A recently published study finds members of Gen X are projected to have more instances of cancer than the previous generation, baby boomers. Among women, data show there were higher rates of thyroid, kidney, colon and pancreatic cancer, among others, in Gen X than in baby boomers. Gen X men had higher rates of thyroid, kidney, colon and prostate cancers, among others, than baby boomers.
With The Show to help explain what’s going on and what it could mean is Dr. Madappa Kundranda, a GI medical oncologist at Banner MD Anderson and chief for the Division of Hematology and Oncology.
Full conversation
MARK BRODIE: Dr. Kundranda, what do you make of this data?
MADAPPA KUNDRANDA: Let’s start with certainly one of those studies that’s comparing what we’ve traditionally thought about as the baby boomer generation, wherein the incidence of cancers in that generation, we’ve noticed over the last few decades of that generation increasing.
This study actually looked at kind of the next step of that process, which is, OK, let’s move on beyond the baby boomers and look at the Gen X. So this was an important study because we knew that with baby boomers aging and the aging population increasing in the US, we were seeing an increased incidence there. But now that we have some of the baby boomers now in their 70s, 80s and 90s, what’s the next generation looking at?
BRODIE: Do you think there actually is more cancer within Gen X, or are we just better at detecting it and noticing that it’s there than we have been in years past?
KUNDRANDA: The technology has evolved, and if anything in cancer detection, whether it’s early diagnosis and thereby an increase in the incidence of cancers, we are starting to see that because, yes — whether it’s a DNA testing for colon cancer, whether mammographies have gotten much better, whether a screening technology, access to health care for the general population has gotten better. Yes it has.
But the biggest thing is there’s something called stage shifting. So what that simply means is if you can diagnose a cancer at a much earlier stage, then you can cure the patient as opposed to diagnosing it as a later stage and then not being able to do anything significant to make sure that that individual lives the rest of his or her life, for the completion of their life.
Detecting these cancers early doesn’t necessarily mean we are stage shifting, meaning to say we’re not really detecting stage one cancer significantly earlier. It is a little bit more of a complex question because in certain cancers we are making a difference, and others we aren’t.
BRODIE: Well it sounds like, at least in some cases, while there might be more instances of cancer in Gen X than baby boomers in previous generations, you’re also able to catch it sooner. So the outcomes maybe are better than they would have been in years past.
KUNDRANDA: Correct. Exactly. So you are spot on with regards to certain cancers when we’re making a difference with regards to the stage shifting. In others, we are still not.
BRODIE: Is there anything interesting to you about the types of cancers that seem to be more prevalent in Gen X men or women than in previous generations?
KUNDRANDA: Yes, that certainly seems to be the case, and not just based on this study, but even everything that we are looking at. For example, early onset (Gastrointestinal) cancers, some of those cancers — such as pancreatic cancer, such as colorectal cancer — have been increasing within this Gen X patient population.
Some other cancers, breast cancer was the poster child for us with mammographies, with early detection, trying to really change the field. And we have changed the field to a certain extent. However with breast cancer, we are starting to see an increased incidence within the Gen X as well.
So it begs the question: What is going on there? And what really changed between that generation that was born between the late ’60s to the late ’70s?
BRODIE: Well, what what do you think? Because for example, you think about something like lung cancer. In the ’60s and even in the ’70s, smoking was so much more prevalent than it is now. Are there certain environmental factors that might be leading to some of these cancers? Is it kind of a luck of the draw? Is there something else going on?
KUNDRANDA: I wish I could say it was the luck of the draw. Unfortunately, it’s not. And also I can’t tell you definitely that there’s one or two factors making a difference. But the one thing that seems to be evolving — and especially over the last half decade or so — is this whole concept of exposome. So the definition of exposome is a measure of all of those exposures that any individual would have in their lifetime and how those exposures relate to their health.
Now this exposure could be external, right? And that’s what you mentioned. Tobacco products. Physical activity, diet, all of those. Or they could just be general external environmental exposure, which none of us really have a whole lot of control over. Which is, again, the climate. It could be urban environment. It could be traffic. It could be the social capital aspect of it.
And the part of it which is interesting is — whether it’s external environments that we have some control over, which are specific, or general external environments that we have limited to no control over — they tend to contribute to this whole thing of the internal environment …. Again, when we look at proteomics, metallomics or transcriptomics, that can eventually affect the health and the overall incidence of cancer in a large patient population.
BRODIE: Given, as you say, that there are some factors at play here that we don’t have a whole lot of control over, would that lead you to believe that future generations might see even higher incidences of cancer than Gen X?
KUNDRANDA: That is speculation, but I certainly would suspect that there would be certain cancers that we would continue to see an increased incidence. And that is exactly what we are seeing at this point in time, because we said, “OK, tobacco can cause lung cancer.” And we’ve seen generations, especially with males, with the decrease in the use of tobacco products and the decrease in tobacco-induced lung cancer.
But then we’ve also seen the opposite of that, wherein with breast cancer, early detection was a huge part of this in the ’70s and ’80s. We got better in terms of early detection as it pertains to mammographies and some of these other early techniques, but now we’re starting to see that increase in this current generation.
So the question becomes whether as a society, as we continue to evolve and change, whether a lot of these factors are going to evolve. Unfortunately it is. We would recognize certain high-risk factors that we would curtail and curb, but then there would be other factors that we continue to see that might cause an increase in some of these other cancers.
