{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:55:31Z","timestamp":1790816131182,"version":"4.1.0"},"reference-count":43,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T00:00:00Z","timestamp":1767398400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Objective: To evaluate population-level temporal relationships between modifiable lifestyle factors and rising breast, colorectal and uterine cancer incidence rates among females under 50 years old. Methods: This retrospective ecological study utilized data from the United States Cancer Statistics (USCS) for cancer incidence, the National Health and Nutrition Examination Survey (NHANES) for health-related behaviors, and the Behavioral Risk Factor Surveillance System (BRFSS) for physical activity. Modifiable lifestyle factors analyzed included obesity (BMI \u2265 30 kg\/m2), smoking, alcohol use, fiber and saturated fat intake, caloric intake, and physical activity. Trends were assessed using average annual percent change (AAPC), and population-level correlations between cancer incidence and lifestyle factors were evaluated using Pearson correlation coefficients. Results: Between 2001 and 2018, 914,659 breast, 144,130 colorectal, and 124,399 uterine cancer cases were identified. The largest increases in cancer incidence occurred in age groups under 30 years old. Colorectal cancer increased by 6.9%, followed by uterine cancer at 4.8% and breast cancer at 1.7%, all p &lt; 0.001. When examining this age group by race, colorectal cancer increased by 8.0% (p &lt; 0.001) annually in White women aged 20\u201324 years, while uterine cancer rose 4.8% (p &lt; 0.001) in Hispanic women in the 20\u201324 and 25\u201329 year age groups. Breast cancer also increased by 2.0% (p &lt; 0.001) per year in White women 25\u201329 years old. Smoking rates decreased, and alcohol consumption and obesity rates increased. No significant correlation was found between cancer incidence and smoking, caloric intake, saturated fat, or physical activity. A moderate positive correlation was identified between alcohol use and cancer risk (r = 0.55\u20130.67, p &lt; 0.05). Obesity prevalence showed strong population-level temporal correlation with cancer incidence for all three cancers with stratified analysis demonstrating the strongest correlations in patients with class III obesity. Conclusions: From 2001 to 2018, the incidence of breast, colorectal, and uterine cancers increased most sharply among women under 30 years of age. Over the same period, obesity prevalence in this population also increased. These population-level observations are hypothesis-generating and require confirmation in individual-level, prospective studies to determine whether and how obesity and other lifestyle factors influence early-onset cancer risk.<\/jats:p>","DOI":"10.3390\/cancers18010167","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T08:40:53Z","timestamp":1767602453000},"page":"167","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Population-Level Trends in Lifestyle Factors and Early-Onset Breast, Colorectal, and Uterine Cancers"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2931-5834","authenticated-orcid":false,"given":"Natalie L.","family":"Ayoub","sequence":"first","affiliation":[{"name":"Department of Gynecologic Oncology, University of California Irvine, Orange, CA 92868, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8606-6817","authenticated-orcid":false,"given":"Alex A.","family":"Francoeur","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, University of California Irvine, Orange, CA 92868, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, University of California Irvine, Orange, CA 92868, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9847-4010","authenticated-orcid":false,"given":"Nathan","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Sutter Health, Walnut Creek, CA 94598, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishnansu S.","family":"Tewari","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, University of California Irvine, Orange, CA 92868, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3659-3253","authenticated-orcid":false,"given":"Daniel S.","family":"Kapp","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Stanford University, Stanford, CA 94304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert E.","family":"Bristow","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, University of California Irvine, Orange, CA 92868, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Gynecologic Oncology, Sutter Health, Walnut Creek, CA 94598, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,3]]},"reference":[{"key":"ref_1","first-page":"12","article-title":"Cancer statistics, 2024","volume":"74","author":"Siegel","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","first-page":"477","article-title":"Breast cancer statistics 2024","volume":"74","author":"Giaquinto","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","first-page":"152","article-title":"Increasing Rates of Colorectal Cancer Among Young People in California, 1988\u20132017","volume":"48","author":"Movsisyan","year":"2021","journal-title":"J. Regist. Manag."