Jeffrey S. Barkin, MD, DLFAPA, is a practicing psychiatrist in Portland and the former president of Maine Medical Association. He co-hosts “A Healthy Conversation” on WGAN.

The first blow often lands in silence. A mother in Lewiston sits across from her doctor, hearing the word “cancer” spoken as if it were meant for someone else. At 39, she thought she had decades before such news could darken her door. She had built her life on the quiet promise that cancer was an illness for another time, another age. But that promise is breaking.

For much of modern medicine, cancer belonged to the later chapters of life. Doctors expected it in their patients in their 60s, 70s and 80s. Families whispered about it as one of life’s final tests. Society accepted it as the price of longevity. But today, the script is being rewritten. Cancer has begun appearing earlier, stealing pages from the beginning and middle of people’s stories.

The numbers are not whispers; they are alarms. Colorectal cancer in Americans under 50 has nearly doubled since the 1990s, according to the National Cancer Institute. A sweeping global study found that cancers in younger adults rose nearly 80% worldwide between 1990 and 2019, with the sharpest increases among people in their 30s and 40s. Maine’s own cancer registry shows that colorectal cancer is now one of the leading cancers in adults under 50.

How did we get here? Part of the answer lies in what fills our plates and our air. Diets thick with ultra-processed foods, the spread of obesity and diabetes, alcohol and tobacco all feed the disease. Environmental chemicals play their part too. PFAS — the “forever chemicals” that have seeped into Maine’s farmland and water — linger in bodies and soils, raising risks long after they are used.

Genes still matter, but they have not shifted in a single generation. What has changed is the environment around them. Epigenetics — the science of how exposures switch genes on or off— suggests that our world may now be pulling cancer’s trigger decades earlier.

The problem is not only biological. It is cultural and institutional. Medicine has long been trained to see cancer as an illness of age. That bias still blinds us. Too many young people are told they are “too young” for cancer. A 38-year-old with bleeding is dismissed as having hemorrhoids. A 42-year-old with exhaustion is told to get more rest. A 35-year-old with weight loss is told it is stress. By the time their voices are believed, their cancers are more advanced, their chances narrowed.

Policy can help rewrite the ending of this story. Maine has already shown courage by confronting PFAS directly. The state banned most uses by 2040 and created a $60 million fund to help farmers whose land and livelihoods were poisoned. That is leadership. But chemicals do not respect state borders, and without stronger federal regulation, the danger remains.

Food policy matters too. Nearly 60% of the calories Americans consume come from ultra-processed products. These foods are cheap, fast and heavily marketed, but they are linked to higher cancer risk. Maine’s obesity rate is the highest in New England, and obesity is tied to at least 13 cancers.

This is not simply about individual choice. It is about systems. We need healthier school lunches, incentives for local produce and limits on predatory marketing that targets the young.

Workplaces must evolve as well. Cancer in youth often collides with careers just beginning or families just being raised. Nationally, medical bills from cancer are one of the leading causes of bankruptcy. Maine’s new family and medical leave program, set to launch in 2026, is a step forward. But we need more: flexible work, remote options and protections that ensure treatment does not mean financial ruin.

Research, too, must change direction. The federal government invests billions in cancer studies each year, but much of it is still focused on older populations. We need to know why cancers are rising in younger adults, how environmental exposures contribute and how to prevent or catch them earlier. Institutions like the Jackson Laboratory in Bar Harbor could help lead this work, if resources are directed to where the crisis is growing.

Maine feels this more acutely than most. We are the oldest state in the nation, already carrying high cancer rates in seniors. Now younger adults are being diagnosed in greater numbers, placing pressure on both ends of the system. Rural hospitals struggle to maintain oncology services. Patients in counties like Washington and Aroostook often drive hours for care. Without planning, staffing and resources, this burden will grow heavier than our system can bear.

And yet, in the midst of the data and policy, there remains the human voice. A young father from Portland, about to begin chemotherapy, told me, “I just want to live long enough to see my kids graduate.” That is the measure of this crisis. Not just survival rates and registries, but graduations, birthdays, weddings — the milestones that form the arc of a life.

The story of cancer is changing. It no longer waits politely for old age. It has begun to intrude on the middle of life’s chapters. But this story does not need to end in despair. If patients trust their instincts, if doctors investigate without bias, if lawmakers act with courage, if communities rally as they always do in Maine, then the tide can turn.

Cancer’s spread into youth is one of the greatest public health challenges of our time. But challenges are also opportunities. With awareness, with bold policy, with compassion, we can ensure that more young adults live long enough to raise their children, care for their parents and grow old in the way their grandparents once did.

The old script is gone. A new one is being written. And with action now, its final chapters can be brighter — for the mother in Lewiston who thought cancer was decades away, for the father in Portland hoping to see his children graduate and for every family that deserves the full story of a life lived in full.