2026 ACRLP Proceedings: Unmasking the Rise of Early-Onset Cancer

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This content is from UT Health San Antonio’s book, “Advancing Cancer Research for Latinos and All Populations: 2026 Conference Proceedings,” which highlights results of the same-named conference in February 2026.

Breast Cancer in the Young

Dr. Marcela Mazo Canola is Assistant Professor of Medicine in the Division of Hematology and Medical Oncology at the Mays Cancer Center at University of Texas (UT) Health San Antonio.

Epidemiology of young onset breast cancer

Dr. Mazo Canola began by discussing the multiple spheres of decision making that young breast cancer patients must face: chemotherapy, endocrine therapy, local therapy, genomics, psychosocial functioning, sexual health and body image, role functioning, and fertility and premature menopause. These represent a significant burden in individuals who may not be ready to make those decisions, or who do not have the support system needed to navigate those decisions.

In 2022, 27,136 new cases of breast cancer were reported in women younger than 45 years of age in the United States. While most cases of breast cancer are in women older than 45 years old, the incidence of cancer in young women is increasing, especially in the past 20 years. Breast cancer continues to be the most commonly diagnosed cancer in women and is the second leading cause of cancer related mortality in women.

Breast cancer in the very young is most commonly defined as breast cancer diagnosed in women under 40 years of age, a population that represents approximately 5-10% of all breast cancer cases in the US. By 2040, new cases are projected to rise by 47.8% from 2022, underscoring an urgent global challenge in breast cancer prevention and control. However, breast cancer screening is not typically recommended for women under 40 years of age.

Causes and subtypes

Young onset breast cancer is caused by a variety of factors, including genetic and familial factors, reproductive events, breast tissue characteristics, and lifestyle and environment. The clinical presentation for breast cancer in the young is unique. First, patients younger than 30 often harbor a germline mutation. Also, young onset breast cancer often presents with higher grade disease, more nodal involvement, and bigger tumors. Clinicians are also less likely to order imaging for young women when they present with symptoms.

Breast cancer is divided into 4 molecular subtypes. Luminal A and luminal B subtypes represent about 70% of cases, while triple-negative represents 15% of cases and HER2-enriched subtypes represent 10-15% of cases. Young breast cancer patients, however, present with a higher proportion of aggressive subtypes, including luminal B. Furthermore, rates of luminal B breast cancer are increasing in Latina and Black women in the US.

Young-onset breast cancer exhibits distinct genomic and molecular features. First, TP53 mutations, which are a hallmark of triple-negative breast cancer, are more common in young women. Luminal A tumors in young women also have increased alterations in GATA3 and ARID1A, which may be linked with more estrogen receptor sensitivity.

Germline mutations are substantially more common in young breast cancer patients, with 11-24% carrying pathogenic variants, most frequently in BRCA1/2 (14%). The prevalence of BRCA mutations in the general US population is estimated to be 1 in 400, excluding women of Ashkenazi Jewish descent in whom the prevalence is 1 in 40. Estimates of the prevalence of BRCA1/2 germline mutations in Latinas range widely (0.7% to 42%) depending on factors like family history, cancer type, and testing methods, with variations observed across different countries of origin.

In 2013, the Clinical Cancer Genetics Community research network evaluated the prevalence of BRCA mutations in the Southwestern US. A 25% prevalence of BRCA1/2 mutations was observed among Mexican American patients with breast cancer. Large rearrangement mutations, not detectable on standard sequencing, represented a significant proportion of the carriers.

Management considerations

Young onset breast cancer also presents with unique management considerations. Bilateral mastectomy, for example, does not offer a survival benefit in this population. Instead, extensive surgeries are linked with worse sexual health and body image. Young patients are also less compliant with hormonal therapy due to the burden of side effects.

Dr. Mazo Canola ended by emphasizing the need for more research into the multiple factors that cause young onset breast cancer. Furthermore, multi-disciplinary teams are needed to care for these patients. Both patients and providers need more education into the complexities of this condition.

Liver and Colorectal Cancers: Experience Treating Latinos

Dr. Sukeshi Patel Arora is Professor of Medicine, Paige Johnson Distinguished Chair in Oncology, Vice Chief for Clinical Affairs in Medical Oncology, and Leader of the Gastrointestinal Malignancies Program in the Divisions of Hematology/Oncology and Medicine at the Mays Cancer Center at UT Health San Antonio.

