Too Many Zebras Wearing Pink

Even if you’re not the same age as me, I think many of you will recognize that there are patterns in our lives by the decade.  Although our trajectories were different, when I look back, we were all basically doing the same thing. Kind of like parallel play in preschool, throughout my life, the people I surrounded myself with were hitting the same big life landmarks as I was.

In my twenties, it was all about adulting – college, grad school or getting a job. Writing a resume, getting an internship, working long hours, and staying out late. The world was our stage.  And somehow mixed into all of this was falling in love.  After much drama and a few failed relationships, I grew up enough to finally find my wonderful husband.

All the boxes were checked

I got married just before I turned 30, and so did everyone else I knew!  For the next 10 years, it was showers galore!! First the weddings, and then the babies. I felt like I had made it to adult-hood. We were legit – married, house, career, kids.  All the boxes were checked.

By the time I turned 40, I was waist high in my career and drowning at home.  But fortunately, it seemed my ‘mom’tourage felt the same way, and we figured out how to carve out time to be together.  For me, this was the decade of book clubs, and girl’s nights out. These women were my lifeboat.

Of course when you turn 50, many things come to mind.  While I truly am an optimistic person, for me, there was a stark realization that there was soon to be a changing of the generational guard.  I lost my Dad a year before my 50th birthday, and sadly I started to go to funerals for the parents of all the friends whose weddings I went to 20 years before.  While the reality of this sucks, and makes you contemplate your own mortality, it is not unexpected.  

However, what I have been blind-sided by in the past few years has been the morbidity of my friends.  There is an ever increasing rate of illness, specifically cardiac and cancer, that is creeping into younger and younger age groups.  And it is unprecedented for my generation.

Unfortunately, for my generation, the norms are changing

When I did my medical training over 25 years ago, we used to say “she didn’t read the book” if you diagnosed a patient with a disease when they did not have the usual risk factors, or symptoms.  That’s because most medical diagnoses went by the book.  There were patterns that had been identified over many generations that were recognizable if you were trained what to look for.   Falling outside the norm was rare.  As a young resident, eager to find something unusual, I was told “stop looking for zebras every time you hear hoof-beats”.  

Unfortunately, for my generation, the norms are changing, and it is not for the better.  There was a study published in the Journal of the American Medical Association in Aug 2023 that looked at Patterns of Cancer Incidence Among People Younger than 50y in the US, 2010-2019.  This has been rattling around my head ever since I read it.  My good friend’s breast cancer diagnosis earlier this week at age 47 brings this crashing into my inner circle.  

This study is what’s called a population cohort study – meaning they just gathered data to look at trends occurring over time.  In a nutshell, they looked at the incidence (meaning the number of people diagnosed) of early onset cancer in the US over the last decade from 17 National Cancer Institute registries across the US.  Early onset is anyone diagnosed with cancer before age 50.

Although anecdotally there has been concern about more young people being diagnosed with cancer, this was the first study of its kind in the US to look at real data, and the results are sobering.  

In the 10 years from 2010 to 2019, not only did the incidence of cancer in people under age 50 increase, but the majority were women between ages 30-50.  During this same time frame, cancer incidence for people over age 50 decreased, and cancers in men < 50 also decreased.  

Let that sink in.  

There are disproportionate increases in the numbers of cancers being diagnosed in women under age 50.  

As a woman watching her friends go through it, this makes me cry

Specifically, they found increases in cancers of the breast and uterus, which were already the most common in young women.  Additionally, gastrointestinal cancers, which were previously rare in this age group, had the fastest-growing incidence rates among all early-onset cancers.

As a provider of women’s health care for 25 years, this disproportionate rise in cancer in younger women is scary. As a woman watching her friends go through it, this makes me cry. 

Cancer used to be a disease of the aged or in those with a strong family history.  It was typical in those over 60-65, because traditionally that is how long it would take for a lifetime of tiny toxic exposures to damage your cells.  

The occasional younger person was generally someone with a strong family history, or a genetic mutation. A zebra, if you will. However, a review of multiple studies shows that approximately 80% of current early-onset breast cancers occur sporadically in women.  Meaning they occur without predisposing mutations or a significant family history of breast cancer.  Now, only 10% of early-onset breast cancers occur in women with BRCA mutations.  

Clearly, the book has been re-written.  And there are zebras everywhere.

A separate study in the Lancet looked at the global burden of young adult cancer and found incidence rates are increasing fastest in countries with higher socio-economic status. Why? Especially when these countries have better access to healthcare across the board?

Clearly the book has been rewritten

While there is much to learn about the reasons why younger women are getting cancer, several studies on breast cancer survival rates show that women with higher rates of obesity, stress, sedentary lifestyles, and alcohol consumption have poorer 5 y survival rates. And that survival can be improved with lifestyle change.

Thus, some of the prevailing theories on increased risk of early onset cancer suggest an association with the increasing incidence of obesity.  As well as changes in our environmental exposures, such as sleep patterns, physical activity, alcohol consumption, diet and gut microbiota, and exposure to carcinogenic compounds.  

All theories aside, the bottom line is that no-one deserves cancer.  This is not about weight, diet or lifestyle shaming.  However, we have to wake up and recognize that societally we are failing ourselves.  In our super-stressed, high paced modern lives, we are not only missing the stripes, we are drowning out the hoof-beats.

It is not enough to just wear pink

We have to recognize that we have more influence and control over our own health and our lives than we might realize. As women we are often so busy taking care of everyone and everything, that very little is left over for taking care of ourselves.  

In this month of breast cancer awareness, it is not enough to just wear pink and do your self exams, and get your mammogram. It is important to recognize and advocate for yourself, knowing that the unusual is becoming more common.  But it is also time to take a self inventory and figure out where you can increase your agency to protect your health and vitality overall, and reduce your risk of cancer.

So please treat yourself the way you would treat your mom, sister, or best friend.  Prioritize your sleep, consider learning how to meditate, move your body more, think about reducing ultra-processed foods, drink more water, and cut back on alcohol.  Evaluate the stressors in your life, and figure out what the barriers are to changing them.  Identify what and who gives you great pleasure in life, and make more room for them.  

Thinking about life by the decade, it is the big landmarks that come immediately to mind.  But we have to remember to live life in the moment, where even the smallest of choices do make a difference.  Unfortunately, the reality is that we need to take ownership of rewriting the book if we want to reduce the numbers of zebras wearing pink.