It’s a medical paradox that’s quietly unfolding in hospitals and clinics worldwide: diseases long thought to be the domain of older adults are now cropping up with alarming frequency among younger generations. Two such conditions—chronic obstructive pulmonary disease (COPD) and cancer of the appendix—are showing unexpected and unsettling trends, particularly among people under 50. While the reasons are complex and still under investigation, the numbers are clear, and the implications for public health are profound.
According to a recent study published in NEJM Evidence and reported by The Economic Times, approximately one in 22 adults aged 18 to 49 now exhibit signs of COPD. These signs aren’t subtle: lung function issues, persistent cough, excess mucus, and shortness of breath are increasingly common complaints among this age group. Even more concerning, younger patients with COPD are more likely to be hospitalized or die from respiratory illnesses, face higher risks of heart failure, and are at greater risk of premature death before age 75.
Dr. Randeep Guleria, chairman of internal medicine, respiratory and sleep medicine at Medanta hospital in Delhi, has seen the shift firsthand. “At Medanta, we are now seeing 30–40 new cases of COPD every month among patients under 50,” he told The Economic Times. “While the majority of cases are still among older adults, we are seeing younger patients more frequently — and if diagnosis and treatment are delayed, outcomes can be worse.”
What’s fueling this surge? The culprits are both familiar and evolving. Tobacco, in all its forms, remains the leading cause. “Cigarettes, bidis, hookah or chillum — they all cause harm,” emphasized Dr. G.C. Khilnani, chairman of PSRI Institute of Pulmonary, Critical and Sleep Medicine. He warned, “Just one hookah session can equal several cigarettes, and second-hand smoke is also dangerous. Even non-smokers regularly exposed to smokers at home are at risk.”
But tobacco isn’t acting alone. Air pollution, both indoors and out, now accounts for nearly half of COPD cases in India—a stark increase from the roughly 10% attributed to pollution in past decades. Exposure to biomass fuels, vehicle emissions, industrial pollutants, and lingering effects from past lung infections are all contributing to the rising tide of respiratory disease. Workers in coal mining, steel plants, and asbestos processing face especially high risks due to their occupational exposures.
The message from experts is clear: prevention is paramount. Quitting smoking, avoiding polluted environments, using protective masks in hazardous workplaces, and keeping indoor air clean are all vital steps. Early detection is also critical. “Even a simple spirometry test can detect COPD in its early stages. Taking action early can save years of breathing trouble later,” advised Dr. Bobby Bhalotra, vice-chairperson of chest medicine at Sir Ganga Ram Hospital.
While COPD’s rise among the young is deeply concerning, it’s not the only disease rewriting the medical textbooks. Cancer of the appendix, once considered a medical oddity, is also on the upswing among younger adults. Historically rare and often discovered only by accident, appendiceal cancer is now being diagnosed with increasing frequency in people under 50, especially those born since the 1970s.
As reported in a new study published in Annals of Internal Medicine, researchers analyzed data from the US National Cancer Institute’s SEER registry spanning 1975 to 2019. They found that people born in the 1970s and 1980s had three to four times the risk of being diagnosed with appendix cancer compared to those born in the 1940s. Americans born between 1976 and 1984 had triple the incidence, while those born between 1981 and 1989 saw a quadrupling relative to earlier cohorts.
“Nearly one in three appendix cancer cases are now diagnosed in adults younger than 50,” the study noted. Although the disease remains rare—about 3,000 new cases are diagnosed annually in the US—the trend is raising red flags among oncologists and researchers. The reasons behind the increase are not fully understood, but several factors are under scrutiny.
Lifestyle changes are high on the list. Increases in obesity, diets high in processed foods, and more sedentary living are all known risk factors for various cancers and may play a role here. Environmental exposures—such as food additives, chemicals, changes in the gut microbiome, and antibiotic overuse—are also being investigated. Some experts suggest that improved detection and heightened clinical awareness may account for part of the rise, but most agree this does not explain the full picture.
The concept of “birth-cohort effects” is gaining traction. This idea suggests that people born in more recent decades—especially after 1945—are exposed to unique combinations of environmental, dietary, and lifestyle factors that may increase their cancer risk. It’s a hypothesis that demands further research, but the numbers are compelling.
Diagnosing appendix cancer is notoriously tricky. Symptoms—such as abdominal pain (often on the lower right side), bloating, swelling, changes in bowel habits, nausea, loss of appetite, and unexplained weight loss—are vague and easily mistaken for more benign conditions like appendicitis or irritable bowel syndrome. As a result, many cases are discovered only after surgery for presumed appendicitis, when the removed tissue is examined under a microscope.
There are currently no standard screening guidelines for appendix cancer. Colonoscopies, the mainstay of colorectal cancer screening, often cannot visualize the appendix. This diagnostic blind spot means that many tumors are found late, when treatment options may be more limited and outcomes poorer. Treatment depends on the type and stage of the cancer, ranging from simple appendectomy for small, localized tumors to complex procedures like cytoreductive surgery combined with heated intraperitoneal chemotherapy (HIPEC) for more advanced disease. Prognosis varies widely, with five-year survival rates depending heavily on early detection and whether the cancer has spread.
What can be done? Increased awareness among both clinicians and the public is crucial. Doctors, especially in primary care and emergency settings, are urged to consider appendix cancer when young patients present with persistent or unexplained abdominal symptoms. For the public, it’s a sobering reminder that rare cancers can strike at any age—so persistent symptoms should never be ignored.
Experts call for more research to uncover the root causes of these trends. Studies are needed to explore the interplay between environmental exposures, diet, the gut microbiome, genetic risk, and the unique influences of growing up in different eras. Better diagnostic tools and biomarkers could help catch these diseases earlier, improving outcomes. And for those diagnosed, referral to specialized centers with experience in rare cancers is vital for ensuring access to the latest treatments and collaborative care.
As the medical community grapples with these shifting patterns, one thing is clear: the boundaries of age-related disease are changing, and vigilance—on the part of both doctors and patients—has never been more important.
