If cancer risks increase for younger generations, family physicians’ duty is clear

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The medical world got good news in 2024 when researchers estimated cancer screenings, prevention and treatments saved 5.94 million lives from 1975 to 2020.

But another study that year described a different scenario: While detection and treatments are getting better, risk for some cancers is increasing for younger generations.

The causes of greater risk may be unclear, but that should not change the mission of family physicians working with patients to prevent and screen for cancer, said Kathleen N. Mueller, MD, FAAFP.

She works as system director for integrative medicine and cancer survivorship for Nuvance, a seven-hospital health system in Connecticut and New York. A member of the board of directors for the American Academy of Family Physicians, Mueller spoke with Medical Economics about the study “Estimation of Cancer Deaths Averted From Prevention, Screening, and Treatment Efforts, 1975-2020,” published in JAMA Oncology in late 2024.

The other findings came from “Differences in cancer rates among adults born between 1920 and 1990 in the USA: an analysis of population-based cancer registry data,” published in The Lancet Public Health and promoted by the American Cancer Society.

This transcript has been edited for length and clarity.

Medical Economics: Results from another study from July 2024 found younger generations may have greater risk of 17 of the 34 cancer types. What do you make of those findings?

Kathleen N. Mueller, MD, FAAFP
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Kathleen N. Mueller, MD, FAAFP: It's really unsettling. There are a number of incidents of cancers that are growing. Other ones are kind of holding their own, but the overall incidence of cancer is going down. That said, more “healthy people,” people who don't have another diagnosis of diabetes or at higher risk of cancer, are getting diagnosed. Younger patients are getting diagnosed at later stages, and we're not sure if that's because we have better screening techniques, we’re able to find it sooner, or if it's just something that's happening. I'm not aware of a study that can tell us exactly why these trends are happening, but I think it comes back to the whole thing of prevention. Since we don't know what is causing this increase, necessarily, we need to be working on what we can do to reduce our own risk, and that includes all of the lifestyle changes and environmental changes that we can do. I'm also really proud the that the American Academy of Family Physicians has enhanced their focus on what we call lifestyle medicine, which is helping physicians teach patients how to make these changes. Just telling you, you need 150 minutes of exercise a week, that does zero except maybe make you feel guilty. But helping someone start an exercise program from five minutes a day, building to 15, then you can get to that 30 minutes a day, helping someone, just, bring in a fruit or vegetable every time they eat, rather than going all organic and eating everything that's green — I think we need the tools as physician educators to help our patients implement these changes before we lead to these cancer diagnoses. And I think we need more research to show us again, like this study did. This study showed us what's working for breast cancer, what's working for prostate cancer. We need studies that are bigger like this, that can say, OK, nutrition is really important for this one. We know it's important for a lot of them, and this is the way that we go about it, just so that we can streamline our approaches.

Medical Economics: Medicine is a huge field. What is the best way for family physicians to stay updated on the latest recommendations and advancements in cancer screenings and treatments?

Kathleen N. Mueller, MD, FAAFP: I am so proud to be a family physician because we for many reasons, but we are the first specialty that required continuing medical education and recertification of any specialty in the country. So, it's part of our DNA, it's what we do anyway. And the American Academy of Family Physicians has done a remarkable job of creating and providing resources for our family docs when they need it, how they need it, whether it's a podcast or it's online CME, or it is a board certification prep or it's a live meeting. Our AAFP has done such a unique and wonderful job in providing the information for our physicians when they need it and how they need it, so it's already in our DNA.

Medical Economics: What would you like to see in the future of cancer care? Would that entail more and better screenings, better treatments, more interaction with family physicians and oncologists, more focus on prevention?

Kathleen N. Mueller, MD, FAAFP: Absolutely all the above. This isn't a put-a-widget-here kind of problem. This is a comprehensive community issue. This is something that we need to approach by where you live and with whom you live. And it involves oncology, it involves hospital systems, it involves family physicians, it involves other primary care physicians, and it involves towns. I would like to see, ideally, in every oncology office and every family medicine office, a team of people who are looking at, oh, we haven't seen Joe Smith in a while, we need to make sure that he's getting in here because he hasn't had his colonoscopy. Oh, he’s afraid, OK, we're going to work on helping him understand the importance of that. Oh, Dr. Jones called, he's the oncologist in town, and he is going to work on a prevention program, we'll do that together. So, it's all of the above, in addition to reducing insurance barriers and financial barriers to getting this really important care.