For more than a year before her stage 4 lung cancer was found, 35-year-old Alisa Secaida, a never-smoker and a physically active Southern Californian, had been experiencing a persistent cough and, increasingly, fatigue.
Early on, Secaida’s symptoms were mostly related to exercise, or so it seemed.
In 2020, in the midst of the COVID-19 lockdown, Secaida grew so concerned that she made an appointment with her primary care physician.
The doctor diagnosed her with “exercise-induced asthma.” Alas, as the coughing and fatigue kept getting worse, Secaida went back to the doctor.
“I’m coughing a little bit more, even outside of exercising,” she told her doctor. “And—same thing—he just kind of stuck with that diagnosis. I thought, ‘You know what? Maybe I should go get another opinion.’”
It wasn’t until November 2021, after a succession of doctors, their successive dismissals, and an out-of-pocket CAT scan that Secaida finally received a cancer diagnosis.
Secaida just didn’t fit the profile of a sick person. She looked healthy and youthful. And almost four years into living with what turned out to be an incurable disease, she still does.
Cancers that, historically, were seen in people over 50 are now being diagnosed with increasing incidence in the 18-49 age group, epidemiologists say.
In the United States, incidence rates of some cancers have increased in early-onset age groups, according to NCI research led by Meredith Shiels and colleagues that was recently published in Cancer Discovery. For many of these cancers, rates have also increased in older-age groups, suggesting whatever is driving the rise in cancer cases is not limited to one age group—it’s likely affecting the whole population.
In another startling statistic, the American Cancer Society earlier this year reported cancer registry-based data showing that cancer incidence rates in women younger than age 50 now surpass that of men.
“For more than 20 years, we’ve been seeing a concerning and steady trend, which is rising cancer rates among younger women under the age of 50, and in particular under the age of 40, which are now much higher than men of the same age—a reversal of prior trends,” said Hope Rugo, division chief of breast medical oncology and a professor of medical oncology and therapeutics research at City of Hope Los Angeles. “And young women, particularly those under the age of 40, have a higher risk of more aggressive, difficult-to-treat cancers.”
A guest editorial by Rugo appears on this issue.
In the 1990s, colorectal cancer was the fourth leading cause of cancer death of adults under 50. Colorectal cancer was usually well down the list of bad things a doctor suspected when seeing a younger patient.
Alas, that’s no longer the case.
Now, for men under 50, colorectal cancer has become the number one cause of cancer death, surpassing lung cancer. For younger women, colorectal cancer is the second leading cause of cancer death, said Kimryn Rathmell, CEO of Ohio State’s James Cancer Hospital and Solove Research Institute and former NCI director at a panel meeting at American Society of Clinical Oncology last week.
“It’s a real phenomenon,” Rathmell said. “And the implications for this phenomenon are tremendous.”
Though there has been a lot of buzz around early-onset colorectal cancers, it’s not only CRC that’s being diagnosed more frequently in people under 50. More than 10 other common cancers are also on the rise, including breast, uterine, and kidney. According to the study by Shiels et al., the increase has been most stark among people in the 20–29 age range.
These disturbing trends are unfolding as the Trump administration has slashed thousands of jobs and dismantled entire federal departments, including the recent changes in NCI’s peer review structure and the institute’s ability to communicate scientific findings relevant to public health. Overall, NCI is under threat of an unprecedented defunding as the Trump administration’s budget request for the fiscal year 2026 seeks to cut the institute by $2.7 billion, which amounts to 37.2%, compared to the current year.
“Everybody has nodules”
“Young women are being dismissed,” said Amanda Schwer, assistant clinical professor in the Department of Radiation Oncology at City of Hope, Orange County. “They’re too young for risk assessments like mammograms or colonoscopy.”
The same holds true for lung cancer.
As a young person and a never-smoker, Secaida wouldn’t meet the criteria for low-dose spiral CT screening for lung cancer.
After receiving her “exercise-induced asthma” diagnosis in 2020, Secaida, seeking a second opinion on her worsening symptoms, turned to Yelp to find another doctor, someone with good reviews.
