Appendix Cancer Rates Quadruple Among Older Millennials, Signs Often Missed
Doctors often miss the signs, and most patients aren’t diagnosed until the cancer has spread. Now, rates are rising in younger adults.
When “X-Men” actor Adan Canto died at just 42 from a tumor in his appendix, it cast a spotlight on a cancer so rare that many physicians have never encountered it.
His death in January 2024 drew attention to a troubling trend that researchers are only beginning to understand: Rates of appendiceal cancer are rising sharply among Gen X and millennials.
A new study published in the Annals of Internal Medicine shows that the rate of appendiceal cancer has quadrupled among people born in the mid-1980s compared with those born in the 1940s.
While the absolute numbers remain small—affecting roughly 3,000 Americans annually—this steep increase has prompted epidemiologists to track an emerging pattern that oncologists say they’re increasingly seeing in younger patients.
“We’re seeing appendix cancer rising fastest in people under 50,” Andreana Holowatyj, a molecular biologist and clinical epidemiologist at Vanderbilt University Medical Center and coauthor of the study, told The Epoch Times. “It’s still rare—but it’s rising, and many doctors and patients don’t even know it exists.”
The Rising Risk
The appendix, a small, finger-like pouch attached to the large intestine, was once considered medically useless. However, some researchers believe it serves a role in gut health. On the flip side, it can also harbor several kinds of cancer.
Researchers analyzed national cancer registry data from 1975 to 2019 and identified 4,858 cases of appendix cancer in adults aged 20 and older. They found a clear generational picture: People born around 1980 were more than three times as likely to be diagnosed with appendix cancer as those born in 1945, while those born around 1985 faced more than four times the risk.
Although still rare—affecting one to two people per million—the incidence of appendix cancer has risen steadily. Case rates increased by an average of 3.7 percent per year, higher than the typical 1 percent to 2 percent annual increase seen in most cancers.
The pattern held across all age groups, but older millennials are seeing the fastest rise, suggesting a “birth cohort effect”—a phenomenon in which people born around the same time may share long-term environmental or behavioral exposures that shape disease risk decades later. Rates rose across all major types of appendix tumors, including mucinous, nonmucinous, and goblet cell adenocarcinomas. Goblet cell tumors, which occur almost exclusively in the appendix, were nearly five times more common in people born in 1980 than in those born in 1945.
Mucinous and nonmucinous tumors more than doubled in the same time frame.“It’s not just age, and it’s not just that we’re finding more because we’re looking harder,” Holowatyj said. “We don’t fully understand the causes yet—but that’s exactly why we need more research and awareness.”There are no established screening tools or prevention guidelines for appendix cancer. Nearly half of all patients are diagnosed only after the cancer has already spread to other organs.
Holowatyj and others say it’s unlikely the rising numbers are due to better detection. Colonoscopies rarely detect tumors in the appendix, and imaging may miss them altogether, especially if the appendix isn’t visible or the cancer presents in unusual ways.
Her lab is now working to uncover the reason behind the rise. In a separate study published in JAMA Oncology, her team found that more than one in 10 appendix cancer patients carries a cancer-linked genetic mutation, suggesting a potential hereditary component.
Hidden and Hard to Diagnose
Appendix cancer symptoms often mimic common digestive problems, leading to delayed diagnosis. Holowatyj’s team surveyed 352 patients and found that 77 percent had symptoms before diagnosis, with more than half suffering for three months or longer.
The most common warning signs include:
Persistent abdominal pain
Bloating
Pelvic pain
Abdominal masses.
Advanced cases may cause abdominal swelling, weight loss, and chronic pain.
“As a millennial myself, I say this to my peers: If something feels off, say something,” Holowatyj said. “It’s better to check and be wrong than to wait and be diagnosed late.”
With no clear diagnostic tools, most appendix tumors are discovered incidentally after an appendectomy—the surgical removal of the appendix, typically performed for appendicitis. Previously, appendix cancers were sometimes misclassified as colon cancers because of their close anatomical location. However, new research has shown these tumors are biologically distinct, the study noted.
Another complicating factor: Younger patients, who are now at the greatest risk, may also be less likely to have their appendix removed at all. A growing number of appendicitis cases are treated with antibiotics instead of surgery.
“Antibiotics won’t resolve tumor cells if they’re present,” Holowatyj said. “If a tumor is there, managing appendicitis nonsurgically may delay a diagnosis that’s already difficult to make.”
Taken together, the findings point to a broader shift in cancer patterns—one that may not be limited to the appendix but could reflect emerging risks to gastrointestinal health overall.
The trend mirrors increases in other early-onset gastrointestinal cancers, including colorectal and stomach cancers, which have also risen among younger adults. These trends may be linked to changes in diet, the microbiome, inflammation, early-life exposures, or yet-unidentified environmental factors.
