Article Topic: Cancer Risk

Faster Aging in Younger Generations Linked To Rise in Early-Onset Cancer

Immune system aging linked to earlier lung cancer; fat tissue aging linked to earlier colorectal cancer

Cancer is often considered a disease of aging. Older adults are at higher risk because they have had more time to accumulate cellular damage that can trigger tumor formation. But as cancer rates in younger adults rise, with each successive generation facing higher risks than the one before it, researchers are asking whether cellular damage is accumulating faster in recent generations, accelerating their body’s biological aging.

A new study led by researchers at Washington University School of Medicine in St. Louis provides evidence that younger generations are indeed aging faster biologically than their older counterparts. The causes remain under investigation around the world, including global efforts led by research members of Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine, and Cancer Grand Challenges, a global initiative co-founded by the National Cancer Institute and Cancer Research U.K.; but importantly, the new research links this accelerated aging to an increased risk of early-onset cancers in younger generations. In general, early-onset cancers are those diagnosed at age 55 or younger.

The larger the gap between biological age — that is, how old our bodies appear to be — and chronological age — which is how many years we have actually lived — the higher the cancer risk, according to the researchers. They found that people in more recent birth cohorts had larger age gaps than those in older birth cohorts, which may help explain the rise in early-onset cancer in recent generations.

Their study also identified links between faster aging in particular organ systems and increased risks for certain cancers. For instance, an immune system that appears older than its actual age was associated with early-onset lung cancer. Similarly, fat tissue that appears older than its chronological age was associated with early-onset colorectal cancer.

The study, published June 22 in the journal Nature Medicine, suggests that measures of accelerated aging could help identify individuals at higher risk of early-onset cancer and guide new strategies for cancer prevention and early detection.

“Our goal is to determine whether blood carries a biological imprint of a person’s past exposures, providing a window into how environmental and lifestyle factors have changed across generations,” said Yin Cao, ScD, MPH, a molecular epidemiologist and an associate professor of surgery and of medicine at WashU Medicine and a research member at Siteman. “We also tested whether blood samples collected years before diagnosis contain early biological signals that could help identify younger people at higher risk of developing cancer at younger ages. On a practical level, this approach complements our efforts to elucidate the underlying causes of rising cancer rates in younger adults.”

“Our ultimate goal is to decode how modern environments become biologically embedded to drive cancer risk, transforming prevention from broad recommendations to personalized interventions,” Cao added. “Blood-based biomarkers offer a unique opportunity to capture how a lifetime of exposures becomes biologically embedded in the body. By integrating multi-omics data, we can now detect both systemic and organ-specific signals of dysregulation, providing a much more comprehensive picture of cancer risk through these signals. This brings us closer to identifying risk earlier and developing prevention strategies that are tailored to an individual’s biology.”

Biological aging

Cao’s team has been at the forefront of identifying individual factors that influence cancer risk across the life course, such as obesity, metabolic dysregulation, alcohol consumption, sedentary behavior, poor diet quality and cesarean delivery. Although these discoveries have revealed important clues to the origins of cancer at younger ages, the contribution of any single factor is modest.

With that in mind, Cao and her colleagues have sought ways to capture the influence of multiple risk factors operating together to spur cancer development. With support from Cancer Grand Challenges, Cao, as co-lead of Team PROSPECT, has been able to go after this problem.

For the current study, Cao’s team analyzed data from more than 154,000 young adults in the UK Biobank, a large biomedical dataset containing biological, health and lifestyle data, and from more than 10,000 individuals in the U.S. participating in the National Institutes of Health’s (NIH) All of Us Research Program, an effort to build a comprehensive health dataset on more than 1 million people living in the U.S.

To estimate the level of biological aging — or age gap — the researchers, including first author Ruiyi Tian, a doctoral student in the Cao lab, examined aging at two levels: across the body as a whole, known as systemic aging, and within individual organs, known as organ-specific aging. For systemic aging, the researchers used established measures, including clinical biomarker-based measures such as PhenoAge and the Klemera-Doubal Method, as well as a metabolomic age score.

