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FE ATURES PENN STATE CHILDREN'S HOSPITAL: COORDINATED CARE FOR MEDICALLY COMPLEX PATIENTS 05 Patients with multiple chronic conditions benefit from the advanced, collaborative care provided by experienced pediatricians and support staff in Penn State Children's Hospita l's Pediatric Complex Care program. LEVERAGING MULTIDISCIPLINARY PERINATAL EXPERTISE TO DELIVER HEALTHIER BABIES 12 The Perinata l Program at Penn State Hea lth Milton S. Hershey Medica l Center and Penn State Children's Hospita l has become the regiona l referra l center for comprehensive diagnosis and treatment of suspected feta l anoma lies. SPECIAL CLINICAL SECTION: PEDIATRICS THE BURDEN OF YOUTH: OBESITY-RELATED CANCERS ON THE RISE IN YOUNG PEOPLE 09 The obesity epidemic may threaten progress in the battle against cancer, scientists say. A S THE OBESIT Y CRISIS CONTINUES, MORE YOUNG PEOPLE FACE THE SPECTER OF OBESIT Y-REL ATED CANCERS. INCIDENCE R ATES FOR SIX MALIGNANCIES LINKED TO OBESIT Y ARE RISING MORE SHARPLY IN SUCCESSIVELY YOUNGER AGE GROUPS, ACCORDING TO A RECENT STUDY, AND E XPERTS SAY THAT COULD THRE ATEN THE PROGRESS MADE IN THE FIGHT AGAINST CANCER. BY THOMAS CROCKER MULTIPLE CANCERS ARE associated with excess weight, the National Cancer Institute reports. These include cancers of thyroid, breast (in postmenopausal women), kidney, liver, gallbladder, endometrium, ovary, and colon and rectum. Now evidence is building that obesity-related cancers are increasingly affecting people at younger ages. In a study published JNCI: Journal of the National Cancer Institute last year, Ahmedin Jemal, DVM, PhD, Vice President of the Surveillance Health Services Research Program at the American Cancer Society (ACS), and other researchers reported an increase in colorectal cancer incidence rates among young adults in the United States, despite a decline in overall incidence rates for colorectal cancer. The group found a decrease in incidence rates older adults due to colonoscopy, according to Jemal. "Our study showed rates increasing in younger adults until 55," he says. "We thought it may be related to obesity because obesity is one risk factor among many for colorectal cancer." That suspicion prompted Jemal and a separate group of ACS researchers to investigate whether early-onset disease was on the rise in other obesity-related cancers. A STEPWISE INCREASE Jemal and his team gathered data on more than 14 million cases involving 30 cancer types — 18 of the 20 most common cancers and 12 obesity-associated cancers — from a database of the North American Association of Central Cancer Registries. The cancers were diagnosed in patients 25–84 years of age from 1995 to 2014. The researchers categorized patients into 15 partly overlap- ping 10-year birth cohorts from 1915 to 1985. They found that for six obesity-related cancers — multiple myeloma and cancers of the endometrium, gallbladder, kidney, pancreas, and colon and rectum — incidences in younger adults increased, and the incidence rate increases were steeper in successively younger five-year age groups. Cancers on the Rise in Young People 059990055_0819_CF_Pediatrics_SinglePages.indd 2 6/28/19 11:12 AM 05 contents /////// PEDIATRICS 2019 RE-EVALUATING YOUNG ADULT CANCER SURVIVAL IN LIGHT OF THE AIDS EPIDEMIC 11 AIDS-related cancers were a significant factor in young adults' cancer morta lity rates from 1975 to 1997, a study finds. DEPARTMENTS DATA VAULT 02 BUSINESS OF MEDICINE 15 09 12