“We need to understand whether this is one story or several,” Holowatyj said. “Are there shared exposures that affect the GI [gastrointestinal] tract broadly? Or are some cancers rising for different reasons?”
What Comes Next
International collaborations, including the Appendiceal Cancer Consortium, are also underway to identify shared environmental and lifestyle risk factors—from early-life exposures to diet and inflammation—that might eventually help guide prevention.
“This is still a rare disease,” Holowatyj said. “But the numbers are going up, and we need both providers and the public to have it on their radar, especially when symptoms persist.”
BUT….your appendix is so much more, and the majority of people do not know how important the appendix is!
Is Your Appendix a Gut-Health Hero?
Appendectomies are linked to Crohn’s Disease and a shorter lifespan, while research shows alternative approaches can alleviate pain better than surgery.
The case for keeping your appendix—when possible—continues to grow, with new evidence emerging that removing it could cause an inflamed bowel down the road.
A systematic review and meta-analysis showed that those who’ve undergone surgery to remove their appendix may have 53 percent elevated odds of developing Crohn’s disease, an inflammatory bowel disease (IBD). This finding, presented in December 2023 at the Advances in Inflammatory Bowel Diseases annual meeting, substantiates accumulating evidence that the appendix plays an important immunomodulating role.
Made up of lymphatic tissues, the appendix is now believed to help maintain balance in the gut microbiota, which consists of the bacteria, viruses, fungi, and other microorganisms that live in the gastrointestinal (GI) tract. The gut microbiome helps coordinate digestive and other bodily functions while playing an immunoprotective role by fighting off pathogenic microbes.
Should It Stay or Should It Go?
It’s been widely accepted that it won’t hurt you to have your appendix removed, but there can be great harm if you leave it in when it needs to go. A ruptured appendix allows infection-causing bacteria to spill out into the abdomen and potentially cause a deadly sepsis infection.
Because appendicitis—inflammation of the appendix—can sometimes lead to rupture, removal is often a rubber-stamped decision. Appendectomy can be performed laparoscopically, making it a low-risk and quick procedure.
While there are several different methods of removing the appendix, appendectomy remains one of the most commonly performed surgeries. About 8 percent of the population can expect to face acute appendicitis requiring emergency surgery.
William Parker, a retired Duke University professor who holds a doctorate in chemistry from the University of Nebraska, and other immune function researchers believe it’s time to re-examine the long-held belief that the human appendix is a vestige of evolutionary development—an organ without use or purpose in a modern age.
But that doesn’t mean patients shouldn’t take appendicitis seriously.
“We never want to encourage anyone to not go to the hospital,” Mr. Parker told The Epoch Times. “If your appendix gets inflamed and starts leaking bacteria, it can kill you. It’s tough to treat death.”
A Bacterial Safehouse
Mr. Parker led a group of researchers who first proposed in 2007 that the finger-shaped organ attached to the large intestine helps modulate immunity by serving as a protective shelter for good bacteria. They suggested the organ provides commensal microbes [bacteria that live in harmony with their host] a place to hide during an attack—such as an infection or food-borne illness—so they can repopulate and rebalance the gut microbiota once the threat clears.
The physical location of the appendix in the lower right quadrant of the large intestine makes it a logical place for such a storehouse, tucked out of reach from the stream of fecal bacteria.
Additional evidence, such as a better understanding of commensal microbes and their relationship with the immune system, makes the theory plausible, according to the article published in the Journal of Theoretical Biology.
The concern is whether appendectomy is throwing off the balance of microbes—a condition referred to as dysbiosis—in a way that would make the immune system overreact. That could potentially lead to tissue damage, including a breakdown of the thin layer of mucus that protects the rest of the body from assaults in the GI tract.
“What you have to keep in mind is [the appendix contains a lot of immune tissue. So when you take out the appendix, you can immunosuppress the patient. You can get increases in certain infections and cancer,” Mr. Parker said.
It’s plausible that the lack of an appendix could be associated with Crohn’s disease—among other health problems—based on his previous research and understanding of the appendix, he added. Effects likely hinge on the microbiome being destabilized.
Could Appendectomies Also Be Protective?
However, the same study also found that having one’s appendix removed reduces—by 40 percent—the likelihood of someone developing ulcerative colitis, the other form of IBD. Similar findings have been previously reported, Mr. Parker said.
IBD—believed to be a chronic condition of the gastrointestinal system—continues to grow in tandem with industrialization. Crohn’s can affect any part of the GI tract, whereas ulcerative colitis affects the large intestine. Nearly 1 in 100 Americans has IBD, according to the Crohn’s & Colitis Foundation.
