Cancer is always more intelligent than we are
A generation is falling ill in ways medicine did not anticipate, and one of Europe's leading oncologists is sounding a measured but urgent alarm. Winette Van der Graaf, who has spent decades at the intersection of cancer research and personal loss, warns that early-onset cancers—colorectal tumors in teenagers, aggressive breast cancers in young women—are rising globally at a pace that defies old assumptions. The disease is arriving earlier, behaving differently, and landing on lives that have barely begun, while the science of why remains, for now, unanswered.
- Colorectal cancer in a nineteen-year-old was once unthinkable—now Van der Graaf sees it, and the epidemiological shift behind it has no clear explanation yet.
- Young patients fall into a medical no-man's-land: too old for pediatric care, too young for systems built around older adults, their specific needs long overlooked.
- When diagnosis arrives at twenty or thirty, life does not pause gracefully—it fractures, suspending education, relationships, and independence at the very moment they are being built.
- Science has delivered real victories—chronic myeloid leukemia is now manageable, immunotherapy has produced genuine cures—but those gains remain the privilege of wealthy nations.
- Van der Graaf's sharpest warning is not biological but moral: the world celebrates new drugs while most of the planet cannot access basic oncology care, and that inequality is rarely named aloud.
Winette Van der Graaf has lived on both sides of a cancer diagnosis. After more than thirty years as an oncologist, she became a parent of a patient when her six-year-old daughter was diagnosed with a brain tumor in the early 2000s. The girl survived, but watching chemotherapy, radiation, and surgery unfold in her own home changed how Van der Graaf understood her work.
Now a professor at the Dutch Cancer Institute and the Erasmus Medical Center, and president of the European Organization for Research and Treatment of Cancer, she was among the first to recognize that teenagers and young adults with cancer occupied a gap in medicine—too old for pediatric oncology, too young for adult systems designed around older patients. That gap became the foundation of her career: building research and care networks specifically for people aged fifteen to thirty-nine.
What troubles her most today is something newer. Early-onset cancers are rising globally in ways she did not expect to see. Colorectal cancer in nineteen-year-olds. Aggressive, triple-negative breast cancers linked to BRCA mutations appearing in young women at higher rates than before. Tumors that once belonged almost exclusively to people over sixty are now climbing in younger populations, and the reasons remain unknown. That uncertainty, she says, is what frightens her most.
For young patients, a diagnosis does not arrive into a life already settled—it arrives into one still being constructed. Peers are studying, working, falling in love. The patient is in a hospital, exhausted by medication, sometimes forced to move back home at an age when independence feels essential. The psychological and social weight extends far beyond the biology of the disease, and when detection comes late—as it often does with early-onset cancers—the prognosis worsens.
Some progress is real. Chronic myeloid leukemia has been transformed from a death sentence into a manageable condition. Immunotherapy has produced genuine cures in some metastatic cases. But Van der Graaf's tone sharpens when she turns to equity. New drugs generate enormous fanfare in wealthy countries while much of the world cannot access even basic oncology care. She would like that disparity named more loudly and more often—on billboards, in public discourse—because until it is confronted, the advances of modern oncology will remain the privilege of the few.
Winette Van der Graaf has spent more than thirty years inside the world of cancer—first as an oncologist, then, in the early 2000s, as a parent. When her six-year-old daughter was diagnosed with medulloblastoma, a brain tumor, the disease moved from the clinical side of her desk to the other side entirely. The girl survived, but the experience left marks. Van der Graaf watched the short- and long-term effects of chemotherapy, radiation, and surgery unfold in her own home. It changed how she saw her work.
Today, as a professor of medical oncology at the Dutch Cancer Institute in Amsterdam and the Erasmus Medical Center in Rotterdam, and president of the European Organization for Research and Treatment of Cancer, Van der Graaf carries both perspectives with her. She was among the first to recognize that teenagers and young adults with cancer—people aged fifteen to thirty-nine—occupied a kind of no-man's-land in medicine. Too old for pediatric oncology, too young for the standard adult cancer world. When a patient turned eighteen, they simply moved into the vast machinery of adult oncology, where nothing was organized for them. That gap became the seed for her life's work: building networks of research and care specifically designed for young people with cancer across the Netherlands and beyond.
