Early-Onset Cancers Often Found Late as Screening Gaps Persist

Young adults with cancer symptoms are often caught between screening guidelines that don’t apply to them and diagnostic pathways that cost more. Meanwhile, delays in cancer detection are compounding as early-onset cancers rise, oncologists warned during a panel discussion at The American Journal of Managed Care’s 2026 Patient-Centered Oncology Care conference in Nashville, Tennessee.

During the session, moderated by Theresa Gillespie, PhD, MA, associate director for cancer health equity and community engagement, at Emory Winship Cancer Institute in Atlanta, Georgia, 4 oncologists described a pattern: patients who appear healthy, fall outside screening ages, and see multiple providers before receiving a cancer diagnosis.

What Are Oncologists Seeing in Younger Patients?

Cathy Eng, MD, cochair of gastrointestinal oncology at Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, said early-onset colorectal cancer (CRC) is now the leading cause of cancer death in people younger than 50 years, a milestone reached in 2023, earlier than initially projected.¹ She noted that most cases are sporadic rather than inherited and that she has treated patients in their 20s and younger, including a 16-year-old with stage IV disease. Younger patients, she said, often present with advanced disease because they are misdiagnosed or assumed to be too healthy for cancer.

“I do want to emphasize: It’s really important to make sure that people pay attention to these young, healthy-appearing individuals that have unresolved symptoms,” Eng said.

In breast cancer, Melanie Sheen, MD, a medical oncologist at Ochsner MD Anderson Cancer Center in New Orleans, Louisiana, reported many young patients with aggressive triple-negative cancers. She noted that New Orleans’ large Black population is at higher risk for this type of cancer, which has double the incidence among Black women as it does among White women.²

Sheen also noted seeing a recent uptick in early-stage diagnoses, including ductal carcinoma in situ, among young women who sought screening because of family history or friends’ diagnoses, or who had their first mammogram at 40 years old.

Denise Yardley, MD, associate director of breast cancer research at SCRI Oncology Partners in Nashville, Tennessee, mentioned the challenge of identifying estrogen receptor–positive cancers in women younger than 40 years without a family history. Some possible contributors to look for include reproductive factors, such as having a first child later in life and early onset of menstruation.

“I think one of the interesting emerging things is alcohol and college binge drinking as a risk factor for some of these patients under the age of 40 that are developing breast cancer,”³ Yardley said. “But I think we really are challenged now [with] how to identify those that are outside of a strong family history or a family that has early[-onset] breast cancer in there.”

Ray Page, DO, PhD, director of research at The Center for Cancer & Blood Disorders in Fort Worth, Texas, said his community practice has seen a broad rise in gynecologic and upper gastrointestinal cancers. He said he has seen more cholangiocarcinoma and appendiceal cancer in the past 5 years than in the prior 25 years.

Those observations echo national data, such as an analysis of 17 Surveillance, Epidemiology, and End Results registries, which found that gastrointestinal cancers grew fastest among people younger than 50 years from 2010 to 2019, with appendiceal cases rising more than 250%.⁴ A 2026 American Cancer Society report found that CRC incidence is rising in adults younger than 65 years even as overall incidence and mortality decline.⁵

Why Are Young Adults Being Diagnosed Late?

Panelists described gaps on both sides of the exam room. Page said young people often underestimate their risk or ignore symptoms, thinking they are not serious. In addition, this population is busy with their careers and raising children while maintaining hobbies and being active in their community.

“I think we have to work on creating that awareness of what their perceived risk factors are that put them at higher risk of developing a cancer at a young age,” he said.

In breast cancer, Sheen has seen a shift over the past decade, with primary care and obstetrics and gynecology more likely to refer patients with breast pain or redness for evaluation than to treat them for mastitis and ask them to return months later. However, this does not align with what Eng has seen in the gastrointestinal space. Instead, she said that patients with gastrointestinal symptoms are frequently told they have hemorrhoids or irritable bowel disease without ever receiving a colonoscopy. These patients will end up seeing 2 to 4 providers before receiving a cancer diagnosis.

How Do Coverage Gaps Affect Young Patients?

Cost is a barrier that screening-focused coverage rules don’t solve, the panelists explained. Yardley said that when a young woman moves from a covered screening mammogram to a diagnostic pathway, which can include ultrasound or breast MRI, she can face high out-of-pocket costs. Creating further challenges, breast MRI generally requires prior authorization and scheduling around the menstrual cycle, Yardley said, and many young patients lack a primary care physician who could coordinate it.

Sheen said an MRI can cost patients about $1000 out of pocket after insurance, which few of her patients can afford, and she operates in a Medicaid expansion state. She added that young patients are more likely to be uninsured and may delay care for months.

“These are financial and life toxicities for these young patients [who] don’t have any idea how to navigate because they’ve never been sick before,” Sheen said.

Page also described payer resistance to annual low-dose CT screening for patients with high-risk lung cancer, citing Medicare Advantage, private, and marketplace plans.

What Would Close the Detection Gap?

Better navigation, data, and resources could all help make inroads to addressing young-onset cancers, the panelists said. Eng called for a single site where young patients can get help, approved transportation, and workplace protection for time off, along with more nurse navigators. Page said better epidemiologic data are needed to risk-stratify patients, as most young adults are diagnosed after symptoms appear.

Yardley said some cancers lack validated screening programs and that alternatives to MRI, such as whole breast ultrasound, are inferior for younger women. Sheen highlighted the American Cancer Society’s VOICES of Black Women cohort study,⁶ which follows women without a cancer history to learn when and at what stage cancers are detected.

Sheen also pointed to multicancer detection tests, but that young people are not being included in these trials. “None of these trials enrolled young patients, and I think that’s really lacking, especially in this environment where we’re seeing a huge uptick in young…people with cancer, and especially these rarer cancers that can be more aggressive,” she said.

References

1. Siegel RL, Wagle NS, Jemal A. Leading cancer deaths in people younger than 50 years. JAMA. 2026;335(7):632-634. doi:10.1001/jama.2025.25467
2. Race, ethnicity, and breast cancer risk. Susan G. Komen Foundation. Updated October 8, 2026. Accessed November 5, 2026. https://www.komen.org/breast-cancer/risk-factor/race-ethnicity/
3. White AJ, DeRoo LA, Weinberg CR, Sandler DP. Lifetime alcohol intake, binge drinking behaviors, and breast cancer risk. Am J Epidemiol. 2017;186(5):541-549. doi:10.1093/aje/kwx118
4. Klein HE. Early-onset cancer incidence in the US increased through 2010s. American Journal of Managed Care. August 16, 2023. Accessed November 3, 2026. https://www.ajmc.com/view/early-onset-cancer-incidence-in-the-us-increased-through-2010s
5. McCormick B. 2026 ACS report shows CRC rising in younger adults despite overall decline. American Journal of Managed Care. March 3, 2026. Accessed November 3, 2026. https://www.ajmc.com/view/2026-acs-report-shows-crc-rising-in-younger-adults-despite-overall-decline
6. VOICES of Black Women. American Cancer Society. Accessed November 3, 2026. https://voices.cancer.org