Screening, therapeutics, and fertility are converging into a new paradigm in oncology care.
Cancer mortality in the U.S. has declined by 34% between 1991 and 2023, preventing an estimated 4.8 million deaths. And yet, adults under 50 are facing cancer diagnoses at an increasingly alarming rate.
Women, in particular, are bearing the brunt of that rise.
A 2025 report from the American Cancer Society found that the cancer incidence for women under 50 is 82% higher than for men the same age compared to 51% higher in 2002.
“In that under 50 population, it's not equal,” Karen Knudsen, the CEO of the Parker Institute for Cancer Immunotherapy, tells HLTH in an interview for The Pulse. “If you take out the pediatric population and you define a young adult age 15 to 39, that's 88,000 new diagnoses this year alone. That's a lot of people.”
Natasha McCants had no symptoms when she went in for a routine colorectal screening at 45. “I went overnight from seemingly healthy to being a stage III cancer patient,” she says, according to a testimonial provided by City of Hope.
Breast cancer rates are rising nearly 1.5% each year for women under 50. Meanwhile, colorectal cancer rates are rising nearly 3% each year for all those under 50. Despite being commonly referred to as a cancer of older adults, colorectal cancer is now the No.1 cancer killer of adults under 50.
“That was really not expected, and something, frankly, that we still don't really understand,” says Knudsen of the overall rising rates in young adults. “The leading hypotheses are all associated with early exposures. So, is it microplastics? Is it ultra-processed food? Is it pesticides? Is it a helicopter of all of those things plus something else? We know that there must be a ‘something else’ because this change in incidence is particular to that under 50 population.”
The decades of hard-won progress in decreasing cancer mortality is colliding with an uncomfortable trend that is exposing the limits of the current healthcare system. The response isn't just clinical. It’s financial and it's about supporting a workforce through sudden life-altering diagnoses. At HLTH, our oncology programming is addressing prevention, early detection, the promise of AI, and the future of survivorship care.
While experts may debate the underlying causes for these trends, many have also been challenging screening protocols for early detection, educating on prevention, grappling with treatments that balance survivorship and quality of life, and ultimately, solving for the affordability question.
“There’s strong data that younger patients with cancer are less able than their older counterparts to pay for their cancer care, resulting in higher rates of medical debt and greater likelihood to experience financial toxicity from their care,” Dr. Yousuf Zafar, a gastrointestinal medical oncologist and the Chief Medical Officer of Access Hope, tells HLTH.
So where do we go from here?
The future of cancer screening
Early detection saves lives for those cancers that have a screening protocol, many of which are the culprits for those under 50. Screening recommendations are being challenged.
“Because [younger patients] fall below guideline screening ages, their cancer is almost never caught incidentally. It is caught at the time of symptoms, which usually means it has already progressed,” Jayant Parthasarathy, PhD, CEO of Astrin Biosciences, tells HLTH. “Breast cancer presents an added structural problem. Younger women have denser breast tissue, which routinely obscures tumors on standard mammograms. For women under 40, routine screening does not exist at all.”
For colorectal cancer, early detection delivers a five-year survival rate of 90% in the U.S.
Knudsen, who served as the former CEO of the American Cancer Society, was involved in the effort to lower the screening recommendation age for colorectal cancer from 50 to 45. And before taking the helm at the Parker Institute, she recalls being in conversations about further lowering the screening age for colorectal cancer. “It’s just unacceptable that people are being diagnosed with stage IV colorectal cancer at age 42, well below the screening time,” she says.
What’s more, many are deterred from routine screening, especially given the traveling burden for those who cannot afford to take off work or caregiving duties, or who live far away from a healthcare system. But we may be entering a world where you receive a cancer diagnosis in the comfort of your home. The American Cancer Society updated guidelines to include use of a blood-based and at-home test for colorectal cancer in May of this year.
And looking ahead, Knudsen is excited about AI’s role in risk-adjusted screening guidelines for individuals based on their genetics and family history.
Beyond screening, novel therapeutics are top of mind to intervene for the under 50 population.
The next frontier
Knudsen calls this moment the “cancer therapeutic vaccine era.”
Radiation yields a greater risk of secondary cancer. From a recurrence perspective, Knudsen says immunotherapies offer hope, especially for younger generations.
“You're training your own immune system to see the cancer and kill the cancer, because it's been alerted to its presence,” she says. “I don't think all cancers will be preventable. We'd love that, but curable is something I think is going to be within our grasp.”
Just this August, a Merck-Moderna partnership developed a cancer vaccine that yielded positive results in Phase III for preventing the return and spread of melanoma. Still, innovations alone don’t solve for who can access them and be supported throughout their care.
Still, these are topline results and more research is needed to prove efficacy. Zafar from Access Hope also reminds us that supporting patients while on treatment and through survivorship is a vital part of improving overall oncology care, especially for younger adults.
“We should ensure that the evidence is translated into the community setting such that patients receive the right treatment for their cancer,” he says.
Changing paradigms
The future of oncology care also includes fertility preservation. Often, people who are thinking about having children and facing a cancer diagnosis are not asked about what that could look like.
“It starts to become a new type of paradigm in the oncology world, where you're dealing with these young adults who still want to have kids, who are coming in with a cancer you didn't expect and that you weren't trained to see,” Knudsen says.
For younger adults, Knudsen says providers need to have more conversations about balancing long-term survivorship with quality of life, which may include fertility preservation.
“There is really strong evidence in the oncology world that science has been converted into health,” says Knudsen. “We do a very good job on the discovery side, but where we are challenged is in translation and in allowing access in the healthcare system.”
This translation remains a gray area for health systems, solution providers, and payers as they navigate a world where young adults are facing a disease the system wasn’t designed to absorb.
Continue the conversation at HLTH USA 2026. Register and save $800 before prices increase Saturday, September 12.
Alexa Mikhail, Content Lead and Senior Health Writer at HLTH, Inc. is leading the oncology agenda and programming at HLTH USA this year. Join her in Las Vegas this November 15-18, 2026.