PhenoAge, for example, measures nine blood biochemistry markers such as albumin, made by the liver, and creatinine, a waste product removed by the kidneys. For organ-specific aging, the researchers used blood proteomic data, which measure levels of multiple proteins linked to specific organ systems, to estimate biological aging in individual organs.

The researchers calculated the average age gap for each birth cohort and used standard deviation to describe how much each group differed from the study average. Standard deviation is a measure of how spread out data points are around the average. The researchers found that individuals in the UK born between 1965 and 1974 had systemic aging that was 23% of one standard deviation higher compared with those born between 1950 and 1954, after accounting for chronological age. In other words, people in the younger birth cohort showed a modest shift toward older biological profiles than people in the older birth cohort when at the same chronological age. The researchers observed a similar pattern in the U.S cohort. Participants born between 1990 and 1999 had systemic aging that was 92% of one standard deviation higher compared with those born between 1965 and 1969.

This increased systemic aging in the younger group was associated with an 8% increased risk of early-onset solid cancers, especially lung, gastrointestinal and uterine cancers. When participants were divided into three groups based on their level of systemic aging, those with the most advanced systemic aging had 15% increased risk of early-onset solid cancer compared with those with the least advanced systemic aging. According to the analysis, the increased risk persisted even after controlling for inherited genetic risks of cancer and genetic susceptibility to accelerated aging. By zooming into organ-specific aging, the researchers found that advanced immune system aging was associated with increased risk of early-onset lung cancer, and advanced adipose (fat) tissue aging was associated with increased risk of early-onset colorectal cancer.

“If we can identify younger people with the highest cancer risk when they are still healthy, we can focus on prevention and early-detection strategies for the individuals who will benefit most from early interventions,” Cao said.

This research is part of Team PROSPECT, a Cancer Grand Challenges team co-led by Cao. Cancer Grand Challenges is a global research funding initiative co-founded by Cancer Research UK and the National Cancer Institute (NCI) that brings together world-leading researchers to take on cancer’s toughest challenges.

“Right now, we don’t have a definitive answer to what’s driving the rise of early-onset cancers around the world, but studies like this are helping us piece together the bigger picture, showing that cancer may be influenced not just by changes inside individual cells, but by wider changes happening across the body as a whole,” said David Scott, PhD, director of Cancer Grand Challenges.  “Research on this scale is possible through Cancer Grand Challenges, which brings together scientists from different fields around the world to tackle these complex questions together.”

Cao and her colleagues are leading efforts to transform the understanding of why cancers are increasingly striking younger generations. Their next frontier is to decipher how environmental, lifestyle and societal changes leave lasting biological imprints, including accelerated aging and other markers of heightened susceptibility. By illuminating the pathways through which risk accumulates across the life course, they seek to uncover the origins of early-onset cancers and redefine opportunities for prevention. In parallel, their work will enable more precise approaches to identify those at greatest risk and intervene earlier, shifting the paradigm from reacting to disease to preventing it before it begins.

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Tian R, Zong Y, Ren D, Tica S, Hong D, Odulyale O, Buenrostro J, Govindan R, Cao Y. Biological aging and generational shifts in early-onset cancer risk. Nature Medicine. June 22, 2026. DOI: 10.1038/s41591-026-04448-w.