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Guo, F., Levine, L., and Berenson, A. (2021). Trends in the Incidence of Endometrial Cancer Among Young Women in the United States, 2001 to 2017, Wolters Kluwer Health.","DOI":"10.1200\/JCO.2021.39.15_suppl.5578"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e107","DOI":"10.1097\/AOG.0000000000005814","article-title":"Associated Trends in Obesity and Endometrioid Endometrial Cancer in the United States","volume":"145","author":"Francoeur","year":"2025","journal-title":"Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1038\/bjc.1983.127","article-title":"The epidemiology of endometrial cancer in young women","volume":"47","author":"Henderson","year":"1983","journal-title":"Br. J. Cancer"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1053\/j.gastro.2017.05.013","article-title":"Colorectal cancer screening: Recommendations for physicians and patients from the US Multi-Society Task Force on Colorectal Cancer","volume":"153","author":"Rex","year":"2017","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e2353331","DOI":"10.1001\/jamanetworkopen.2023.53331","article-title":"Breast cancer incidence among US women aged 20 to 49 years by race, stage, and hormone receptor status","volume":"7","author":"Xu","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1056\/NEJMsr1606602","article-title":"Body fatness and cancer\u2014Viewpoint of the IARC Working Group","volume":"375","author":"Scoccianti","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S0140-6736(08)60269-X","article-title":"Body-mass index and incidence of cancer: A systematic review and meta-analysis of prospective observational studies","volume":"371","author":"Renehan","year":"2008","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.metabol.2018.11.001","article-title":"Obesity and cancer risk: Emerging biological mechanisms and perspectives","volume":"92","author":"Avgerinos","year":"2019","journal-title":"Metabolism"},{"key":"ref_12","first-page":"209","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Arnold, M., Jiang, L., Stefanick, M.L., Johnson, K.C., Lane, D.S., LeBlanc, E.S., Prentice, R., Rohan, T.E., Snively, B.M., and Vitolins, M. (2016). Duration of Adulthood Overweight, Obesity, and Cancer Risk in the Women\u2019s Health Initiative: A Longitudinal Study from the United States. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1002081"},{"key":"ref_14","unstructured":"Centers for Disease Control and Prevention (2024, December 01). US Cancer Statistics Public Use Database, Available online: https:\/\/www.cdc.gov\/united-states-cancer-statistics\/public-use\/?CDC_AAref_Val5https:\/\/www.cdc.gov\/cancer\/uscs\/public-use\/index.htm."},{"key":"ref_15","unstructured":"Centers for Disease Control and Prevention (2024, December 01). NHANES Questionnaires, Datasets, and Related Documentation, Available online: https:\/\/cdc.gov\/nchs\/nhanes\/."},{"key":"ref_16","unstructured":"Centers for Disease Control and Prevention (2024, December 01). 2021 BRFSS Survey Data and Documentation, Available online: https:\/\/cdc.gov\/brfss\/annual_data\/annual_2021.html."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"370","author":"Altman","year":"2007","journal-title":"Lancet"},{"key":"ref_18","first-page":"177","article-title":"Colorectal cancer statistics, 2017","volume":"67","author":"Siegel","year":"2017","journal-title":"CA Cancer J. Clin."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.bpobgyn.2011.12.007","article-title":"Endometrial cancer","volume":"26","author":"Arora","year":"2012","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1038\/s41571-022-00672-8","article-title":"Is early-onset cancer an emerging global epidemic? Current evidence and future implications","volume":"19","author":"Ugai","year":"2022","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1158\/2159-8290.CD-24-1678","article-title":"Trends in Cancer Incidence and Mortality Rates in Early-Onset and Older-Onset Age Groups in the United States, 2010\u20132019","volume":"15","author":"Shiels","year":"2025","journal-title":"Cancer Discov."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1056\/NEJMoa021423","article-title":"Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults","volume":"348","author":"Calle","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1093\/annonc\/mdu509","article-title":"Obesity and the outcome of young breast cancer patients in the UK: The POSH study","volume":"26","author":"Copson","year":"2015","journal-title":"Ann. