|Year : 2016 | Volume
| Issue : 3 | Page : 457-459
Spectrum of cancer in adolescents and young adult: An epidemiological and clinicopathological evaluation
D Sharma, G Singh
Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi, India
|Date of Web Publication||24-Feb-2017|
Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Changing scenario of cancer in adolescents and young adult (AYA) age group becomes an emerging and alarming problem. The age span that falls under the AYA umbrella, i.e., 15–29 years, is broad and having unique characteristic as compared to older and pediatric cohort. Only a few data are available in English literature about this age group where the spectrum of cancer varies accordingly as the function of age. OBJECTIVE: The aim of this study was to evaluate the incidence and pattern of tumor in adolescents and young age group. MATERIALS AND METHODS: A retrospective observational study was done at a tertiary care center. Medical records of patients aged 15–29 years registered from 2011 to 2015 were retrieved for analysis. RESULTS: Incidence rate of malignancy in AYA age is 5.71% in this observational study. Male:female ratio was 1.81:1. Most common cancer in this age group was head and neck cancer > central nervous system > gastrointestinal tract in the entire cohort. CONCLUSION: The malignancy spectrum, their subtypes, and demographic distribution in the AYA cohort have diversity among different cancer centers within India as well as in different countries across the world.
Keywords: 15–39 year, adolescents, cancers, unique pattern, young adult
|How to cite this article:|
Sharma D, Singh G. Spectrum of cancer in adolescents and young adult: An epidemiological and clinicopathological evaluation. Indian J Cancer 2016;53:457-9
| » Introduction|| |
Cancer is usually considered as a disease of old age, especially cancer of prostate, breast, colorectal. A recent trend has shown that the incidence of cancer is increasing in young age, especially adolescent and young age (15–29 years of age). Cancer in adolescents and young adults (AYA) has distinct characteristics as compared to that of older and pediatric cohort., The incidence and pattern of cancer in adolescents and young age differ between AYAs and older and young cohort, but there is sparsely published literature on this because of its uncommon nature.
The objective of this study is to find the incidence and pattern of cancer in AYAs in a tertiary care center from North India and to compare this with the available data in the Indian and western literature.
| » Materials and Methods|| |
A retrospective, observational study was conducted in our department. Medical records of patients aged 15–29 years registered between January 1, 2011, and December 31, 2015, were retrieved epidemiology, and clinicopathological features were recorded for analysis. The diagnosis was categorized according to the Birch classification which has been recommended to classify tumors in AYA.
| » Results|| |
A total of 8685 cases were registered during the last 5-year period. Of these cases, 496 (5.71%) were in the age group between 15 and 29 years. Male: female ratio was 1.81:1 [Table 1]. It has been found that majority of the patients were in the age group of 25–29 years (n = 213, 42.9%), followed by 20–24 years (n = 160, 32.3%). The most common involved site was head and neck cancer, followed by central nervous system (CNS) and gastrointestinal tract (GIT) in the entire cohort. In age group of 15–19 years, most common cancer was leukemia, followed by lymphoma, bone, and CNS. The most prevalent cancers in younger AYA (15–19 years) were acute lymphoblastic leukemia (ALL), Hodgkin's lymphomas, bone tumors, and CNS. In contrast, older AYA (25–29 years) were diagnosed mainly from head and neck cancers, and cancers of CNS, breast, and GIT.
|Table 1: Adolescent and young age spectrum in cohort 15-29 years and age-wise distribution|
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| » Discussion|| |
Here, we present an overview of patterns of cancers and age and sex distribution of 496 patients of AYA group.
We have compared our results with the available literature from India  and also from international reported series [Table 2].,,
|Table 2: Five most common adolescent and young adult cancers (in descending order) based on the Birch classification in our study and published data from other international cancer registries|
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Our observation is that 5.71% of our patients are AYA. This is similar to 5.8% seen in urban population-based cancer registry (PBCR), India. However, the incidence of cancer in AYA group is less in other countries; this may be contributed due to type of population pyramid in India as compared to 2.3% in Korea and 2% Surveillance, Epidemiology, and End Result (SEER) monograph.,
The cancer incidence increases with age in AYA. In the present study, 42.9% of the patients were more than 24 years. This observation correlates with other series as well.,,,, The male:female ratio of 1.81 is higher than that reported from India and the UK as well as from the Netherlands, Korea, and Australia.,,, It is slightly higher as compared to other studies in western literature and India. This might be due to preference for male child and some cases are common in males such as lymphoma. A study from Tata Memorial Hospital, in which 10,717 patients were analyzed between age group of 15 and 24 years, also demonstrated that majority of the patients belong to older age group with male:female ratio being 2.1:1. These results are in accordance to our study.
In comparison to US SEER database, Australian database, and the Netherlands PBCR, the incidence of melanoma and skin malignancy is very less in India.,, This may be due to chronic continuous sun exposure seen in tropical countries such as India and increased melanin in dark-skinned individuals acts as a natural sun-protection factor.
In the age group of 15–19 years, the data from our center are very similar to other study from India. In a study by Singh et al., first three most common cancers in 14–19 years were ALL, followed by Hodgkin's lymphoma and osteosarcoma; these results are very similar to that from our study as per the US SEER database.
In the age group of 24–29 years of the present study, the most common cancer was head and neck squamous cell carcinoma, followed by CNS tumors and carcinoma of breast as compared to skin malignancies, followed by lymphomas and malignancies of female genital tract as per the US SEER database. This may be contributed by excessive use of tobacco and smoking in India.
Some of the limitations are small sample size, retrospective data collection, and lack of survival analysis. There is difference from other data in respective cohort, which may be contributed by inconsistent variation in defining the criteria of AYA population, for example, 15–44 years Kalyani et al. versus 15–24 years tata memorial hospital (TMH) study., Wu et al. also demonstrated that etiological factors for nonepithelial cancers such as viruses, chronic infections, radiation, and genetic and environmental factors and for epithelial malignancies such as tobacco use, alcohol consumption, and dietary factors along with racial and ethnic differences are also responsible for the observed variation among different reports.
| » Conclusion|| |
The spectrum of malignancies, their (sub) types, and demographic distribution in the AYA cancer patient population varies not only among different countries across the world but also among different cancer centers within India. Therefore, international collaborative research should be done for this group to improve prognosis and for better understanding of genetic and other etiological factors for its causation.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]