But lately, something has begun to trouble her deeply. Early-onset cancers are rising globally, and the cases she is seeing now would have been unthinkable a decade ago. Colorectal cancer in a nineteen-year-old. Breast cancers in young women that behave differently from the hormone-positive tumors typical of older patients—instead, a higher proportion of triple-negative cancers linked to BRCA1 and BRCA2 mutations, the most aggressive subtype. The epidemiology is shifting. The incidence of cancers that once appeared almost exclusively in people over sixty is now climbing in younger populations. She does not yet know why. That uncertainty itself is what frightens her most.
When a diagnosis arrives at that age, Van der Graaf explains, life enters a kind of suspension. While peers are studying, working, falling in love, building independence, young patients are consumed by disease and its treatment. They enter hospitals for the first time and see things they cannot unsee. They grow tired from medication when they want to be young. They may have to move back home with parents at an age when they crave autonomy. The social and psychological weight extends far beyond the biology of the tumor itself. And when the cancer is detected late—as early-onset cancers often are—the prognosis darkens further.
Van der Graaf is not optimistic about finding a single answer. If pollution, climate change, and pesticides are playing a role, as some evidence suggests, then today's young adults may indeed be the generation facing the highest cancer risk. But she emphasizes that the science must first understand the mechanism before it can intervene. The cancer itself remains a moving target. It is not one disease but many, a collection of cells and mutations that are, as she puts it, far more intelligent than the people trying to stop them. They escape treatments. They resist. They adapt.
Some progress has been real. Chronic myeloid leukemia, once a death sentence, has become manageable—patients on treatment now live as long as the general population. Immunotherapy has cured some patients with metastatic disease. But not all tumors respond to immunotherapy, and the victories remain unequally distributed. Here, Van der Graaf's tone sharpens. There is, she says, enormous fanfare around new drugs in wealthy countries, but far less attention to the fact that much of the world cannot access even basic oncology care. The disparity is staggering. She would like to see that inequality named more often, in public, on billboards: cure cancer in the whole world, not just for the fortunate few in high-income nations. Until then, the era of cancer treatment remains one of profound inequity, even as science inches forward.
Notable Quotes
Young cancer patients describe their life as being in suspension—while peers study and work, they are consumed by disease and treatment effects.— Winette Van der Graaf
There is enormous fanfare around new drugs in wealthy countries, but far less attention to the fact that much of the world cannot access even basic oncology care.— Winette Van der Graaf
The Hearth Conversation Another angle on the story
You've spent decades in this field. What shifted for you when your daughter was diagnosed?
Everything. I understood cancer intellectually before, but I didn't understand what it meant to be the parent sitting in that chair, watching your child endure chemotherapy and radiation. I saw the long-term effects unfold in real time. It made me see the patient behind the disease in a way I hadn't before.
And that led you to focus on young adults with cancer specifically?
Yes. I realized there was no organized care for them. They aged out of pediatric oncology at eighteen and entered this vast adult system where nothing was designed for their needs. They were invisible in both worlds.
What troubles you most about the early-onset cancers you're seeing now?
That I don't understand why they're happening. Colorectal cancer in a nineteen-year-old—I never thought I'd see that. When you don't know the cause, you can't prevent it. That's what keeps me awake.
Do you think today's young people will face more cancer than previous generations?
It's possible, if environmental factors like pollution and climate change are involved. But we need to understand the mechanism first. We're still in the dark.
You mentioned cancer is always more intelligent than the doctors treating it.
It is. Cancer isn't one disease—it's thousands of mutations in thousands of cells, all finding ways to escape our treatments. We make progress, then the cancer adapts. It's a constant game we're losing.
But immunotherapy has shown real promise?
In some cases, yes. We've cured patients with metastatic disease. But the real scandal is that these advances exist only for the wealthy. Most of the world can't access basic cancer care. That's the inequality that should be shouted from every rooftop.