January 29th, 2018 by Dustin Dennison (Site Admin) | NAACCReview Home Leave a comment


Dennis Deapen, DPH
Director, Los Angeles Cancer Surveillance Program
(NAACCR Committee Member)



A new comprehensive overview of cancer survival among adolescents and young adults (AYAs) is available from the Los Angeles Cancer Surveillance Program.

One unsettling aspect of being diagnosed cancer as a teenager or young adult is that doctors are less able to provide an accurate prognosis due to a limited understanding of age-appropriate cancer data for this group, a Keck School of Medicine of USC researcher Amie Hwang notes.

“Cancer survival data are poorly understood for 15- to 39-year-olds,” said Dr. Hwang, assistant professor of clinical preventive medicine. “That makes it difficult for oncologists to accurately estimate, for example, how long a 29-year-old African-American man diagnosed with melanoma is expected to survive because we don’t have detailed cancer trends for this age group.”

Until now. Hwang and her colleagues at the Los Angeles Cancer Surveillance Program published the book “Cancer in Los Angeles County: Survival Among Adolescents and Young Adults 1988-2014.” The report card is the first to break down cancer survival rates for 15- to 39-year-olds, USC researchers said. It segments the data by race or ethnicity, sex, age group, socioeconomic status, and cancer stage for 18 most common cancer sites for this age group.  The report card includes data on Asians and Pacific Islanders, blacks, whites and Latinos.

The National Cancer Institute released a cancer trends report for this AYA group nearly two decades ago. In addition to now being dated, the report did not note how socioeconomic status may impact health outcomes.

“Adolescents and young adults may feel the need to go to the doctor less often because they have this superhero mentality, like they’re invincible,” said Dennis Deapen, senior author of the report and professor of clinical preventive medicine at Keck School of Medicine and director of the Los Angeles Registry. “Once they do go to a health professional, their cancer diagnosis can be delayed because cancer isn’t the first concern doctors have for this age group. It comes as no surprise that patients diagnosed with late-stage cancer have reduced survival rates.”

Cancer is the leading cause of non-accidental death among 15- to 39-year-olds in the United States, according to the report.

“Outcomes for children and older adults with cancer have improved greatly over the past three decades; however, there has been little improvement in survival among AYA cancer patients,” the report noted, illustrating how overlooked this “middle child” group is.

About 87,000 adolescents and young adults are diagnosed with cancer in the U.S. each year, seven times more than the number of children and early teens diagnosed, the report noted. Pediatric oncologists are widespread, but AYA oncology is a budding research and clinical area.

In Los Angeles County, about 2,600 AYAs are diagnosed with cancer each year. In total, the report card includes 71,225 cancer cases diagnosed among 3.7 million AYAs who lived in Los Angeles County between 1988 and 2014.

The overarching message from this report card is that 15- to 39-year-olds are hit by preventable cancers, Hwang said.

“Prevent cancer by taking charge of your health,” she said. “Screen for cancer, get the HPV vaccine, check for moles that are new or unusual, eat more fruits and vegetables, and exercise. Stay away from tobacco products and heavy drinking.”

Some of the report card’s highlights:

  • Colorectal cancer is on the rise among 15- to 39-year-olds even though the disease is on the decline for older populations. More sedentary lifestyles and poor diet may be a contributing factor, Hwang said. While colorectal screenings may benefit this group, the preventive measure currently is recommended only for people who are 50 or older.
  • African-Americans experience the worst survival rates for most cancers, including breast, cervical, kidney and leukemia. Part of the reason for this trend may be the fact that they were the least likely to be diagnosed with cancer in a timely manner and do not receive appropriate treatment. It’s possible they had late-stage cancer by the time they were seen by doctors, Hwang said.
  • Breast cancer is the most common cancer in AYA women and accounts for about 27 percent of their diagnosed cancers. Survival is generally lower for younger women because they generally have more aggressive forms of breast cancer. People of lower socioeconomic status also carry worse chance of survival. In addition there is a lack of routine breast screening practices for this age group.
  • AYA men have lower survival rates than AYA women for most of the cancers examined, except for breast, colorectal, stomach cancers and leukemia. There is inherent biological differences between men and women, but men in this age group are less likely to seek routine medical care resulting in delay in cancer detection.
  • Cervical cancer has lower survival rates among blacks, older AYAs and people of low socioeconomic status. There is now a vaccine to prevent cervical cancer, which may account for why older AYAs have lower survival rates. Latinas (54 percent) and poor people (31 percent) are more likely to get cervical cancer due to poor screening practice.

USC and Keck Medicine of USC are leaders in tackling intractable problems such as cancer. The Los Angeles Cancer Surveillance Program has tracked every diagnosed case of cancer for the past 46 years. Keck School of Medicine and the USC Norris Comprehensive Cancer Center oversee this registry in collaboration with the California Cancer Registry of the California Department of Public Health.

Click here to view a PDF version of the book

Live interview with Dr. Hwang can be viewed here.

A companion book on AYA cancer incidence in Los Angeles can be accessed here.

The opinions expressed in this article are those of the authors and may not represent the official positions of NAACCR.

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