Appendix cancer incidence has quadrupled in older millennials

Embargoed for release until 5:00 p.m. ET on Monday 9 June 2025   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Appendix cancer incidence has quadrupled in older millennials

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02479  

URL goes live when the embargo lifts              

A new study estimated incidence rates of appendiceal adenocarcinoma (AA), or appendix cancer, across birth cohorts in the United States. The researchers observed a sharp increase in AA incidence rates for those born after 1945, particularly for Generation X and Millennials. These patterns suggest a timely need for etiologic research and increased AA awareness among physicians and the public. The study is published in Annals of Internal Medicine. 

Researchers from Vanderbilt University Medical Center and colleagues used the National Cancer Institute SEER (Surveillance, Epidemiology, and End Results) Program to estimate age-specific incidence rates of AA per 100,000 persons in 5-year time periods between 1975 and 2019. The researchers created 21 overlapping birth cohorts and estimated the incidence rates relative to a 1945 birth cohort. The researchers identified a total of 4,858 persons aged 20 years or older who were diagnosed with a pathologically confirmed primary AA (nonmucinous, mucinous, goblet cell, or signet ring cell carcinoma). They found that age-specific AA rates increased by time period, and incidence rates of AA more than tripled among the 1980 birth cohort and quadrupled among the 1985 birth cohort. This pattern was reflected across all AA histologic subtypes, however, the magnitude varied. The increase in AA incidence rates was especially large among Generation X and Millennials. Because incidence rates in younger generations are often indicative of future disease burden, the findings suggest the need for histology-specific investigations of AA as well as more awareness of rare AAs among physicians and the public. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To contact corresponding author Andreana N. Holowatyj, PhD, MSCI, please email Tommy Wilemon at tommy.e.wilemon@vumc.org.

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2. Experts debate management of patient with knee osteoarthritis interested in total knee joint arthroplasty

This ‘Beyond the Guidelines’ feature is based on a discussion held at the General Medicine Grand Rounds conference on 20 December 2024.

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01411

URL goes live when the embargo lifts             

In a new Annals “Behind the Guidelines” feature, two physicians discuss treatment for a patient with knee osteoarthritis (OA) in the context of the American College of Rheumatology (ACR) and the American Association of Hip and Knee Surgeons (AAHKS) recent guideline on the optimal timing of total joint arthroplasty (TJA) in patients with moderate-to-severe OA for whom nonoperative therapy has been ineffective. Currently, 14 million people in the U.S. have knee OA and while many patients can benefit from nonoperative treatment, most eventually will require TJA. As such, asking “What would you recommend for this patient interested in a total knee joint arthroplasty?” is an important clinical question.

They reviewed the case of Ms. K, a 70-year-old woman with a medical history that includes obesity, prediabetes, and chronic back pain who has had several years of progressive knee OA. To manage her knee OA, she tried oral medications, physical therapy and corticosteroid and hyaluronic acid injections, however, she did not see a sustained benefit. She was told she was a candidate for TJA, would need to lose weight to proceed. She was referred for laparoscopic sleeve gastrectomy and encouraged to make nutritional changes and exercise, and she has lost several pounds so far.

The first discussant, Tara Skorupa, MD, is a member of the Divisions of Rheumatology and General Medicine at Beth Israel Deaconess Medical Center and an Instructor in Medicine at Harvard Medical School, Boston, Massachusetts. She noted that because Ms. K has tried many nonoperative treatments for her knee OA, a 5% to 10% weight loss would likely offer the greatest potential benefit in improving pain. She notes the prohibitive cost of GLP-1 medications and the short-and long-term risks that come with bariatric surgery and would advise Ms. K to undergo a nutrition and exercise program. In line with the ACR/AAHKS guidelines, Dr. Skorupa would not recommend Ms. K delay TJA to achieve further weight loss.

The second discussant, Ayesha Abdeen, MD, is Chief of the Division of Hip and Knee Arthroplasty at Boston Medical Center, and Associate Professor of Orthopaedic Surgery at Boston University, Boston, Massachusetts. Dr. Abdeen agrees that Ms. K has tried many nonoperative options for OA to little avail. She notes that obesity is associated with increased risks during and after surgery and that obesity is an independent risk factor for medical complications after TJA. Based on the evidence showing reduced complications in patients undergoing bariatric surgery before TJA, Dr. Abdeen recommends this strategy for additional weight loss, but if pain and functional decline continue or she can’t continue weight loss after surgery, she does not recommend further delay of TJA.

All “Beyond the Guidelines” features are based on selected clinical conferences at Beth Israel Deaconess Medical Center (BIDMC) and include multimedia components published in the Annals of Internal Medicine.  

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with one of the discussants, please contact Kendra McKinnon at Kmckinn1@bidmc.harvard.edu.

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Also new this issue:

Skeletal Muscle Mass Loss and Glucagon Like Peptide-1 Receptor Agonists: Are Older Patients at Risk?

Anjali P. Kakkar, DO; Eric Ravussin, PhD; and Thierry H. Le Jemtel, MD

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03950

Precision Social Care Delivery

Sahil Sandhu, MD, MSc; Michael Liu, MD, MPhil; Laura M. Gottlieb, MD, MPH; and Rishi Manchanda, MD, MPH

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00323

Care of the Patient with Asthma

Meghan D. Althoff, MD, PhD; Fernando Holguin, MD, MPH

In the Clinic

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01034