This work was part of the PROSPECT team supported by the Cancer Grand Challenges initiative funded by Cancer Research UK, grant numbers CGCATF-2023/100043 and CGCATF-2023/100037; the National Cancer Institute of the NIH, grant numbers OT2CA297577 and OT2CA297576; the French National Cancer Institute; and the Bowelbabe Fund for Cancer Research UK. The project was also supported by grants from NIH/National Cancer Institute, grant number R37CA246175; the NIH/National Institute of Diabetes and Digestive and Kidney Diseases, grant number P30DK052574; the Alvin J. Siteman Cancer Center through the Foundation for Barnes-Jewish Hospital. Further support was provided by a pre-doctoral fellowship in the Cancer Biology pathway supported by NIH Molecular Oncology Training Grant T32CA113275 to Washington University School of Medicine in St. Louis; the Pediatric Gastroenterology Research Training Program grant T32DK077653 to Washington University School of Medicine in St. Louis; the Washington University School of Medicine in St. Louis Institute of Clinical and Translational Sciences, grant number UL1TR002345; and the Foundation for Barnes-Jewish Hospital. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Skin Cancer Risk Often Comes From Everyday Sun Exposure, Not Just Severe Burns

Routine outdoor work, driving, hobbies and missed spots like the scalp and ears can add up over time — so make sun protection a daily habit, not just during vacation.

One of the most common themes I hear from patients with skin cancer is not a single dramatic sun exposure — it’s years of routine, unremarkable exposure that never felt risky at the time.

Occupational exposure plays a big role. People who work outdoors — construction workers, landscapers, electricians, delivery drivers, mail carriers, farmers — accumulate significant ultraviolet (UV) exposure over time. Even pilots and cabin crew have roughly double the risk of melanoma due to chronic UV exposure at altitude.

Hobbies matter too. Activities like golf and fishing often involve hours in direct sun with little shade, and patients rarely think of them as “high-risk.”

Other Contributors to Cancer Risk

Another important contributor to skin cancer is immunosuppression. Patients with conditions like rheumatoid arthritis or inflammatory bowel disease often are prescribed medications that dampen the immune system. Organ transplant recipients are at especially high risk — approximately 100 times more likely to develop squamous cell carcinoma.

That risk often catches people completely off guard.

I hear versions of this story all the time: “I had one bad sunburn there only once … .” And that’s exactly where we end up treating a skin cancer.

Another pattern I frequently see is skin cancer along the hair part in younger women. The scalp — especially the part line — is one area of the body that is exposed most directly to the sun, but it’s often missed when applying sunscreen.

Another area to keep in mind is the left side of the body in drivers. In the U.S., we commonly see more sun damage and skin cancers on the left hand and forearm from years of incidental exposure through the car window. It’s not something people ever think about in the moment, but it adds up significantly over time.

Keeping Kids Safe in the Sun

Parents and guardians also have an important role to play here. Children’s skin is especially vulnerable to UV damage, and the habits they learn early can help lower their skin cancer risk later in life. Modeling sun-safe behavior — applying sunscreen before school, sports and outdoor play; choosing hats, sunglasses and protective clothing; and seeking shade when possible — helps make protection feel normal, not optional. Just as important, teaching kids to reapply sunscreen and to think of sun safety as part of everyday life, not just beach or lake days, can help those habits last into adulthood.

Make It a Daily Habit

For ourselves and people of any age, it’s very important to make sun protection part of one’s routine. That means:

  • Applying sunscreen on ordinary days — not just vacations
  • Covering high-risk areas people forget (the scalp part, ears, hands, even eyelids)
  • Wearing sunglasses — not just for comfort, but to protect the delicate skin around the eyes, where skin cancer surgeries can be especially challenging

Just as important is getting familiar with your own skin — and remember that you have skin from the top of your head to the bottom of your feet. Many skin cancers are first noticed by patients or their partners. Look for the “ugly duckling” — a spot that stands out — or anything that’s changing, bleeding or not healing.

Another point I always emphasize is this: There’s no such thing as a “healthy tan.” A tan is a visible sign of DNA damage in the skin.

Finally, when it comes to sunscreen, the best one is the one you’ll actually use. I encourage people to try a few (with a Sun Protection Factor, or SPF, of 30 or higher) and find something that fits easily into their daily routine — because consistency is what really makes the difference over time.

Make an Appointment

To schedule an appointment with Dr. McEvoy or another WashU Medicine dermatologist at Siteman Cancer Center, call 800-600-3606 or fill out this form, and our Patient Care Coordination Center will contact you.

