Can You Get Cancer In Your 20s? Yes, This Is What You Need To Know

While cancer is often diagnosed in older adults, it can also affect young people. Statistics from the latest Singapore Cancer Registry Annual Report 2023 show that between 2019 and 2023, there were 4,995 cancers diagnosed in individuals under the age of 40 – 34 per cent more than in 2003–2007. Even after accounting for population growth, the cancer rate among young people aged 15 to 39 has risen: an NCCS analysis of 50 years of Singapore Cancer Registry data found that it increased by about 42 per cent, from around 36 to 51 cases per 100,000 people between 1968 and 2017, with the rise speeding up from 2003 onwards. Today, about 550 young people aged 15 to 39 are diagnosed with cancer in Singapore every year. This highlights a need to improve awareness, treatment and support for young adults in Singapore being diagnosed with cancer.

At the National Cancer Centre Singapore (NCCS), we have observed that young adults diagnosed with cancer face unique challenges beyond medical treatment. These include decisions about fertility, disruptions to work or studies, and concerns about long-term survivorship.

Understanding these challenges helps healthcare providers to improve treatment and support to cater to their unique needs and improves awareness so that cancer in younger adults can be detected and treated early.

Key Takeaways

• Cancer can occur in people in their 20s, although it is less common than in people aged above 60 years of age.
• Certain cancers, such as breast, thyroid, nasopharyngeal (nose) and colorectal cancers, as well as blood cancers such as lymphoma and leukaemia, are among the more common cancers diagnosed in young adults in Singapore.
• Symptoms may be overlooked or ignored in younger individuals because cancer is not usually expected at a young age.
• Early awareness and medical consultation improve the chance of timely diagnosis and effective treatment.
• Support including specialised cancer care and survivorship programmes, are important to help young people cope with a cancer diagnosis.

Understanding Cancer In Young People In Singapore

Cancer in young adults refers to people diagnosed with cancer during adolescence and young adulthood, a group described in the oncology field as adolescents and young adults (AYA). The age range used to define AYAs varies between countries, and many international studies use 15 to 39 years. In Singapore, we have adopted an age range of 16 to 45 years, as this better reflects our local culture and the life stages of young people here, such as completing education, establishing a career and starting a family.

Although cancer risk generally increases with age, cancer remains a concern for young people in Singapore because certain cancers are more common within this younger demographic.

Young adults often face different concerns compared to older patients. These may include:

• Fertility preservation before cancer treatment
• Managing the challenges of study, career and family
• Emotional and psychological adjustment
• Financial and insurance considerations
• Long-term survivorship planning

The healthcare team at NCCS recognises these needs and integrates them into cancer care through EMPOWER (EMPowering Our young adults to live WEll through a cancER diagnosis), NCCS flagship Adolescent and Young Adult Oncology (AYAO) service. It is designed to provide holistic care for young adults with cancer and runs in parallel to the patient’s oncological treatment.

Why Cancer Can Occur In Your 20s

Many people assume cancer only develops after decades of exposure to environmental risks. However, several biological and genetic factors can lead to cancer earlier in life.

Genetic Predisposition

Some individuals inherit genetic mutations that increase their likelihood of developing certain cancers at a younger age.

Examples include:

• BRCA gene mutations associated with breast and ovarian cancer
• Lynch syndrome which is linked to colorectal and other cancers
• Familial adenomatous polyposis (FAP), which causes many polyps to grow in the bowel and a very high risk of colorectal cancer from a young age
• Li-Fraumeni syndrome, which is linked to several cancers, including sarcomas (cancers of the bone and soft tissue), breast cancer and brain tumours

At present, while the proportion of cancers in young adults caused by a genetic syndrome may not be big, genetic counselling may be recommended if the family history is suggestive.