She found one and made an appointment. “But, of course, when I walk into the office, I’m not coughing, I look perfectly normal,” Secaida said. “I’m not symptomatic when I need to be.”
The new doctor ordered labs, which came back clean.
“I don’t think there’s anything to worry about. I really think your cough is related to long COVID,” the doctor concluded.
Secaida didn’t have much of a cough when she had COVID, but, still hypothesizing, her doctor told her that a lingering and late-onset cough was turning out to be a somewhat common side effect.
“So, I just kind of took his suggestion and ran with that,” Secaida said. “He didn’t order any chest X-rays. He had listened to my chest, and there was nothing, I guess, to warrant any alarm on his end to order anything.”
The doctor also ventured an explanation for Secaida’s fatigue: It was probably due to working too much while being a parent to young kids. Indeed, Secaida had a five-year-old and a seven-year-old at the time.
“Maybe just take some time off of work, or don’t work so much. You need to take it easy,” the doctor suggested.
“But as the months wore on, I was getting worse, not better. My cough was becoming more prominent. My fatigue was getting to the point where I would have a Venti[-sized coffee] in the morning at Starbucks and a Trenta in the afternoon, and I was still falling asleep during the day as soon as I got home,” Secaida said.
Next, Secaida developed persistent shoulder pain.
One night, when Secaida was out with her girlfriends and sharing her concerning symptoms, one of her friends who works for the Los Angeles Fire Department told her she could get a CAT scan without her doctor’s approval.
“She was really concerned about my symptoms, and I said, ‘Really? I thought you needed a doctor’s order.’ And she’s like, ‘Oh no, the fire department has mobile trucks we use all the time, because of our cancer risk; you can just go get, like, a Groupon.’ And I was, like, ‘Oh, that’s a great idea.’”
So, in July 2021, Secaida found a place in Orange County that would give her a CT scan without a referral. She ordered one, paying approximately $450 in cash.
In August, Secaida was contacted with the results of the report.
“They said, ‘Just so you know, we did find some kind of a nodule or tumor in your upper left lung, and there’s some enlarged lymph nodes,’” Secaida recalled the radiologist telling her. “And at that point, I was like, ‘Oh, that’s not good.’ I knew people who’d had cancer, and I always knew that combo wasn’t always the best combo: large lymph nodes and a mass.”
The radiologist suggested that Secaida follow up with a pulmonologist and get a PET scan. Secaida brought this information back to her primary care doctor, thinking he would be “Team Alisa,” she said.
She was wrong.
“He was furious that I had gone behind his back,” Secaida said. “He said he hated those Groupon body scans because all they did was have incidental findings and it was turning all of his patients into hypochondriacs.”
He did not seem concerned about the CT scan results, Secaida said.
“Everybody has nodules in Southern California,” the doctor told her. Due to pollution and Valley fever, everyone’s lungs are filled with benign nodules. Secaida’s nodules were small.
“You seriously have nothing to worry about,” the doctor assured Secaida.
“I just looked too healthy to be as sick as I told him I was.”
The changing face of cancer
Cancer is no longer only a condition associated with aging. But guidelines have not caught up with this trend.
“We’re seeing an increase in lung cancers, particularly in younger women who have not had a long or extensive smoking history. So, they’re not eligible for lung cancer screening based on guidelines today,” said Alpa Patel, senior vice president of population science at American Cancer Society. “We also are conducting really large population studies of individuals that start at age 25 or 30 and then follow these women over time to be able to understand what is driving these risks.”
Risk factors in younger women are not well understood, said Patel, and that is due largely to a lack of representation of younger women in clinical studies, because, historically, cancer has been an issue of aging.
“There are environmental factors that we’re examining,” Patel said. “There is the combination of lesser genetic contributions, what we might call polygenic risk scores, and how that plays into it, because we see that many of these women don’t have a prior family history.”
Lifestyle and changes in reproductive patterns of women have also changed, she said. The age of menarche is actually getting slightly younger, Patel said, and women are not only having fewer children, but they’re having children at a later age.
