematochezia and abdominal pain,⁴ could facilitate earlier diagnosis and receipt of timely treatment. Additionally, screening before 50 years of age has been associated with both early diagnosis and reduced incidence and mortality,^5,6 and is recommended to begin at age 45 years for people at average risk and earlier for people with a genetic or family history that increases risk. This study is limited by national-level ecologic data, but nevertheless identifies an urgent need for CRC prevention and early detection in younger adults.

Supplement.

Data sharing statement