Environmental And Lifestyle Factors

Although long-term exposure is usually required for cancer development, some environmental and lifestyle factors may contribute to the development of cancer. Examples include:

• Tobacco exposure
• Heavy consumption of alcohol
• Diets high in processed meat. Diets high in ultra-processed foods have also been associated with a higher cancer risk, although they have not been shown to directly cause cancer
• Excess body weight (a raised body mass index, or BMI) and physical inactivity, which are linked to certain cancers such as colorectal cancer

However, it is important to understand that many young adults diagnosed with cancer have no obvious risk factors.

Common Cancers Affecting Young Adults

Singapore Cancer Registry data show that the types of cancer seen in young people change with age. Blood cancers, bone and soft tissue sarcomas and brain tumours are more common in teenagers and people in their early 20s, while cancers such as breast, thyroid, ovarian and colorectal cancers become more common from the late 20s onwards. Over the past 50 years, the most common cancers among Singaporeans aged 15 to 39 were breast, thyroid, ovarian and cervical cancers and lymphoma in women, and nasopharyngeal cancer, lymphoma, colorectal cancer, leukaemia and testicular cancer in men.

• Thyroid cancer: Thyroid cancer is the second most common cancer in young women in Singapore, and is much more common in women than in men.
• Leukaemia and lymphoma: Blood cancers such as leukaemia and lymphoma are the most common cancers in both men and women under 30 in Singapore, and lymphoma rates in young adults have risen over time.
• Breast cancer (young-onset): Breast cancer is the most common cancer among women in Singapore. While most breast cancers are diagnosed in women over 50, breast cancer is also the most common cancer in young women, accounting for about one in four cancers in women aged 15 to 39. Rates are highest, and have risen most, among women in their 30s.
• Colorectal cancer: Colorectal cancer is the third most common cancer in young men in Singapore, and rates of colorectal cancer in adults under 50 have risen over the long term. Symptoms such as blood in the stool or a change in bowel habits are sometimes mistaken for haemorrhoids (piles) and should be checked by a doctor.
• Nasopharyngeal cancer: Cancer of the back of the nose was the most common cancer in young men in Singapore over the past 50 years, although rates have fallen steadily.

Below is a helpful overview.

Understanding these patterns helps healthcare professionals evaluate symptoms more effectively in younger patients.

Signs And Symptoms Young People Should Not Ignore

Cancer symptoms in younger adults can sometimes be dismissed as due to stress, an infection, or fatigue. However, persistent or unusual symptoms should not be ignored and should be promptly assessed by a medical professional.

• Persistent Unexplained Fatigue: Extreme tiredness that does not improve with rest may indicate underlying health issues.
• Unusual Lumps Or Swelling: Any persistent lump in the neck, breast, testicle, or other area should be medically examined.
• Unexplained Weight Loss: Sudden weight loss without lifestyle changes can sometimes signal medical conditions that require clinical investigation.
• Prolonged Fever Or Night Sweats: These symptoms may be linked to infections but can also appear in certain cancers such as lymphoma.
• Changes In Bowel Habits Or Blood In Stool: Persistent changes in bowel habits, or blood in the stool, should be checked by a doctor even in young people.
• Changes In Skin Or Moles: Unusual skin changes, new moles, or changes in existing moles should be examined.

While these symptoms do not necessarily mean cancer, consulting a medical professional early is always recommended if symptoms persist.

Challenges Faced By Young Adults With Cancer

Young people diagnosed with cancer often experience challenges that differ from those faced by older patients.

Fertility Considerations

Some cancer treatments, such as chemotherapy, radiation therapy, surgery and some hormone treatments, may affect fertility.

Patients may discuss the following options to preserve fertility with their treating doctor:

• Egg freezing (for women), or embryo freezing for married couples
• Ovarian tissue freezing (for women), which may be an option when cancer treatment needs to start urgently
• Medication given during chemotherapy that may help protect the ovaries (for women)
• Sperm banking (for men)

These options are ideally discussed before cancer treatment begins. In Singapore, fertility preservation services are available at public hospitals, including the Centre for Assisted Reproduction (CARE) at the Singapore General Hospital and OncoFertility Clinic (OFC) at the KK Women’s and Children’s Hospital. At NCCS, the EMPOWER team provides fertility preservation advice and can help to arrange referrals.