“There is a lot that we know,” Patel said. “We know that 40% of cancers are attributed to lifestyle, such as avoiding tobacco smoke, being physically active, having a good diet, maintaining a healthy body weight, avoiding alcohol, and sun protection. But there is a lot that we have left to learn, and that’s where research continues to be so critical.”
I just looked too healthy to be as sick as I told him I was.
Alisa Secaida
The new trends strike down the pillars of conventional wisdom on cancer.
“In medical school, we’re really trained to think of cancer as a disease that develops later in life,” City of Hope’s Schwer said. “I mean, you just don’t even think about it. But, in my clinic, every single day, so many of the women I see are in their twenties, thirties, forties. There’s been several times where all I have to do is look at my schedule for the day, and a majority of my breast cancer patients are younger. Not even just that there’s some of them. It’s that the actual majority is younger.”
NCI has been tracking early onset cancer for more than 10 years and has supported 30 intramural and 25 extramural early-onset cancer projects, and more than 60 cancer centers report engaging in early-onset cancer research (The Cancer Letter, March 3, 2023).
“We need more data,” Rathmell said at the ASCO panel. “We need more coordinated efforts. We need to understand the issues out in the open and have dialogues and conversations.”
NCI recently established an early-onset cancer initiative led by Leanne Bailey, the chief of NCI’s Integrated Networks Branch (The Cancer Letter, Dec. 6, 2024). The initiative was developed to address the reported rise in early-onset cancer and will focus on the biological mechanisms of early-onset cancer, the interactions between several known risk factors, and prevention strategies.
“There is a current funding opportunity that is available to those who are recipients of P 30 and P 50 mechanisms,” Bailey said at the ASCO panel. “This opportunity provides a first step in addressing scientific research gaps in the field. And these supplements are intended to inform future funding opportunities for early onset cancer.”
Like everything else at NCI, the fate of these initiatives hangs in the balance as the Trump administration continues to impose sweeping layoffs and deep funding cuts across entire departments.
“The global incidence of early-onset cancer is increasing at an alarming rate,” NCI’s Bailey said at a joint meeting of the National Cancer Advisory Board and the Board of Scientific Advisors on Dec. 3. 2024. “We really need to accelerate the pace of discovery. There are time constraints associated with large cohort studies, so we’d like to be able to look outside of the traditional epidemiological approaches that we currently utilize, like cohort studies.
According to NCI research, early-onset cancer has increased by 79.1% between 1990 and 2019. And the number of early onset cancer deaths increased by 27.7%.
“A recently published NCI study analyzed cancer statistics for different age groups in the United States and found that from 2010 through 2019, the incidence of 14 cancer types increased amongst people under the age of 50,” Bailey said of the NCI research led by Sheils et al.
The paper focuses on the absolute increase in four primary cancer types: female breast cancer, colorectal, kidney, as well as uterine corpus, Bailey said.
Cancer mortality rates have continued to decline overall, but the decline has been less pronounced in women, compared to men.
“Mortality rates for many cancers, including breast cancer, have declined, which shows the impact of a greater understanding of tumor biology and targeted treatments,” Rugo said. “Unfortunately, this trend has not impacted women under the age of 40 to the same degree, highlighting the importance of understanding cancer in younger women.”
Victories in smoking cessation, early cancer detection, and treatment advancements have reduced cancer death rates in the U.S. by 34% over the past 30 years, effectively sparing about 4.5 million lives that could have been lost had cancer mortality rates remained at its peak, according to the ACS statistics.
These declines in the death rates are due to steady declines in the four most common types of cancer, breast, lung, colorectal, and prostate cancers.
Although cancer death rates have declined, cancer remains the second leading cause of death in the U.S. and the leading cause among individuals under age 85.
American Indian and Alaska Native individuals are two to three times more likely than white individuals to die from cancers of the cervix, kidney, liver, and stomach. Similarly, Black individuals face twice the risk of dying from prostate, stomach, and uterine cancers compared to their white counterparts.
“My story is not unique”
At that first appointment after receiving the alarming results of her out-of-pocket CT, Secaida begged her doctor for a referral for a PET scan.