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For Your Health: Genetic testing for cancer is becoming more common. What should we know?



Of the many advances in science and technology over the past 25 years, genetic testing is arguably one of the most notable. Once a rare part of health care, it is now becoming much more common. And it’s possible that someone you know — or maybe even you — has had it done. Most often, people get genetic testing to settle curiosity about which parts of the world their ancestors may have come from or to connect with relatives from other branches of their family tree.

But genetic testing can also reveal important information about our health, including the risk of cancer.

“Genetic testing for cancer risk uses a saliva sample or blood sample to look for changes in specific genes — or pieces of DNA — that are associated with increased risk of certain types of cancers,” said Erin Linnenbringer, PhD, a board-certified genetic counselor and associate professor at WashU Medicine.

There are many genes that are related to cancer. Two of the most well-known examples are BRCA1 and BRCA2, Linnenbringer added. Women with harmful changes — known as “variants” or “mutations” — in these genes have a much greater risk of developing breast, ovarian and pancreatic cancer. Men with these mutations also have a greater risk of breast and pancreatic cancer as well as prostate cancer.

While most gene mutations don’t increase cancer risk as much as those in BRCA1 and BRCA2 can, they can still have an important impact. And knowing that can help with managing the increased risk from a mutation. Screening tests or regular health exams can begin at younger ages and be done more often, which can help find a cancer earlier when it’s more treatable. And, for some types of cancer, medication, surgery or screening can even help prevent the disease.

Right now, this type of genetic testing is typically ordered through a health-care professional and is done in people who have had cancer or have a strong family history of cancer.

“People who are diagnosed with an adult-onset cancer at a young age, such as having breast cancer before the age of 40, who have been diagnosed with an aggressive or late-stage cancer, or who have certain types of rare cancers, like ovarian cancer or pancreatic cancer, should consider having genetic testing,” Linnenbringer said. “The same is true if you have more than one relative on your mom or dad’s side of the family who has had cancer, or if your parent, brother or sister was diagnosed with cancer at a young age.”

If you have concerns about your family history and cancer risk, the first step is often sharing that with your health-care provider. “They may be comfortable reviewing your family history and ordering an appropriate genetic test, or they may refer you to a genetic counselor or other specialist,” Linnenbringer said. “You can also search for a counselor near you, at findageneticcounselor.nsgc.org.”

Genetic counselors are a great resource for thinking through the elements that go into deciding if genetic testing is right for you. “They are health-care professionals with specialized training in both genetics and patient communication and counseling,” Linnenbringer said. In addition to assessing cancer risk from your personal and family history, genetic counselors can also help with considering the implications of testing that might not immediately come to mind. This can include its possible effect on life insurance and emotional health, as well as other family members — who may have the same mutations that your testing could find.

If you don’t have a good idea of your family health history, the upcoming holidays can be a fantastic opportunity to connect with family members and get more details. Try to find out the types of cancer any relatives may have had, and around what age they were diagnosed. It can also be helpful to know if any have had genetic testing. This may not always be the easiest conversation, but it can be worth the effort — providing valuable information about whether genetic counseling or genetic testing may make sense.

Looking to the future, Linnenbringer feels the benefits of genetic testing will likely only increase as we learn more through continued research and expanded testing across a wider range of people.

AI-Based Breast Cancer Risk Technology Receives FDA Breakthrough Device Designation

Software developed at WashU Medicine on accelerated path to approval

A new technology that harnesses AI to analyze mammograms and improve the accuracy of predicting a woman’s personalized five-year risk of developing breast cancer has received Breakthrough Device designation from the Food and Drug Administration (FDA). Developed by researchers at Washington University School of Medicine in St. Louis, the software has been licensed to Prognosia Inc., a WashU startup company.

The system analyzes mammograms to produce a risk score estimating the likelihood that a woman will develop breast cancer over the next five years. The technology is compatible with both types of mammogram imaging available: the four 2D views of the breast produced by full-field digital mammography and the synthetic 3D view of the breast produced by digital breast tomosynthesis.