Financial support is also available. Since June 2025, eligible patients whose medical treatment may cause permanent infertility can receive means-tested subsidies of up to 80 per cent for egg, embryo and sperm freezing at public healthcare institutions, and from June 2026, MediSave and MediShield Life coverage has been extended to these procedures. Patients who need further help can speak to a medical social worker about financial assistance such as MediFund.

Emotional And Psychological Impact

Being diagnosed with cancer at a young age can affect mental wellbeing. Many young adults report feelings such as:

• Isolation from peers
• Anxiety about the future, dysthymia and depression
• Body dysmorphia
• Concerns about relationships and family planning

Psychological support is an important part of modern cancer care and is especially important for younger patients.

Career And Education Disruptions

Treatment schedules may require time away from:

• Studies
• Career development & professional training

Healthcare teams may work with patients to plan treatment while maintaining aspects of normal life where possible.

How Cancer Is Diagnosed In Young Adults

The diagnostic process for cancer is generally similar across age groups but may require careful planning in younger patients.

Medical History And Physical Examination

Doctors begin by assessing symptoms, the patient’s family history and overall health.

Imaging Tests

Imaging techniques help identify abnormal growths or changes within the body.

Common imaging tests include:

• X-Rays
• CT scans
• MRI scans
• Ultrasound

Laboratory Tests

Blood tests may help detect abnormal cell counts or tumour markers.

Biopsy

A biopsy involves collecting a small sample of tissue for examination under a microscope. This confirms whether cancer is present and allows healthcare teams to determine the most suitable treatment plan.

Treatment Options For Young Adults With Cancer

The type of cancer treatment recommended depends on the type, stage, and location of the cancer as well as the patient's overall health.

Common treatment approaches include:

• Chemotherapy, which uses drugs to destroy cancer cells
• Radiation therapy, which uses targeted radiation to eliminate tumours
• Surgery, which removes cancerous tissue
• Targeted therapy, which attacks specific cancer cell pathways
• Immunotherapy, in which the individual’s immune system is stimulated to recognise and destroy cancer cells
• Hormone therapy, which blocks or lowers the hormones that some cancers, such as certain breast cancers, need to grow
• Stem cell transplant, which replaces damaged blood-forming cells and may be used for some blood cancers such as leukaemia and lymphoma
• CAR-T therapy, where a patient’s own immune cells is modified to recognize and attack cancer cells

Many patients undergo a combination of the above treatments to effectively target cancer.

Advances in cancer research have significantly improved survival outcomes for many cancers affecting young adults.

Clinical trials test new treatments and can give patients access to promising therapies. However, young adults with cancer are under-represented in clinical trials worldwide. Patients can ask their doctor whether there is a suitable clinical trial for them.

Prevention And Early Awareness For Young People And Cancer in Singapore

While not all cancers can be prevented, awareness and health monitoring for early detection remain important.

Young adults can take proactive steps to protect their health by:

• Going for recommended cancer screening, such as cervical cancer screening for women aged 25 and above who have ever been sexually active (a Pap test every 3 years from age 25 to 29, and an HPV test every 5 years from age 30)
• Speaking to your family doctor about a personalised screening plan if you have a strong family history of cancer, as your screening needs may differ from those of the general population
• Seeking medical advice if symptoms persist or worsen
• Avoiding smoking and limiting alcohol consumption
• Maintaining a healthy weight, a balanced diet and regular physical activity
• Protecting your skin from the sun and checking for unusual changes in moles
• Keeping up with recommended vaccinations, such as the HPV vaccine, which protects against cervical and some other cancers, and the hepatitis B vaccine, which protects against liver cancer

In Singapore, HPV vaccination is recommended for females aged 9 to 26. It is offered free to female Secondary 1 students through the Health Promotion Board’s school-based programme, and is free for Singaporean females aged 17 and below at polyclinics and CHAS GP clinics. Singaporean women aged 18 to 26 who missed it can receive subsidised catch-up vaccination at polyclinics and CHAS GP clinics, and MediSave can be used. Hepatitis B vaccination is part of the national childhood immunisation schedule, and adults who have not been vaccinated or are not immune are recommended to receive three doses.