He declined, saying that it wasn’t necessary, Secaida said.
Secaida went home in tears. This was the worst appointment she’d ever had, she said to her husband that day.
“My husband actually went to go see him a few days later for his own appointment, and just chewed him out and said, ‘This is ridiculous. My wife came to you. Your job is to help her. I don’t understand the reluctance’—the next day I got an email for a referral to see a pulmonologist,” Secaida said.
There’s been several times where all I have to do is look at my schedule for the day and a majority of my breast cancer patients are younger. Not even just that there’s some of them. It’s that the actual majority is younger.
Amanda Schwer
The pulmonologist was the first to diagnose Secaida with lung cancer.
“I didn’t know the staging or how bad it was until I got to City of Hope,” Secaida said. “That’s where they officially diagnosed me with stage IVB adenocarcinoma.
“It had metastasized to my brain.”
The disease had also metastasized to lymph nodes across her chest region, and to her spine, she later learned.
“But the thing is, my story is not unique,” Secaida said. “I have met so many women who were in their twenties and their thirties, who too came to their physicians telling them, ‘Hey, I have these symptoms. Something is not right.’ But they were being dismissed.”
These women, too, were too young to have any of the risk assessments done.
“For myself, lung cancer, I never would’ve received any kind of risk screening, because I’m not a former smoker, and I was under the age of 50,” Secaida said.
The most up-to-date U.S. Preventative Services Task Force screening guidelines for lung cancer recommend annual screening for adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.
The USPSTF guidelines recommend stopping screening once a person has been smoke-free for 15 years or develops a serious health condition that significantly reduces their life expectancy or makes them unable or unwilling to undergo curative lung surgery.
Screening challenges
“Cancer research, treatment, and even our supportive care is still tailored primarily to older patients that historically were most impacted by cancer,” City of Hope’s Rugo said.
That supportive care includes fertility and sexual health, an emerging area of research in early-onset cancer, but one that is still often overlooked (The Cancer Letter, April 11, 2025).
“I think the first very critical need is for us to understand, given these alarming trends that we’re seeing, what is driving risk in some women at younger ages, what is contributing to that?” ACS’s Patel said. “How does lifestyle, environment, genetics—all of these different factors—how are they contributing to the overall likelihood of developing a particular type of cancer? And then that evidence will inform how guidelines should change. And as guidelines change, insurance coverage typically follows.”
This was the case with early-onset colorectal cancer: after the American Cancer Society first documented rising trends several years ago, it prompted a change in screening guidelines—lowering the recommended starting age from 50 to 45 for people at average risk.
“I think the big challenge right now is helping to disentangle what is considered higher-than-average risk,” Patel said. “What is considered average risk, and what level of risk is tolerable to subject or not subject someone to a screening test. We don’t want, and we don’t have the capacity, to test every single woman from age 18 to older, but how do we actually appropriately disseminate that kind of screening?”
There are some current screening modalities that may not work as well for younger women, she said. Mammography is a classic example of this challenge. The mammogram’s imperfections and ambiguities often result in false positives, overdiagnosis, and overtreatment. False positives are more likely to occur in younger women, and even more likely in younger women with dense breasts (The Cancer Letter, Sept. 27, 2024).
“So, we also need to continue to do research to develop additional effective ways of identifying cancer in these younger populations as this disease burden is shifting,” Patel said.
“We’re calling for wider availability of risk assessments that can help women understand their risk for early occurrence of cancer,” Rugo said.
When appropriate, those risk assessments include genetic testing, taking into account the influence of family history across diverse racial and ethnic groups, along with lifestyle factors that affect both the risk and outcomes of breast cancer and other cancers, Rugo said.
There are some risk assessment tools to direct who might benefit from genetic testing or lifestyle modifications. ACS has a tool called CancerRisk360, and NCI has a breast cancer risk assessment tool called the Gail Model.
“[These tools] allow women to know if they’re at risk and may call for earlier or more frequent screening and can certainly improve both awareness and self-advocacy. It’s important to keep in mind that risk assessments also include an overhaul of how we evaluate early cancers, because in young women, our traditional screening approaches are not as helpful,” Rugo said.