Colorectal cancer in younger adults

Dr. Arora began the presentation by discussing the epidemiology of colorectal cancer in younger adults. In contrast to decreasing colorectal cancer incidence in older adults, rates have been increasing in adults 20 to 39 years of age since the mid-1980s and in those 40 to 54 years of age since the mid-1990s. From 2011 to 2019, rates increased by 1.9% per year in people younger than 50 years and in those aged 50 to 54 years. Colorectal cancer is now the leading cause of cancer death for adults under 50 in the U.S.

Increased rates of colorectal cancer in younger adults may be due to lifestyle factors, environmental factors, hereditary risk factors, and/or the microbiome. Modifiable risk factors include obesity, poor diet, inactivity, smoking, and alcohol use. Nonmodifiable factors may include chronic conditions such as inflammatory bowel disease, as well as family history and hereditary disorders like Lynch syndrome. Up to 15%-30% of these cancers have pathogenic germline variants, indicating a hereditary predisposition to developing cancer. Colibactin, a genotoxic bacterial toxin, is 3 times more common in the microbiome of patients under the age of 40 with colorectal cancer compared to older patients with colorectal cancer.

Colorectal cancer screening guidelines call for individuals at average risk of this type of cancer to be screened starting at age 45. Individuals 45 to 49 years of age make up 50% of diagnoses under the age of 50, so increased access to prevention and screening services may prevent disease as well as death. Increased public awareness about the roles of genetics and family history in colorectal cancer may also help increase screening rates. Clinician awareness is also vital in avoiding delays in diagnosis.

Certain substances have been shown to prevent colorectal cancer. Aspirin and nonsteroidal anti-inflammatory drugs, for example, have been well studied for this purpose. However, side effects such as stomach ulcers may prevent long-term use. The active compound in green tea, Epigallocatechin gallate (EGCG), has also shown benefits in general cancer prevention. Finally glucagon-like peptide-1 (GLP-1) receptor agonists may exhibit anti-inflammatory and anti-proliferative effects in colorectal cancer cell lines through inhibition of the phosphoinositide-3 kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway.

HCC in younger adults

Dr. Arora’s presentation also involved a discussion of hepatocellular carcinoma (HCC). In the U.S, after decades of increase in HCC incidence, rates of liver cancer have stabilized in men but continue to rise in women by about 2% per year. HCC had an overall 5-year survival of <12% in 2011. Although 5-year survival for HCC has increased over the last few years, it is still only 22%. Incidence rates among Black and Hispanic men and women have increased in recent years, and are predicted to continue to increase.

Latino, Asian, and American Indian/Alaska Native (AI/AN) populations are underrepresented in HCC clinical trials. Latinos represent the fastest-growing subpopulation in the US and have the second-highest incidence rate of liver cancer in the US (behind AI/AN individuals). However, Latino participants represent only approximately 10% of patients in phase I or II clinical trials for liver cancer in the US in the past 2 decades. This rate of clinical trial participation has not appreciably changed over the past 20 years.

The treatment of HCC involves unique patient and disease considerations: patient frailty and performance status, comorbidities such as bleeding risk and autoimmune disorders, whether the patient has had a transplant, liver function, patient preferences and quality of life, and goals of care.

A recent study by Dr. Arora and colleagues evaluated racial and ethnic differences in HCC care at a Latino-rich National Cancer Institute (NCI)-designated cancer center. The average age at diagnosis was lower among Hispanic and Black patients compared with non-Hispanic White patients, while the average age for Asian patients was even lower. Delays in treatment initiation were most pronounced in Asian and Black patients, while Hispanic patients experienced moderate delays compared with non-Hispanic White patients.

Dr. Arora’s presentation highlights the need for more patient and provider education about prevention and screening for colorectal cancer and HCC. Differences in treatment and outcomes based on race also warrant more research. Finally, initiatives are needed to ensure participation in clinical trials reflects all races and ethnicities.