Importantly, the system produces an absolute five-year risk that makes it possible to compare a woman’s risk to an average risk based on national breast cancer incidence rates. This provides a meaningful estimate that is aligned with the U.S. national risk reduction guidelines, so that clinicians will know what steps to take next if a woman’s risk is elevated.

The FDA Breakthrough Device designation provides an expedited review process for full market approval in an effort to give patients and clinicians accelerated access to new medical devices. Products that receive the designation have already undergone rigorous testing and shown excellent promise in their potential to improve treatment or the diagnosis of debilitating or life-threatening conditions.

The software package, called Prognosia Breast, was developed by Graham A. Colditz, MD, DrPH, the Niess-Gain Professor of Surgery at WashU Medicine and associate director of prevention and control at Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine; and Shu (Joy) Jiang, PhD, an associate professor of surgery in the Division of Public Health Sciences in the Department of Surgery at WashU Medicine. Colditz and Jiang co-founded Prognosia in 2024 in collaboration with WashU’s Office of Technology Management (OTM) and BioGenerator Ventures, the latter of which provided both financial support and business strategy expertise from Entrepreneur-in-Residence David Smoller, PhD.

The software is a pre-trained machine learning system that analyzes mammogram images and provides an estimate of how likely a patient is to develop breast cancer over the next five years, based solely on images and a woman’s age. According to the developers, Prognosia Breast estimates a person’s five-year risk of developing breast cancer 2.2 times more accurately than the standard method, which is based on questionnaires that consider factors such as age, race and family history. The system was trained on past mammograms from tens of thousands of individuals who underwent breast cancer screening through Siteman Cancer Center. Some of them went on to develop cancer, teaching the system what to look for in the earliest stages of tumor development. Such early signs of disease can’t be perceived even by a well-trained human eye.

“We’re excited about the potential of this technology to improve risk prediction and prevention of breast cancer broadly, no matter where a woman is getting screened,” Colditz said. “The long-term goal is to make this technology available to any woman having a screening mammogram anywhere in the world. No matter the type of imaging they receive, our data show the software’s potential to identify women at increased risk of developing breast cancer over the next five years, providing them with opportunities to take targeted steps to reduce that risk.”

The new device could have a large impact on risk prediction because the infrastructure is already in place to begin immediately using the software anywhere mammography is provided. Furthermore, many women already receive regular mammograms. According to 2023 survey data from the Centers for Disease Control and Prevention, more than 75% of women ages 50 to 74 reported having received a mammogram in the past two years.

Even with widespread screening, about 34% of breast cancer patients in the U.S. are diagnosed at later stages of the disease. According to the investigators, being able to assess risk up to five years in advance of the onset of cancer is likely to improve early detection, reducing the number of late-stage cancers diagnosed. Early detection has been shown to make treatment more effective and reduce deaths from breast cancer.

“Receiving a Breakthrough Device designation is a powerful validation of the extraordinary dedication and vision of this research team to improve breast cancer diagnosis and care,” said Doug E. Frantz, PhD, vice chancellor for innovation and commercialization at WashU. “It takes years of concerted effort to produce software that could quickly be integrated into the workflow of any mammography center, significantly enhancing the clinical value of routine mammograms no matter where they are provided. This is a prime example of the vital role of entrepreneurship and commercialization at WashU in transforming cutting-edge research into real-world technologies that improve patient care.”

The device produces a five-year risk score that is intended to complement, not replace, the analysis provided by radiologists, who will continue to review the mammograms following standard protocols. According to the American Society of Clinical Oncology and the U.S. Preventive Services Task Force, a five-year risk score of 3% or higher is considered elevated. According to guidelines from these organizations, women with elevated scores should be referred to specialists who can further advise them on their options for additional screening and prevention strategies.