Living with an incurable disease
In the past three-and-a-half years, Secaida has endured chemotherapy, immunotherapy, surgery, and radiation. After a reoccurrence and subsequent biopsies, Secaida’s liquid biopsy uncovered that she had a genetic mutation in her ALK gene, which qualified her for targeted therapy as well.
“Because I’m stage 4, I’ll be in some form of systemic treatment, if I’m lucky, for the rest of my life, just to kind of keep me going—managing this like a chronic disease,” Secaida said. “It is not lost on me that had we caught my disease earlier, I might have been able to avoid a lot of these treatments.”
In February, Secaida had a lobectomy, and she just recently completed 30 rounds of radiation.
“I get that I didn’t fit the profile for what they would be looking for in a cancer patient, but I honestly believe that that’s why so many women, especially young women, fall through the cracks,” Secaida said.
After she got sick, Secaida turned to social media to find people like her: younger female patients.
“I found so many. And I’ve been able to kind of form my own little support group with some of these ladies. I’ve joined different support groups that are specific to my cancer and my cancer genetic type. And it’s been nice,” Secaida said.
Secaida recently connected with a local Southern California mother who was diagnosed with stage 4 cancer two weeks after having twins, Secaida said.
“When we’re both struggling with the fears of the unknowns of having young children and a stage 4 diagnosis, I can call her. That’s not something I can go talk to my neighbor down the street—who I’m really close with. She doesn’t understand that fear, right? Like, her biggest fear is her kid getting suspended from school and mine’s, like, I don’t know that I’ll watch mine graduate elementary school. And it’s hard to have those kinds of morbid conversations with people who aren’t living that,” Secaida said.
Supportive care for young women following a cancer diagnosis is sorely lacking, Secaida said. At City of Hope, she was fortunate to have integrative oncologist Richard Lee—her “go-to guy,” as she puts it. But for many younger patients, especially women with children, that kind of care simply isn’t available.
It is not lost on me that had we caught my disease earlier, I might have been able to avoid a lot of these treatments..
Alisa Secaida
“Many women are navigating a cancer landscape that, to date, has failed to address their unique needs, including the preservation of quality of life long after diagnosis,” Rugo said. “These are the patients that we treat who are potentially the most impacted by the side effects of treatment for many years.”
This rising cancer trend in younger women has struck a personal chord for City of Hope’s Schwer, who is in her forties and who also has young children.
“I don’t like to make it about me,” Schwer said. “But honestly, there have been several times—and I’ve done this for years—in my clinic where I’ve had to take a break to kind of compose myself because of these stories that we’re seeing, and the complexity, the emotional complexity, the physical complexity, everything these patients are dealing with is just a lot different when they’re younger.”
Schwer said she hears stories like Alisa’s all the time. It’s a sad variation on a theme, something like, “I felt something in my breast, but I was 26, and I was told I was too young. It must be a cyst.”
“It’s really, really an issue. We need to educate physicians to listen,” Schwer said. “You know your own bodies—be your own advocate. And for doctors out there, we need to listen. Those are the main takeaways, is that this is real, and it’s really palpable in our clinics these days.”
Earlier this week, Secaida got to see her now-11-year-old daughter graduate from elementary school. Most days, her biggest complaint is a chronic cough.
“There are good days and bad days,” she said. “We had to go somewhere for my son’s baseball team the other day, and I’m around all these young moms, and they’re all looking great. And I’ve got my hair and my makeup done. But secretly, the whole time I’m there, I feel like trash. I’m just mentally and physically fatigued. And that’s hard. Like, I’ll joke sometimes, like, I’m 36, but I feel like there’s times I’m trapped in a 96-year-old’s body, just because of everything I’ve been through.”
Now that she has completed radiation, Secaida is able to be more active—so much so that her friends sometimes tease her, because she’ll go for a walk or hike with them and appear perfectly healthy.
“They’re like, ‘How the hell are you keeping up with this right now? You’re missing a third of your lung.’
“And I’m like, ‘Determination, ladies! Let’s go!’”