The new study, led by Dr. Suprada Vinyak of Ballad Health, examined trends in 23 studies from a pool of more than 100,000.
“Subsequently, our quantitative analysis included six studies that conformed to the highest standards,” Dr. Vinyak said in a news release.
Researchers expected both forms of IBD to be associated with having had an appendectomy, which made the results a bit surprising, she said in a MedPage Today article.
According to Dr. Vinyak, more research is needed to validate how appendectomies offer protection from ulcerative colitis, tease out any biases in data, and determine the underlying mechanisms.
Evolutionary Favor
The new finding isn’t the only interesting one about the value of the appendix that has recently surfaced in research.
An animal study published in September 2023 in Scientific Reports examined the veterinary records of 1,251 primates belonging to 45 species. Of those, 13 species had an appendix. A lower risk of severe diarrhea (by about 85 percent) was discovered among those species with an appendix, including a delayed onset of diarrhea. There were also no cases of acute appendicitis for 20 years among those primates with an appendix.
“The observation of a particularly high protective effect in the first part of life, the period most vulnerable to severe diarrhea, but also the most optimal in terms of reproductive capacity, argues in favor of a selective advantage role in evolution,” said Éric Ogier-Denis, Inserm research director at the Oncogenesis Stress Signaling unit at France’s University of Rennes, in a news release.
Another study by Inserm in 2021 documented that the appendix has developed at least 16 times during the evolutionary history of mammals, illustrating its positive selection advantage. Examining data on 258 mammals, the researchers concluded the appendix was also associated with longevity.
The researchers stopped short of saying that people should try to keep their appendix. Rather, Mr. Ogier-Denis reported in the news release that “the treatment for appendicitis remains appendectomy, and this work does not provide any evidence to suggest this treatment approach should be changed. Only an appendectomy performed in a patient without appendicitis might have harmful consequences in the context of inflammatory and infectious bowel disease.”
Honoring the Necessity of Every Organ
Kat Owens, certified functional nutritional therapy practitioner, said it never made sense to her that any organ in the human body would be completely unnecessary.
“It’s not like we are just fundamentally broken machines. Our body can heal, and they were made that way for a reason,” she told The Epoch Times. “I think people can come to that conclusion, whether their perspective is that God created you and he didn’t make a mistake when he made us, or whether your perspective is that your body developed this way, and why would we have something completely unnecessary.”
Ms. Owens said a humanist perspective has brought society to a place where we no longer question efforts to alter the body. New research on the appendix, she said, illustrates that we can learn more about what the organ does so that we might value preserving it.
Has Sanitation Hijacked the Role of the Appendix?
Mr. Parker’s 2007 paper refers to research from the 1980s, which suggests that industrialization is behind the rise in appendicitis, potentially because we have severely eliminated a lot of the threats that would allow our appendix to spring into action.
That research from the 1980s, now widely accepted, indicates that our overly sanitized lifestyles don’t put us in a position where we need to tap into the appendix’s microbial reserve. In addition, that sanitation leads to an overactive immune system that can, in turn, lead to appendicitis, as well as high incidences of immune-related ailments such as allergy and autoimmune disease.”
This kind of use-it-or-lose-it argument makes sense to Ms. Owens.
“We live in these overly sanitized conditions, and that has probably kept us from experiencing the kind of things that would put our appendix to work,” she said. “It is so interesting to realize that not only does the appendix have an important job, but it needs to be used, and we create problems for ourselves when it doesn’t need to be used.”
Another Treatment Option
Newer research is pointing to an alternative to appendectomy—a minimally invasive procedure called endoscopic retrograde appendicitis therapy (ERAT). The procedure involves a flexible endoscope that irrigates and drains the infection in an inflamed appendix. It can be performed under conscious or local anesthesia.
ERAT offers the most immediate pain relief out of all treatment options for appendicitis, which includes surgery and antibiotic therapy. It also reduces immediate health care costs.
That’s according to a meta-analysis published in October 2023 in Surgery that looked at six studies comparing the treatment options. Appendectomies show superior outcomes for recurrence, but the study concluded that this should be balanced against the benefits of a gentler approach for patients.
Antibiotic treatment is the acceptable first-line therapy in uncomplicated cases of acute appendicitis. In complicated cases, antibiotics may kill the bacteria, but they won’t solve the problem of obstructions. Antibiotics alone fail in about 10 percent of cases, and more than 27 percent of those who take them experience a recurrence of infection within a year.