Too Young, Too Soon: Unmasking the Rise of Early-Onset Lung Cancer

Dr. Narjust Florez is Co-Director of the Young Lung Cancer Program, Associate Director of the Cancer Care Access Program, Director of the Smoking Cessation Program, Thoracic Medical Oncologist at the Dana-Farber Cancer Institute, Assistant Professor of Medicine at Harvard Medical School, and Associate Editor at JAMA Oncology.

Early-onset lung cancer in women

Dr. Florez began by stating that for the first time in history, young women are getting lung cancer more often than men. However, young women are less likely to be offered tests for lung cancer diagnosis and may be ignored when presenting to a provider with complaints that could suggest a lung cancer diagnosis. Instead, symptoms are often attributed to anxiety.

A recent study found that over one third of lung cancer patients reported never using tobacco products. Although 41% had a direct family history of lung cancer, most individuals (89%) reported never having discussed the possibility of developing lung cancer with a healthcare provider. In fact, most participants’ (63%) healthcare providers never recommended lung cancer screening. Nearly one third (31%) of lung cancer patients felt that they experienced delays in diagnoses despite seeking medical care.

A unique presentation

Early-onset lung cancer is defined as a diagnosis of lung cancer before the age of 50 and has a unique presentation. Early-onset lung cancer is more common in women, especially those of Hispanic or Asian/Pacific Islander descent. It also occurs primarily in non-tobacco users. The most common histology in early-onset lung cancer is adenocarcinoma, and there is a higher likelihood of late-stage diagnosis compared with older-onset cases. Targetable alterations and brain metastases are also more common.

Lung cancer is the fourth most common cancer in adults younger than 50 years of age, and the number one cancer killer in this population. Among early onset lung cancer patients, 52-91% of patients have targetable mutations. The most common single nucleotide variants are TP53 (57.1%), KRAS (15.5%), EGFR (21.4%), STK11 (10.1%), and SMARCA4 (7.7%). The most common fusions or skipping variants are ALK (14.6%), RPS6KB1 (3.3%), ROS1 (3.3%), RET (2%), and MET (2%). Furthermore, uncommon mutations are more frequent in young patients compared with patients over 50 years of age. An ongoing study performed by Dr. Florez and colleagues aims to evaluate the feasibility of an EGFR plasma cell-free DNA (cfDNA) test as a tool for early cancer diagnosis among non-tobacco-using Asian and Hispanic populations at risk for EGFR non-small cell lung cancer.

Young lung cancer patients experience improved overall survival compared to older patients. They are also more likely to receive aggressive treatments, multimodal intervention, surgical resection for oligometastatic disease, and consolidation radiation. However, younger patients are more likely to experience paclitaxel induced neuropathy, platinum-based nausea and emesis, and long-term adverse events such as irritable bowel syndrome (IBS), dental damage, and early menopause. Young women in particular are more likely to experience immune-related adverse events than older patients. Because young patients are more likely to receive aggressive treatments, it is vital to understand optimal survivorship in this population, which may be more likely to suffer in long-term follow-up.

Financial toxicity and fertility considerations

Young lung cancer patients are also more likely to experience financial toxicity than cancer patients over 50 years of age. In a recent study performed by Dr. Florez and colleagues, 40% of early onset lung cancer patients reported not having any or only a little money available to pay for lung cancer treatments. Furthermore, 35% felt considerably financially stressed, and 32% reported that their cancer had been a significant financial hardship. Half of the participants reported significant worry about future financial problems. The study also found that young patients were more likely to be diagnosed at a disruptive time in their lives than older patients, and had higher rates of depression, anxiety, and poor quality of life, particularly among women.

Young female lung cancer patients also face the complexity of fertility and how it is impacted by a lung cancer diagnosis. Most young women with lung cancer do not receive fertility counseling, and fertility preservation procedures are underutilized. If diagnosed while pregnant, over 75% will be advised to terminate the pregnancy.

The incidence of lung cancer in young Hispanic and Asian women is increasing. Early onset lung cancer patients are more likely to have targetable mutations than patients over 50 years of age, and are more likely to receive multi-modal and aggressive treatment. These patients also experience greater burdens involving long-term adverse events, financial toxicity, and fertility complications. Healthcare providers and researchers must listen to and believe these young women, taking into account the unique considerations of fertility, family, and youth.

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