Recently, a young African American man came to my office in a panic, with visible fear in his eyes. He described intense abdominal pain that started a few days earlier while he was working in construction, saying he had never experienced anything like it. Upon physical examination, he was hemodynamically stable with no signs of an acute abdomen. There was some epigastric and supra-pubic pain, and he mentioned diarrhea as a related symptom. He also acknowledged that he had engaged in unprotected sex before the onset of pain. I ordered tests for sexually transmitted infections, a complete blood count, a chemistry profile, and lipase. I called him back with the positive chlamydia result with treatment and said that I wanted to talk to him about his new onset anemia.

When I asked about rectal bleeding, he admitted he had been frightened to mention the bright red blood he’d seen in the toilet for several days before the visit. I asked him if he had a family history of colon cancer, and he said his father had been diagnosed with colon cancer in his early 40s. I recommended a colonoscopy to the patient and arranged for it to be scheduled. The diagnostic and curative study revealed several polyps, which the gastroenterologist successfully removed. Early detection prevented the development of colorectal cancer in this young man.

Patients like this are why I believe that establishing a primary care doctor and following up on unusual symptoms is crucial to preventing early-onset cancers.

While cancer in young people may seem like an anomaly, research shows us it is not. Early-onset cancers are on the rise in adults between the ages of 18 and 49 years. A study published in The Lancet Public Health in July 2024 revealed increasing incidence rates of 17 out of 34 cancers including breast, pancreatic, and gastric cancers in Gen-Xers and Millennials, alongside higher mortality rates. These cancers present unique challenges to young adults, of which they are often unaware. Cancer in young people can impact family planning, as some cancers and their treatment can affect fertility. Chemotherapy may lead to early menopause in women, and treatment for prostate cancer can cause erectile dysfunction in men. Early cancer diagnoses are often linked to a higher risk of recurrence, especially in cases like thyroid cancer. Body image can change with hair loss and weight gain from certain treatments, while the need for frequent treatments puts a significant burden on patients’ time and finances.

Young adults should establish care with a GP and consistently follow up on any new or unexplained symptoms. These ambiguous symptoms should never be dismissed. My patient initially feared coming to the doctor, as previous visits resulted in weight and blood pressure shaming rather than counseling. His concern about his abdominal pain and embarrassment of rectal bleeding made him hesitant to schedule an appointment. Despite all this, my patient ultimately met with me and we were able to take preventative measures. Sadly, for a lot of young people, fear, shame, and the belief that they will be young and healthy forever prevent them from seeking the care they need. 

Family history, a crucial part of this encounter, often influences care recommendations since young adults frequently don’t meet the age criteria for routine cancer screenings. For instance, individuals with a family history of colon cancer may need to start screening 10-15 years before the family member’s diagnosis. This is why establishing a relationship with a primary care physician and appropriate questioning from that physician are crucial to cancer prevention. 

Unfortunately, millennials are less likely to establish care with a primary doctor. They are twice as likely as baby boomers to self-refer to a specialist and seek care at urgent care clinics. Urgent care, retail clinics, and telemedicine sites offer convenience but lack long-term relationships and preventative care, such as pap smears and colon cancer screenings, which are hallmarks of primary care. 

What Physicians Can Do to Prevent Early-Onset Cancer

Primary care relationships are an excellent place for physicians to make an impact in influencing and supporting cancer-preventative behaviors in their patients. For example, a study from Boston University’s Black Women’s Health Study revealed that long-term use of chemical hair relaxers is associated with an increased risk of uterine cancer in postmenopausal black women. Primary care doctors should be aware of modifiable risk factors that can affect patient health and can counsel patients on safer alternatives.

Diet is another modifiable risk factor. Avoiding a diet high in ultra-processed foods can significantly reduce cancer risk. Physicians are essential in counseling patients on dietary choices and can refer them to dietitians for further guidance. Doctors can also screen for food access and ensure patients do not live in food deserts that only offer processed foods rather than fresh vegetables, fruits, and lean meat. Doctors can write prescriptions for vegetables in local farmers’ markets and offer advice on grocery stores that supply more fresh food than processed food. Primary care doctors can also act as role models for patients with his or her own dietary choices. Simple and attainable changes such as cutting out soda, iced tea, or the afternoon slump candy bar can reduce cancer risk. 

Lifestyle factors such as physical inactivity, alcohol consumption, and smoking also contribute to early cancer incidences in young adults. Obesity, often a result of a sedentary lifestyle, is associated with several cancers, including multiple myeloma, colorectal, uterine corpus, gallbladder, kidney, and pancreatic cancers. 

Primary care visits include screening for alcohol abuse disorder, smoking, and BMI. The visit with the internist helps the patient prioritize these health issues in his or her life. Frequent visits and continuity of care allow for accountability and progress towards these new goals of weight loss, reducing alcohol consumption, and smoking cessation. Knowing you have the support of a physician who cares for you can make a significant difference in pursuing and achieving these behavioral changes. 

Looking to the Future of Care and Prevention

With the recent rise of early-onset cancers, I urge researchers to delve deeper into why this phenomenon is occurring and how best to help our patients. I also encourage young people to establish care with a primary doctor. 

Physicians, of course, are crucial in this relationship. They must pay close attention to ambiguous symptoms in younger patients and not dismiss their stories. Rectal bleeding in a young person does not always mean hemorrhoids, and breast pain in a young woman does not always indicate mastitis. The patient-doctor relationship needs to be a safe space for patients, and building it takes time, trust, and in-person evaluations. 

My patient returned to my office with a follow-up colonoscopy in three years based on the amount of polyps found in his colon. His symptoms had resolved and he needed a return to work note. He thanked me for my care and set an appointment with me in 6 months– I look forward to seeing him and building our care relationship together. 

What is your experience with forming patient relationships and their impact on care? Share below!

Dr. Kathleen Grant is a primary care physician in Athens, Georgia. She enjoys hiking, yoga, and playing ukulele with her husband. Interests in general internal medicine include rural populations, medical education, and cancer prevention. Dr. Grant is a 2024–2025 Doximity Op-Med Fellow.

Illustration by Diana Connolly