The Princess of Wales is among a growing number of young people developing cancer, scientists said last night.
While cancer in younger people is still rare, experts say in the UK there has been a 22 per cent rise in cases of the disease among 18 – 49 year olds over the last 25 years.
The number of “early onset” cancers – in those under 50 – increased from 23,000 to 30,000 between 1993 and 2019. While diet and lifestyle have been linked to part of this, experts say the rise still “remains a mystery.”
The campaigner Dame Deborah James who died in June 2022, aged 40, after being diagnosed with incurable bowel cancer six years before, highlighted the unique issues faced by younger cancer sufferers such as how to cope with telling young children of your diagnosis.
Dr Shivan Sivakumar, Associate Professor in Oncology, University of Birmingham, said: “There is an epidemic currently of young people getting cancer (under 50s). It is unknown the cause of this, but we are seeing more patients getting abdominal cancers.”
He added: “Part of this is due to the obesity epidemic, but this doesn’t fully explain everything and this is clearly not the case in people like the Princess of Wales.”
Prof Andrew Beggs, Senior Clinical Fellow and Consultant Colorectal Surgeon, University of Birmingham, said: “Young onset cancer is by no means rare. I run a clinic for early-onset cancer in adults and we are seeing more and more people in their 40s with cancer. Some of this is better awareness which has been helped by the growing number of young people willing to talk about their cancer such as Dame Deborah James, but much of it remains a mystery.”
Professor Beggs, who specialises in cancer genetics said: “We have looked at genetics, and this doesn’t seem to explain the rise. It is a mystery and the focus of research.”
And he added: “Sadly the NHS cannot keep up with the demand which was built up during the pandemic.”
Prof Gordon Wishart, an expert in cancer screening at Anglia Ruskin University said: “The best way to improve cancer survival in the Uk is by detecting cancer earlier through different strategies including cancer prevention, cancer screening and getting patients fast access to diagnosis when they have worrying symptoms.”
Prof Wishart, Chief Medical Officer of the early cancer detection company Check4Cancer added: “Given that it appears Kate Middleton’s cancer was detected during a planned surgery it seems very possible it has been picked up earlier than it might otherwise have been. If this is so, it is more likely to lead to a better outcome.”
The Princess of Wales is now having a course of preventive chemotherapy, which is when drugs are given to “mop up” or destroy any cancer cells not removed by surgery. This could be immunotherapy – when drugs are used to prompt the body’s own immune system to target cancer cells. It could also be a more traditional type of chemotherapy drug which attacks all rapidly dividing cells, including cancer cells.
The type of chemotherapies used for abdominal cancers can often cause a rash, sore mouth, stomach upset and nausea, but not hair loss which is more often linked to breast cancer drugs. Kensington Palace have not disclosed what type of cancer Kate has.
Professor Beggs said: “Preventive chemotherapy after surgery is given to reduce the risk of the cancer coming back in the future – a bit like mopping a floor with bleach when you’ve spilt something on it, chemotherapy kills any spilt cells.”
Many experts say Kate’s relatively young age may help her tolerate the cancer drugs which would usually be given in cycles for 3-6 months.
Prof Bob Phillips, Professor of Paediatric Oncology, University of York, said: “Generally speaking, the healthier someone is before cancer treatment, the closer-to-optimal the amount of chemotherapy and the gaps-between-chemo can be. Generally, the younger someone is, the healthier they will be.”
“Young people also better tolerate higher doses of chemotherapy and so can be given stronger regimens that are more likely to kill any leftover cells.”
Prof Phillips indicated that it could be months after her treatment has ended that Kate is well enough to resume public duties again. He said while recovery varied between people and type of chemotherapy used, “When all treatment is finished, it can be a few months before the person is back to nearly full strength.”
Dr Mangesh Thorat, Honorary Reader, Queen Mary University of London and Consultant Breast Surgeon, Homerton University Hospital, explained the need for Kate to be given chemotherapy. He said: “Surgery is the most curative form of treatment for early-stage cancers of solid organs. However, occasionally some cancer cells escape the organ of their origin and start residing in other organs such as lung or liver. Tests and scans currently available are unable to detect such microscopic spread and therefore to improve chances of cure.”
He added: “It is this collateral damage that often leads to some of the side-effects of chemotherapy for example low blood counts with increased risk of infection or mouth ulcers or diarrhoea. The other side-effects, such as nausea and vomiting are often directly induced by the drugs.”
He added that Kate’s young age could mean she tolerates the drugs better: “The risk of some side-effects and their consequences is often lower in younger individuals due to greater functional reserves and ability of young tissues to heal more rapidly.”
Prof Richard Sullivan, leading cancer expert at King’s College London, who helps run the Institute of Cancer Policy, said: “Every citizen of the UK, irrespective of where they live or their means, deserves timely access, diagnosis and the best treatment that is commensurate with an affordable healthcare system.
“Technology is not a magic bullet. What saves cancer patients or provides them with a comfortable, pain free end of life is the structure, organisation and culture of our services and systems. Cancer is a complicated set of very different diseases that reflects all the strengths and weaknesses of the NHS as a whole.”