Age and Gender as Risk Factors for NETs

Neuroendocrine tumours (NETs) are a diverse group of neoplasms that originate from neuroendocrine cells and can develop in various parts of the body, including the gastrointestinal tract, lungs, and pancreas. 

While the exact cause of NETs is not always clear, as investigation into the disease has progressed, with several risk factors having been identified, including:

• Genetic mutations
• Family history
• Environmental exposures

Among these, age and gender emerge as key factors that can significantly influence the risk of developing NETs, the type of NETs that occur, and therefore the outcomes for patients.

Understanding the role that age and gender play in the development of NETs is crucial for early diagnosis, risk assessment, and developing tailored treatment strategies. 

This article explores the interplay between age and gender in NET risk, highlighting the factors that contribute to the development of these tumours and the clinical implications for personalised care.

Neuroendocrine Cancer Australia (NECA), is dedicated to supporting individuals diagnosed with NETs, and their families. NECA offers a wealth of resources, educational programs, and advocacy efforts aimed at deepening the understanding of NETs, improving patient care, and encouraging research advancements. Patients diagnosed with NETs can engage with NECA’s comprehensive support and information by calling the NET nurse line.

Age as a risk factor

Age is a significant risk factor in the development of NETs. Research indicates that the incidence of NETs increases with age, with most cases diagnosed in middle-aged and older adults. 

Although NETs can occur at any age, they are more commonly found in individuals over the age of 50. This pattern suggests that factors associated with ageing, such as cumulative environmental exposures and biological changes, may contribute to tumour development.

NET types commonly associated with age

Certain types of NETs are more strongly associated with ageing. For instance, gastrointestinal and pancreatic NETs are more frequently diagnosed in older individuals. These tumours may be linked to age-related changes in the digestive system and metabolic processes. 

Conversely, some rarer types of NETs, such as pheochromocytomas, which affect the adrenal glands, can occur at younger ages, often in patients with genetic predispositions or familial syndromes.

Age-related factors contributing to NET development

Several factors related to ageing may increase the risk of developing NETs, including genetic mutations and environmental exposures accumulated over time.

Genetic mutations

As we age, the likelihood of acquiring genetic mutations increases. These mutations can disrupt normal cell growth and repair mechanisms, leading to the formation of tumours. 

In some cases, individuals may carry inherited mutations that predispose them to develop NETs, such as those seen in multiple endocrine neoplasia (MEN) syndromes.

Environmental exposure over time

Prolonged exposure to environmental factors can also contribute to the development of NETs in older adults. These include:

• Radiation
• Toxins
• Chronic inflammation

These exposures can damage DNA and affect cell signalling pathways, increasing the risk of tumour formation.

Prognosis and treatment based on age and gender

Prognosis and treatment response in NET patients can vary significantly depending on age and gender. Here are some examples: 

• Older adults may have a reduced ability to tolerate aggressive treatments such as chemotherapy or surgery, leading to certain treatment pathways. 

Clinical implications

There are a range of clinical, diagnostic, and treatment implications that age and gender place on NETs that must be considered by healthcare professionals. 

Age and gender considerations in diagnosis

When it comes to diagnosing NETs, age and gender are considered.

• Age-related factors, such as the increased likelihood of genetic mutations should be taken into account when assessing a patient’s risk. 
• Gender-specific risk factors, including hormonal influences, should also be considered to ensure accurate diagnosis and tailored treatment planning.

Personalised treatment approaches

Age and gender are important considerations when developing personalised treatment approaches for NET patients. 

As discussed earlier, older patients might benefit from more conservative treatments.

Monitoring and screening

Age and gender should also inform monitoring and screening strategies for NETs. 

• Younger patients may benefit from early screening if they are at risk of developing NETs due to genetic mutations or other factors

Research and future directions

Ongoing research is exploring the impact of age and gender on the development and progression of NETs. Studies are investigating how these demographic factors influence tumour biology, treatment response, and overall survival. This research aims to improve the understanding of the interplay between age, gender, and NET development, ultimately leading to more effective treatments.

As researchers continue to investigate the role of age and gender in NETs, there is potential for new therapeutic targets based on these demographic factors. 

Hormonal pathways, in particular, offer promising avenues for targeted therapies that could address gender-specific risks. 

Age-related treatments that focus on minimising side effects while maximising efficacy could significantly improve outcomes for older NET patients.

Further information and support for people diagnosed with NETs is available by calling the NECA NET nurse line.