Nearly one in ten adolescents and young adults diagnosed with early-stage cancer later develop metastatic recurrence, according to a new UC Davis study. The condition, which occurs when cancer spreads to other parts of the body, is linked to significantly lower survival rates.
The research, led by scientists at the UC Davis Comprehensive Cancer Center, stresses the urgent need for more personalized survivorship care. “As treatments improve survival, young patients with cancer face unique challenges,” said Ann Brunson, UC Davis research analyst and lead author of the study. “Our findings deepen understanding of survivorship and the burden of metastatic recurrence using statewide data.”
Published in JAMA Oncology on November 26, the study is the first large-scale analysis of metastatic disease among adolescents and young adults (AYAs).
It examined more than 48,000 patients in California, ages 15 to 39, diagnosed with cancer between 2006 and 2018, with follow-up through 2020. Data were drawn from the California Cancer Registry and linked with health records from the California Department of Health Care Access and Information.
Among those studied, 9.2 percent had metastatic cancer at diagnosis, while another 9.5 percent developed metastasis later. Colorectal cancer (44.2 percent) and sarcoma (41.7 percent) showed the highest overall rates of metastasis, followed by breast, cervical, and testicular cancers.
For patients first treated for non-metastatic disease, the five-year chance of developing metastatic cancer was highest among those with sarcoma (24.5 percent), colorectal cancer (21.8 percent), and cervical cancer (16.3 percent). Stage 3 cervical cancer saw the highest risk overall, with recurrence in 41.7 percent of cases.
Cervical cancer recurrence rose sharply over time, increasing from 12.7 percent in 2006–2009 to 20.4 percent in 2015–2018. This trend was most pronounced in early-stage cases, even as recurrence rates for melanoma and colorectal cancer declined.
Survival outcomes were far worse for patients whose cancer returned and metastasized than for those whose disease was metastatic at first diagnosis. Breast, cervical, melanoma, sarcoma, and colorectal cancer patients faced the steepest declines in survival, with breast cancer patients nearly three times more likely to die after recurrence.
Researchers verified their methods by comparing findings with data from Kaiser Permanente Northern California, showing a 96.9 percent consistency rate when accounting for patients who were never fully disease-free.
“These findings underscore the heavy burden of metastatic recurrence among young cancer survivors,” said Theresa Keegan, the study’s senior author. “Recognizing these patterns helps target care, reduce disparities, and improve long-term outcomes for those facing cancer at a young age.”
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