In light of concerning cancer trends over the last few decades, a new study sought to answer the question of whether early-onset cancer — defined as cancer diagnosed before the age of 50 — should be considered a global epidemic. This is in light of the fact that with every generation born into a new decade, there are higher chances of developing cancer relatively earlier than the previous decade’s generation.

Published on Tuesday in Nature Reviews Clinical Oncology, the research looked at possible reasons for rising early-onset cancer incidences. Lifestyle factors — such as poor sleep, worsening food quality, and changes in risk-factor exposure since the 20th century could be some of the reasons, as per several other studies the researchers analyzed. They also found the risk to be climbing across 14 different types of cancers — a fact that makes it unlikely that early screenings alone are responsible for the numbers.

Early exposure to the said risk factors is key here. The study points out how bright lights in cities impair sleep patterns in children. Not only that, exposure to alcohol, smoking, sedentary lifestyles, and “Westernized diets”, among others, in adolescence manifest as illnesses later in life.

Another factor pertains to changing gut microbe compositions. “Among the 14 cancer types on the rise that we studied, eight were related to the digestive system. The food we eat feeds the microorganisms in our gut,” said Tomotaka Ugai, from the department of pathology at Brigham and Women’s Hospital, whose researchers conducted the study.

Previous studies have also found that colorectal cancers are rapidly increasing in younger people — even those in their 20s. Changes in people’s gut microbiomes could be one big reason why; things like diet, medication, and other comorbidities are implicated in this. Environmental factors also play a role in changing people’s gut microbiome composition, as studies have shown.

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A limitation of the study is that it didn’t have sufficient data to analyze early-onset cancer in low-and-middle-income countries. But this doesn’t change what the trends show: “…although available data on the incidence of early- onset cancers in low- income and middle- income countries are currently limited, the rise of early- onset cancers is likely to be increasingly prominent in those countries, potentially leading to a global early- onset cancer pandemic,” the paper states.

Some stats help put this into perspective. Other research has looked into the rise of processed, sugary foods across the world — particularly in low-and-middle-income countries, where fewer health regulations allow corporations to market ultra-processed food. Exposure to smoking is on the rise too — as tobacco companies specifically target children in low-middle income countries using strategies designed to attract them to cigarettes.

Then, climate change is also a looming threat. A Lancet analysis of five major studies projected that environmental toxins, disruptions in food supplies, and ultraviolet radiation is likely to increase the global cancer burden — with collapsing healthcare systems catalyzing the impact.

The findings then speak to the urgent need to revamp healthcare systems to accommodate the rising cancer burden. Some research has even pointed out that younger people diagnosed with cancer are failed by the inaccessibility of the healthcare system, which makes treatment too expensive.

Recognizing early-onset cancer as a global epidemic — or even a pandemic — then not only requires healthcare interventions in terms of treatment, but also holistic changes in public policies that can reduce dangerous exposures that increase these risks. Food security, income security, and public infrastructure to facilitate movement and health are key.