As a doctor, even I thought my young niece’s common childhood complaint would pass… it was terminal cancer. There are 4 often overlooked symptoms everyone under 50 must know: DR JANETTE NESHEIWAT

I’ll never forget the day a 20-year-old man walked into my clinic complaining of a persistent cough.

He had visited another healthcare provider days earlier, been diagnosed with what appeared to be bronchitis and prescribed antibiotics. But his cough wasn’t improving.

All he wanted was cough syrup to help him feel better, but I wanted to investigate further.

So, I recommended a chest X-ray.

At first, he was reluctant. He was a smoker, though generally healthy and understandably frustrated. After all, what could possibly be seriously wrong with a man barely out of his teens?

Eventually, he agreed to the X-ray and when I studied it, I struggled to believe what I was seeing.

There appeared to be a mass in his lung.

Stunned, I asked a colleague to confirm what I thought I saw. Further investigation led to a diagnosis neither of us could have imagined when he walked through the door: lung cancer. At just 20 years old.

Fortunately for him, his cancer was detected early enough to make treatment possible. A year later, I received an email from him around New Year’s Day. He was in remission, he told me, and beginning the year cancer-free.

The experience reinforced a lesson I have never forgotten: Youth does not make you immune to cancer. And, tragically, that is a hard reality that I am increasingly reminded of.

As a double board-certified physician specializing in family and urgent care medicine, I find myself on the frontlines of a deeply troubling medical trend – sharply rising cancer diagnoses in patients under 50 years. These cases no longer surprise me the way they once did.

Recently, a 28-year-old man came to me complaining of abdominal pain, bloating and blood in his stool. His appetite had almost disappeared. He looked pale and had been experiencing symptoms for months.

There were several possible explanations; irritable bowel syndrome, Crohn’s disease or ulcerative colitis. I could also not rule out colorectal cancer.

I arranged for him to see a gastrointestinal specialist as quickly as possible and my fears were justified. Thankfully, his cancer was caught early enough for medical intervention that helped save his life.

And it is not just young men falling victim to surging cancer cases.

I’ve treated a woman in her early 40s who complained of intermittent abdominal pain resembling menstrual cramps. She had already seen two other doctors.

I considered several explanations, including endometriosis, appendicitis or a urinary problem and ordered a CT scan, which revealed another finding: uterine cancer. She received specialist treatment before the disease spread and did well.

Uterine cancer was not at the top of my potential diagnosis list, especially since it is a disease more commonly seen in post-menopausal women between the ages of 55 and 65.

These cases are not proof of a nationwide trend. But they illustrate what is at stake when serious symptoms are dismissed because of a patient’s age and the scientific evidence increasingly suggests that something troubling is indeed happening.

A major study published in BMJ Oncology in 2023 examined the global burden of early-onset cancers – defined as diagnoses before age 50.

Researchers found that worldwide, new cancer cases among younger adults (ages 14-49) had increased approximately 79 percent between 1990 and 2019, without accounting for population growth and demographic changes.

More concerning, they projected that new early-onset cancer cases could increase by approximately 30 percent by 2030 – amounting to nearly one million additional cases.

It’s a staggering prediction.

Researchers examining American cancer incidence have also identified increases in multiple cancers among adults under 50, including colorectal, breast, kidney and uterine cancers.

Naturally, patients ask me the same question: Why is this happening?

I wish I could give them one simple answer. But the truth is that cancer is an extraordinarily complex disease and researchers are still working to understand why certain cancers are appearing more frequently in younger generations.

There are likely multiple contributing factors. Obesity is associated with increased risk of at least 13 types of cancer. Excess body fat can affect hormone levels and contribute to chronic inflammation. Diet may also play a role. Processed meat, for example, has been linked to colorectal cancer.

Researchers are investigating environmental exposures, including those experienced early in life and those that impact the gut microbiome – the microorganisms living in our digestive systems.

Genetics, alcohol consumption, smoking and other lifestyle factors also influence risk. Lastly, improved diagnostic technology may explain part of the increase in detected cases.

But there is no single explanation.

Nor should anyone assume that a young person who develops cancer must have done something wrong. I have seen too much suffering to believe that.

For me, this crisis is more than a medical issue. It is deeply, devastatingly personal.

This year, my five-year-old niece died after a two-year battle with a rare childhood brain cancer called sonic hedgehog medulloblastoma – a fast-growing, malignant brain tumor.

She was just three when her fight began.

Then a beautiful vibrant child, she returned from school one day with a limp. We assumed she had just injured herself on the playground.

Her parents took her to an orthopedist who told them that everything was fine. But a few weeks later, she could no longer walk and ended up in the emergency room.

Only because of the persistence and advocacy of her parents, did doctors find the cause: cancer.

For two years, our family hoped, prayed and watched her battle an unimaginably cruel disease. Then we lost her.

There are no words that can adequately describe the heartbreak of losing a little girl you love, even for a physician, who is accustomed to confronting illness.

I know, better than most, that medicine cannot always deliver the outcomes we desperately want, but the loss of my niece has strengthened my determination to deliver a message I believe every young American needs to hear.

If you notice something unusual happening in your body, do not ignore it. Do not assume it is nothing. And, above all, do not assume you are too young for cancer.

There are certain warning signs I want young people, in particular, to recognize.

Blood in your stool, even occasionally, deserves medical attention. It may be caused by hemorrhoids, but that should not be assumed without an appropriate evaluation.

Persistent changes in bowel habits, unexplained abdominal pain or bloating and unintentional weight loss also warrant investigation. So does fatigue that persists despite adequate rest, particularly when accompanied by other symptoms. Sometimes fatigue is caused by iron deficiency or anemia. But even then, we need to ask what is causing it.

A new lump in the breast, testicle, neck or elsewhere in the body should be assessed, as should unexplained vaginal bleeding, persistent difficulty swallowing, changes in a mole or skin lesion, or a cough or shortness of breath that does not improve as expected.

These symptoms do not automatically mean cancer. Most people experiencing them will have another explanation, but they should not simply be dismissed.

And remember: Cancer does not always cause pain. Waiting until something hurts badly enough to interfere with your life is not a sensible strategy.

Finally, one of the most dangerous misconceptions I encounter is the belief that because someone is too young for routine cancer screening, they are too young to develop the disease.

These are two very different things. In the United States, routine colorectal cancer screening generally begins at age 45 for adults at average risk. Routine mammograms are recommended beginning at age 40 for most women. And annual lung cancer screening is recommended for certain adults between 50 and 80 with a significant smoking history.

These recommendations are designed to detect disease in people without symptoms, but screening is not the same as diagnostic testing.

My 28-year-old patient with blood in his stool did not need to wait until his 45th birthday to have his symptoms investigated.

A 30-year-old woman who discovers a lump in her breast should not wait until she is old enough for routine mammograms.

And my 20-year-old patient with the persistent cough did not need to meet the criteria for lung cancer screening before his symptoms could be evaluated.

Family history matters, too. If a close relative developed cancer unusually young, tell your physician. Some people need earlier screening or genetic counseling. And when you visit your doctor, be specific. Explain when your symptoms began, how frequently they occur and whether they are getting worse.

Sometimes the details a patient hesitates to mention are precisely the ones that doctors most need to hear.

I do not want young Americans living in fear of every ache, cough or unusual sensation. I want them to understand that paying attention to their health is not something that should begin in middle age.

Speaking up could save your life.

Dr Janette Nesheiwat is a board-certified physican, working in family and emergency medicine

TOMORROW: Young mom who begged for cancer test for years but doctors wouldn’t listen