Awareness campaigns in Singapore continue to highlight the importance of recognising cancer symptoms early, even among younger populations.

Supporting Young People And Cancer in Singapore Through Comprehensive Care

Caring for young people diagnosed with cancer requires a holistic approach that goes beyond treatment alone. Young patients often benefit from specialised care that supports both the medical and psychosocial aspects of their journey.

At NCCS, EMPOWER, our dedicated AYAO service, focuses on multidisciplinary care that brings together oncologists, nurses, counsellors, and supportive care teams that help to guide young adults through cancer diagnosis, treatment, and survivorship.

Our team works closely with patients to address issues such as treatment planning, emotional wellbeing, and long-term health considerations. By combining medical expertise with personalised support, we aim to help young patients manage cancer while maintaining their quality of life.

If you or someone you care about has concerns about cancer symptoms or risk, seeking professional medical advice is an important step towards managing your health.

Frequently Asked Questions

1. Is cancer in young adults becoming more common in Singapore?
   Yes. The number of cancers diagnosed in people under 40 in Singapore rose by 34 per cent between 2003–2007 and 2019–2023. NCCS’s analysis of 50 years of registry data also shows that the cancer rate among people aged 15 to 39 rose by about 42 per cent between 1968 and 2017, with a faster rise from 2003 onwards. Even so, cancer remains far more common in older adults.
   
   Better screening and diagnostic tools may pick up some cancers earlier, but this accounts for only a small part of the increase and is unlikely to be the main driver. Researchers have also found a “birth cohort” effect: people born from the 1970s onwards have a higher risk of cancer at the same age than earlier generations, with those born in the 1990s having close to twice the risk of those born in the early 1960s. This suggests that changes in lifestyle and environment across generations play a role.
   
   Possible contributors include exposure to cancer-causing substances such as tobacco, alcohol and processed meat, as well as excess body weight, as a raised body mass index (BMI) is linked to a higher risk of certain cancers, including colorectal cancer. Diets high in ultra-processed foods have also been associated with a higher cancer risk, although there is currently no evidence that they directly cause cancer.
   
   
2. Do lifestyle choices in your teens affect cancer risk in your 20s?
   Some lifestyle habits, such as smoking, excessive alcohol consumption, and poor diet may contribute to long-term cancer risk. However, most cancers in young adults are not directly linked to lifestyle choices.
   
   
3. Should young adults undergo routine cancer screening?
   Routine screening is recommended only for specific cancers and age groups. For young adults, the main one is cervical cancer screening for women aged 25 and above who have ever been sexually active. Most young adults do not need other routine cancer screening. However, if you have a strong family history of cancer or a known inherited gene change, speak to your family doctor about a personalised screening plan, as you may need to start screening earlier or more often. Anyone with persistent or unusual symptoms should see a doctor rather than wait for screening.
   
   
4. Can cancer treatment affect future family planning?
   Certain treatments may affect fertility, which is why discussions about fertility preservation with the treating doctor often occur before treatment begins. Options such as egg or sperm preservation may be possible before starting cancer treatment.
   
   
5. Are survivorship programmes available for young cancer patients?
   Cancer centres such as NCCS offer survivorship support. At NCCS, EMPOWER, our dedicated AYA oncology service, offers programmes that cater to the unique needs of younger cancer patients. Support may include follow-up care, mental health support, and lifestyle guidance to help patients maintain long-term health.