When youth is no longer protection: Gynecological cancers strike earlier

On June 9, 2025, an 18-year-old Chinese girl, fresh from her college entrance exams, rushed into the emergency room at Peking University Shenzhen Hospital in Shenzhen, Guangdong Province, clutching her abdomen. Dr Guang Xiaoyan, chief physician of the Department of Obstetrics and Gynecology, quickly admitted her and ordered a series of tests after hearing her symptoms. The girl had been suffering from intermittent abdominal pain and a visibly growing belly for over a month before the exams but delayed seeking treatment until after they were over.

Tests revealed a massive ovarian tumor, measuring up to 27 centimeters in diameter. During surgery, Dr Guang discovered the tumor was a malignant germ cell tumor, already ruptured and metastasized to the omentum, classified as stage IIIC (an advanced stage in which cancer has spread beyond the ovaries to the abdomen). Had she sought treatment earlier, the rupture and metastasis could have been avoided. Whether due to her youth or her desire not to disrupt her exams, she missed the best treatment window. She eventually underwent a fertility-sparing debulking surgery and received standard chemotherapy. Her condition has stabilized, and she has since successfully started her college life.

The alarming trend: Gynecological cancers are affecting younger women

Gynecological cancers – commonly referred to as the "silent threat" to women's health – include endometrial, ovarian and cervical cancers. These are not a single disease, but a group of malignancies originating in the female reproductive system. Early symptoms are often subtle or mistaken for common gynecological issues, leading to many cases being diagnosed at a later stage.

With society's rapid pace and evolving lifestyles, what were once considered diseases of older women are now increasingly affecting younger patients. According to the latest data from the WHO's International Agency for Research on Cancer (IARC), the incidence of cervical, endometrial and ovarian cancers among Chinese women aged 20-39 has risen by 2-3 percent per year over the past decade. In major hospitals across China, the proportion of young patients with gynecological cancers has increased from less than 10 percent to as high as 15-20 percent.

Dr Guang notes that the trend towards younger patients is particularly pronounced in cervical cancer. Once most common in women aged 50-55, about one-third of new cervical cancer cases in China are now in women under 35. The youngest cervical cancer patient reported in Shenzhen in 2024 was just 17. Endometrial cancer is increasing across all age groups, but cases among women under 40 have doubled, now accounting for 5-25 percent of patients – up from 5-10 percent previously. Ovarian cancer is following a similar concerning pattern.

Why are gynecological cancers targeting the young?

As with all cancers, the high-risk factors for gynecological cancers vary. For endometrial cancer, anything that disrupts the balance between estrogen and progesterone – such as prolonged estrogen exposure without sufficient progesterone – can significantly increase the risk. Other risk factors include obesity, diabetes, hypertension, polycystic ovary syndrome (PCOS), nulliparity, infertility, estrogen-secreting ovarian tumors, hereditary cancer syndromes like Lynch syndrome, and certain medications such as tamoxifen.

According to Dr Guang, several factors in modern young people's lifestyles contribute to the increasing risk. Western-style diets high in sugar and fat and low in fiber, combined with insufficient physical activity, are driving up obesity rates. Additionally, academic and work pressures, delayed marriage, and a trend towards having fewer or no children create a high-risk environment for gynecological cancers.

Dr Guang notes that many young women believe that if they are single, nulliparous and not sexually active, they are not at risk for gynecological diseases. As a result, they often skip checkups, leading to delayed detection. Irregular vaginal bleeding can be a symptom of endometrial cancer, but because it is so common in premenopausal women – and only 0.3 percent of such cases are actually due to cancer – it is often assumed to be harmless, resulting in missed diagnoses. Even when imaging reveals abnormalities such as atypical endometrial findings, ovarian masses, or abnormal cervical screening results, many patients decline further tests or surgery, believing their youth protects them from cancer. As a result, they miss the optimal window for early treatment.

Compared to endometrial cancer, Dr Guang emphasizes that ovarian cancer is even more challenging: about 70 percent of patients – including younger women – are already in advanced stages by the time they are diagnosed. Most early ovarian cancer cases Dr Guang has seen were discovered incidentally – either during unrelated surgeries or when what was presumed to be a benign ovarian mass was later found to be malignant. She stresses that all ovarian tumors should be taken seriously, and young women should seek prompt and appropriate treatment.