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1001\/jamaoncol.2018.4280","article-title":"Association of obesity with risk of early-onset colorectal cancer among women","volume":"5","author":"Liu","year":"2019","journal-title":"JAMA Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"4225","DOI":"10.1200\/JCO.2016.69.4638","article-title":"Addressing the role of obesity in endometrial cancer risk, prevention, and treatment","volume":"34","author":"Onstad","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1089\/jwh.2010.2529","article-title":"Trends in endometrial cancer incidence rates in the United States, 1999\u20132006","volume":"20","author":"Duong","year":"2011","journal-title":"J. Women\u2019s Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1158\/1055-9965.EPI-07-2567","article-title":"Body mass and endometrial cancer risk by hormone replacement therapy and cancer subtype","volume":"17","author":"McCullough","year":"2008","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"506.e1","DOI":"10.1016\/j.ajog.2020.10.042","article-title":"An ecological evaluation of the increasing incidence of endometrial cancer and the obesity epidemic","volume":"224","author":"Smrz","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/j.1749-6632.2012.06750.x","article-title":"Obesity and cancer risk: Evidence, mechanisms, and recommendations","volume":"1271","author":"Vucenik","year":"2012","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1152\/physrev.00030.2014","article-title":"Obesity and diabetes: The increased risk of cancer and cancer-related mortality","volume":"95","author":"Gallagher","year":"2015","journal-title":"Physiol. Rev."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"And\u00f2, S., Gelsomino, L., Panza, S., Giordano, C., Bonofiglio, D., Barone, I., and Catalano, S. (2019). Obesity, Leptin and Breast Cancer: Epidemiological Evidence and Proposed Mechanisms. Cancers, 11.","DOI":"10.3390\/cancers11010062"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1111\/nyas.14916","article-title":"The impact of obesity and adipokines on breast and gynecologic malignancies","volume":"1518","author":"Tewari","year":"2022","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1038\/s41416-021-01393-y","article-title":"Targeting obesity-related dysfunction in hormonally driven cancers","volume":"125","author":"Rubinstein","year":"2021","journal-title":"Br. J. Cancer"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"70","DOI":"10.21037\/cco-20-40","article-title":"How far should we go in optimal cytoreductive surgery for ovarian cancer?","volume":"9","year":"2020","journal-title":"Chin. Clin. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3582","DOI":"10.1002\/cncr.34951","article-title":"Association of habitual sleep duration and its trajectory with the risk of cancer according to sex and body mass index in a population-based cohort","volume":"129","author":"Ning","year":"2023","journal-title":"Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3892\/ijo.2023.5572","article-title":"Role of stress in the pathogenesis of cancer (Review)","volume":"63","author":"Lempesis","year":"2023","journal-title":"Int. J. Oncol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/S0140-6736(11)60813-1","article-title":"The global obesity pandemic: Shaped by global drivers and local environments","volume":"378","author":"Swinburn","year":"2011","journal-title":"Lancet"},{"key":"ref_38","first-page":"1","article-title":"Recommended community strategies and measurements to prevent obesity in the United States","volume":"58","author":"Khan","year":"2009","journal-title":"MMWR Recomm. Rep."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1038\/bjc.2014.579","article-title":"Alcohol consumption and site-specific cancer risk: A comprehensive dose-response meta-analysis","volume":"112","author":"Bagnardi","year":"2015","journal-title":"Br. J. Cancer"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.14309\/ajg.0000000000000803","article-title":"Smoking and Colorectal Cancer Risk, Overall and by Molecular Subtypes: A Meta-Analysis","volume":"115","author":"Botteri","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1038\/sj.bjc.6604917","article-title":"Physical activity and colon cancer prevention: A meta-analysis","volume":"100","author":"Wolin","year":"2009","journal-title":"Br. J. Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/S1470-2045(21)00279-5","article-title":"Global burden of cancer in 2020 attributable to alcohol consumption","volume":"22","author":"Rumgay","year":"2021","journal-title":"Lancet Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"20211033","DOI":"10.1259\/bjr.20211033","article-title":"Understanding breast cancer as a global health concern","volume":"95","author":"Wilkinson","year":"2022","journal-title":"Br. J. Radiol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/1\/167\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T08:45:12Z","timestamp":1767602712000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/1\/167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,3]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["cancers18010167"],"URL":"https:\/\/doi.org\/10.3390\/cancers18010167","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,3]]}}}