Thanks to the advancement in medical technologies, most lethal diseases are finding cures, or, at least, their devastating effects on humanity have been lowered. COVID-19 spread across the "global village" like fire, but our knowledge of behavioral modification and medical immunology saved humankind from being wiped off the map, as feared initially. Now, we can see the light at the end of the tunnel when 70% of the world's population is vaccinated, and helps reduce the spread of COVID-19.
Apart from Covid, this lockdown could aggravate a rising issue that's affecting people around the world. Mainly, obesity due to lack of physical activity.
The Center for Disease Control and Prevention (CDC) has associated around 13 cancer with obesity. These obesity-related cancers are on the rise among young people. A recent study found that obesity-related cancers incidence, excluding colorectal cancer, increased by 7%, whereas non-obesity-related cancers kept on declining, up to 13% between 2005-2014 [10]. You will not be surprised to know that lockdown during COVID-19 has increased people's body weight worldwide, and the incidence of obesity has increased significantly. As suggested by an increasing number of studies, the extra burden of the overweight and obese population is at increased risk of most lethal diseases, including cardiac diseases and obesity-related cancer. An article published in Telegraph stressed that the emerging statistics could be used to predict health burden due to lockdown associated obesity and physical inactivity. If the trend continues, the National Health Services might be unable to support the healthcare services in the future.
Obesity is a well-known risk factor[7]. Age is the other major risk factor and works well to describe breast cancer incidence.
Breast cancer has been one of the major health concerns over the last few decades. Currently, the breast cancer mortality rate is 2.6% in the US. This means that breast cancer mortality has actually dropped by 34% from 1975 to 2015 [2], and it continues to decrease approximately 1% per year [1]. This is most likely due to improving treatments and early detections.
However, if we focus on a point, we are sure to miss the full picture. The focus on long-term trends misleads the experts.
When the cancer statistics are split for different age groups, the cancer mortality decrease only in older women and remains the same among younger women. Rather, a recent study published in February 2021 in the journal of Radiology has shown that breast cancer mortality may be increasing among young women. The study was led by Prof. R. Edward Hendrick, Ph.D., a Fellow of the American College of Radiology and Clinical Professor in the Department of Radiology, University of Colorado. The study found that the cancer incidence has increased slightly by 2.8% in women aged 20-29 years and 0.3% in women aged 30-39 years old since 2010 [3]. Similar studies were published in developing countries like Brazil, wherein breast cancer-related deaths increase in young women [4].
Conversely, an overall increase in the breast cancer mortality rate was reported in peri- and post-menopausal women (45 years and above) in 4 European countries [5]. In addition to mortality, breast cancer incidence increases gradually (0.5%) in the US [1]. Another recent study published in one of the most trusted medical journals, The Lancet, found that breast cancer incidence is more remarkable in premenopausal or young women among high-income countries [6]. As cancer statistics become more comprehensible, we can only hope that researchers and clinicians can find a solution to this unanticipated health challenge sooner than later.
A review of the literature published in the most prestigious scientific journal, CA-A Cancer Journal for Clinicians, found sufficient evidence suggesting that obesity is related to breast cancer incidence [8]. They also described that regular work/activity and reduction of weight might improve the treatment outcome. However, most of the literature reviewed in their article targeted post-menopausal or older women.
To add to the confusion, a recent study led by the National Institute of Health found that young women with higher body fat are less likely to develop breast cancer [9]. Therefore, other factors such as family history, environment, and lifestyle are termed as associated factors. However the study also cautions that young people should maintain a healthy weight, as there are other health risk for being obese. Additionally, if young women does not correct their weight through old age, then the risk for breast cancer could potentially be higher.
After all this discussion, we feel compelled to identify the key risk factors of cancer that can shadow young people in the coming years. Scientists believe many of these factors are "modifiable" risks, and the population can be educated to save them from the disease.
Lifestyle changes, such as balanced nutrition, alcohol intake, smoking, working style, and physical status are directly related to the increasing incidence of many types of cancers. COVID-19 has affected the lifestyle of humankind due to periodic partial and full lockdowns. Various studies have shown that physical activity was reduced during lockdown [11], and the weight of the population was also increased [12]. Nutrition status and leisure-time habits are also changing according to emerging literature. Therefore, young people are advised to adopt a healthy lifestyle, e.g., a healthy diet, and maintain an active lifestyle. According to Leyton-Roman and her team, young people should positively foster their need for competence to achieve self-determination and commitment to a healthy lifestyle [13].
Suppose you have a family history of hereditary cancer (e.g., breast, colon, prostate, ovarian, uterine, melanoma, or pancreatic cancer). In that case, you have a very high chance of getting cancer at a certain age. Researchers have identified some modifiable risk factors that can help you maintain body weight and adopt lifestyle habits, such as food, smoking, and drinking [14]. However, these lifestyle modifications are not universal. For example, in breast cancer, the modifiable risk factors are clinically significant only when certain genetic mutations (BRCA 1 and 2) are absent and vice versa.
Reproductive behavior around the world is changing to have fewer children. Similarly, oral use of contraceptives, predominantly hormones, has increased manifold; their cultural and societal impact is beyond the scope of this article. The incidence of premature menopause is also increasing among young (40 years or below), which is also treated by hormonal therapy. Reproductive behavior and hormonal therapy are associated with many types of cancer, such as breast, ovarian, prostate, and lung cancer [15]. Other reproductive factors, menstrual factors, child-bearing factors, and health-seeking behavior are also crucial. It may come by surprise, but scientists have proved that unsafe sexual intercourse can also facilitate the transmission of cancer-causing viruses [16]. Educating young people about their reproductive health has never been more important.
Many social and behavioral factors of modern life are precipitating factors of cancer. Yang and his coworkers stressed that socio-behavioral risk factors are becoming more common in the young American population[18]. These factors can include increased body weight, inadequate sleep, low physical activity, consumption of red meat, excessive exposure to the sun, and sugar-rich beverages [17]. Some of these factors, such as inadequate sleep, leisure-time activities, and dietary habits, can lead to inflammation which is now recognized as the chief culprit in the emergence of cancer.
The best way to reap the fruits of technological advancements is to visit your doctor regularly, even if you feel well. They are trained professionals who can identify the problem that we usually can't see. Screening has proven to be the best human intervention for reducing cancer-associated deaths due to early detection and feasible treatment. Screening can also identify if you are at an increased risk of getting cancer. In this case, your doctor can make a personalized plan for your lifestyle modification, including ideal body weight, dietary habits, exercises, use of supplements, etc. Certain medications can also increase your risk of getting cancer. That's why self-medication behavior needs to stop immediately. Your healthcare provider is going to play a key role in your foreseeable war against cancer by keeping you under check and keeping current with medical technologies.