“Similarly, emerging evidence shows that an increasing number of parents prefer conservative management of uncomplicated appendicitis over surgical management for their children owing to fears of surgical risks and complications. Considering that the appendix plays an essential role in regulating immunity and the composition of the intestinal microbiome, all efforts should be made to preserve the organ in children during their period of development until solid evidence on the long-term consequences of appendectomy on the potentially increased risk of colorectal cancer and cardiovascular diseases has accumulated,” the study concluded.
Strategies for Life Without an Appendix
Furthermore, Mr. Parker said patients are often not told certain strategies can help their immune system function better if they have already had an appendectomy, which also needs to be part of the treatment conversation.
For anyone who’s had an appendectomy, he suggested supplementing with vitamin D, lowering stress levels, and taking a probiotic, especially when taking an antibiotic.
A Study Found an Increased Risk of Epilepsy and Appendicitis in Children After COVID-19 Vaccination.
Researchers analyzed records from more than 5 million children.
Children who received the AstraZeneca or Pfizer-BioNTech COVID-19 vaccines faced an elevated risk of epilepsy and appendicitis, according to a new study.
Pfizer recipients were also more likely to suffer from demyelinating disease or heart inflammation, researchers found.
Dr. Julia Hippisley-Cox, a professor of clinical epidemiology at the University of Oxford’s Nuffield Department of Primary Health Care Sciences, and colleagues obtained data from a national database on COVID-19 vaccination, mortality, hospital admissions, and COVID-19 infections. They wanted to look at the link between COVID-19 vaccines from AstraZeneca, Pfizer, and Moderna, with 12 outcomes, including the heart inflammation condition called myocarditis.
The population of nearly 5.2 million included 1.8 million children aged 5 to 11 and 3.3 million children aged 12 to 17. The data examined were through Aug. 7, 2022.
In the primary analysis, researchers found 12- to 17-year-olds who received Pfizer’s vaccine were at increased risk of myocarditis, with an additional three cases per million versus the expected rate after a first dose, and additional five cases per million after a second dose, and hospitalization with epilepsy, with 12 cases per million after a second dose. Females in the age group also faced an increased risk of demyelinating disease after receiving a second dose of the vaccine.
Researchers also identified a “substantially increased risk of hospitalization with epilepsy” among females after receipt of a first dose of AstraZeneca’s shot, with 813 more hospitalizations with epilepsy than expected per million doses, and an elevated risk of appendicitis after a second dose of the vaccine, with 512 excess events per million doses.
While no excess events were found among Moderna recipients, the study lacked the power to detect statistically significant issues, due to few children in the UK receiving Moderna’s vaccine. Further, no elevated risks of the 12 issues were found among 5- to 11-year-olds.
A secondary analysis, involving matching some of the vaccine recipients to unvaccinated children, confirmed an increased risk among 12- to 17-year-olds of hospitalization with epilepsy following Pfizer vaccination, and elevated risks of severe allergic shock and appendicitis in the age group following Pfizer vaccination. No increased risks of any outcome were identified among minor Moderna or AstraZeneca recipients. But among a group of 18- to 24-year-olds studied, elevated risks of several conditions were found, including myocarditis, immune or idiopathic thrombocytopenia, epilepsy, and acute pancreatitis.
The study was funded by the National Institute for Health and Care Research School for Primary Care Research. Multiple authors declared conflicts of interest, including funding from Moderna and AstraZeneca. Limitations included reliance on hospital admission codes and death certificates.
Pfizer, Moderna, and AstraZeneca did not respond to requests for comment.
The paper was published by Nature Communications.
The authors said that their findings “support a favorable safety profile of COVID-19 vaccination using mRNA vaccines in children and young people aged 5-17 years.” The Pfizer and Moderna shots utilize messenger ribonucleic acid (mRNA) technology.
Dr. Hippisley-Cox, the study’s corresponding author, did not return a request for comment seeking data on the position. The authors cited in part how they found unvaccinated children faced increased risks of some of the outcomes, including multisystem inflammatory syndrome in children.
Udi Qimron, a professor at Tel Aviv University’s Department of Clinical Microbiology and Immunology, said that the authors wrongly downplayed the risks associated with the vaccines.
“It’s not surprising to learn that some of the study’s authors have financial ties to Moderna and AstraZeneca and/or have served on various UK and Scottish Government COVID-19 advisory groups. One author was even a member of AstraZeneca’s Thrombotic Thrombocytopenic Taskforce and the Joint Committee on Vaccination and Immunisation. The conflict of interest in this case is significant,” Mr. Qimrom, who was not involved in the paper, told The Epoch Times via email.
“It is concerning that respected scientific platforms are being used to cover up mistakes and wrongdoing, particularly the coercion and immense societal pressure to vaccinate young children. This should never have been done,” he added. “It is disheartening to see scientific journals collaborating with such practices, which undermine public trust in scientific research, especially when it involves the health and safety of children.”