In this issue of Baylor University Medical Center Proceedings, Fulton et al conclude that there is a rising incidence of hepatobiliary cancer (HBC) in patients under 40, principally among women.1 In a review of the SEER 21 registry from 2000 to 2022, the age-adjusted incidence for HBC in patients aged 15 to 39 increased from 0.34 cases per 100,000 in 2000 to 0.56 per 100,000 in 2022. This was largely driven by an increased incidence in the female population, who had an annual percent change of 3.18%, compared to 0.10% in males. Once stratified by ethnicity, Hispanic females led the way, with an annual percent change approaching 7% from 2008 to 2022.
With this paper, the authors contribute yet another brick in the growing wall of evidence suggesting that cancer is on the rise among younger patients. This trend gained initial prominence in studies of colorectal cancer, but similar concerns have been raised for breast, pancreatic, gastric, kidney, and uterine cancers, among others.2 While there has been some controversy as to whether this rise is real or results from increased screening and overdiagnosis, large epidemiologic studies suggest a genuine increase in the incidence of many early onset cancer diagnoses.3,4 Given most HBC cancers present with symptoms, as opposed to being found incidentally or on screening exams, the rise in incidence noted in this paper is less likely to result from overdiagnosis. In fact, the concomitant rise in female mortality from HBC reported by the authors appears to corroborate the rising HBC incidence in this population as a clinically meaningful finding.
The real question then becomes, why is this occurring? The authors offer several possibilities, principally the emerging obesity epidemic and metabolic dysfunction–associated steatohepatitis. While that is certainly plausible, the current study is limited by a lack of demographic and clinical data to explore this hypothesis further. Other risk factors related to diet/lifestyle, environmental exposures, or infectious etiologies may certainly be in play. Future studies should seek to not only validate this paper’s findings of increased early onset HBC, but also to characterize the associated risk factors. Ultimately, understanding these contributing factors may better define populations at risk for early onset HBC and allow for earlier intervention, if not prevention.
–Charles Kimbrough, MD, MPH
Division of Surgical Oncology,
Baylor University Medical Center
Dallas, Texas, USA
charles.kimbrough@bswhealth.org
http://orcid.org/0009-0003-2585-0845
References
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