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About one in eight women in the U.S. will be diagnosed with breast cancer in their lifetime. Those found to be at elevated risk of this cancer have the option to receive more frequent screening — which may include other types of imaging, such as MRI — and in some cases may choose to take a type of chemotherapy called tamoxifen or endocrine therapy as preventive treatments. With such options available, identifying women at high risk is important so they have access to specialists who can help guide them in making these important choices.

The developers are planning a clinical trial at Siteman Cancer Center that will apply the risk score from Prognosia Breast in combination with the standard mammography screening protocols. Standard screening protocols include the review of mammograms and measures of breast density already provided to all patients. Individuals found to be at elevated risk will be referred to Siteman’s breast health specialists, who focus on helping individuals navigate the options they have for managing high breast cancer risk.

“Despite the sophistication of today’s breast imaging and its broad use for identifying existing tumors, today’s risk prediction for breast cancer is still questionnaire-based and not very good at estimating future risk,” Jiang said. “Our work has focused on filling that need for better methods. Moving to image-based risk prediction — which our studies have shown is much more accurate — has the potential to be revolutionary for patient care.”

The current FDA designation applies to the software’s analysis of mammogram images taken at a single time point. In the future, the researchers plan to update Prognosia Breast to analyze several years of mammograms from the same individual, which may further improve the accuracy of the prediction.

For Your Health: Staying cool and sun-safe this summer

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Food sizzling on the grill is one of the classic sounds of summer — right up there with kids splashing in sprinklers and the crack of a bat at the ballpark.

That sizzling can also be a good stand-in for how we might feel outside on a sweltering day.

With a little planning, though, we can make our time in the sun feel cooler and more comfortable — and much better for our skin.

“Any amount of tan, and certainly sunburn, represents damage to the DNA of our skin cells,” said Dr. Aubriana McEvoy, a dermatologist at WashU Medicine in St. Louis. “And the more sun people get over their lives, the more of a chance there is for damaged cells to turn into skin cancer, which can affect our quality of life and, in some cases, the length of our lives.”

Too much sun can also lead to wrinkles, coarse skin and discoloration, making our skin look older than it is, she added.

Some simple steps can go a long way toward lowering the risk of skin cancer while keeping our skin looking healthier as well. And everyone can benefit, from those with fair skin to those with darker skin.

Sunscreen is a great place to start. Choose one with Sun Protection Factor (SPF) 30 or higher and be sure to use a generous amount, about an ounce for an adult at the pool — reapplying every couple hours. There are a lot of sunscreen options these days, so try out a number of them to find one you and your family like.

“My favorite sunscreen is the one you will wear,” McEvoy said.

Clothes are another way to stay sun-safe. Long-sleeved shirts, pants and wide-brimmed hats do a great job covering skin and don’t need to be reapplied like sunscreen. And there are many inexpensive, lightweight options that are specifically made to protect from the sun and that have their own rating, called Ultraviolet Protection Factor (UPF). As with sunscreens, the higher the UPF number, the greater the protection.

The combination of clothes and shade from trees or sun shelters can be particularly important for kids. Sunscreen is not recommended for children under 6 months old. And older kids can be so active that it can be hard to keep them well-covered in sunscreen, McEvoy added.

Shade and lightweight, loose-fitting clothes can also help with staying cool and feeling good on a hot day summer day. And it’s hard to overstate the importance of drinking enough water. It can be easy to get behind on our hydration, especially on a fun-filled outing with family and friends. Try to keep a bottle close by filled with plain water or low-sugar sports drink mix. Make it as easy as possible for you and your family to stay hydrated.

For many of us, summer is the best time of year, in no small part because we get to spend so much time enjoying long days and warm weather outside. And that’s an important part of life, McEvoy feels. Also important, of course, is doing so safely and healthfully.

When asked for one of her favorite tricks for staying cool and sun-safe in summer heat, she replied:

“If I’m at the playground or park with my kids, I’ll wear a sun-protective shirt and just wet it down. That keeps me way cooler and protects me from the sun.”