Getting Sicker, Younger

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Satenik Safaryan had decided she would become a doctor from a young age, and after graduating with a medical degree in Yerevan, she chose oncology. She was in her second year as a resident, treating people with cancer, when she herself began to feel unwell. Satenik would be nauseous in the morning, she ate less, and was unable to stomach the meat that her mother Nune would send from Stepanakert, her home. 

When her test results came back, she would be diagnosed with gastric cancer that had already progressed into the most advanced stage, having moved from her stomach to other organs and tissue around her body. When she first had tests done, “It didn’t even cross our mind that it could be a tumor,” says her mother Nune Safaryan. 

Satenik died a mere eight months after her diagnosis, in June 2020, at age 25, and her story is becoming less of an anomaly in Armenia. Cancer now accounts for 21% of all deaths in the country, coming second only to cardiovascular disease. And new diagnoses have reached highs of more than 10,000 in 2024, up from about 7,000 in 2020, according to the most recent statistics from the National Institute of Health. The rate of cancer per 100,000 people climbed from 234 to 335 in that same time period. Still, the number is likely to undercount the burden given an unknown number of people who are never treated, or those who go abroad. Some cancers, like lung and prostate, have immensely improved survival rates compared to several years ago. But others, like gastric and colorectal, remain a problem, especially among younger people, a group in which clinicians say they are observing more and more cases of aggressive cancer, even though official statistics don’t yet capture this phenomenon. 

Many cancers in Armenia are caught late. In 2024, just under half of all newly diagnosed patients were found at stages one or two when treatment is most likely to be effective. However, more than 27% were diagnosed at stage four. For stomach cancer (or gastric cancer) in particular, about 80% of cases were diagnosed at the later stages, according to a 2023 study across three major oncology centers—a slightly higher proportion than described in the official statistics. “We almost never see T1 disease,” says Amalya Sargysan, an oncologist at the Yeolyan Hematology and Oncology Center who co-authored the study, referring to the earliest stage where the cancer is still small and localized. “Usually people present with an already bulky disease.” 

Colorectal cancers are also concerning experts in the country. The one causing worldwide alarm, colon cancer, is now the fourth most commonly diagnosed cancer in both men and women in Armenia, according to the NIH’s yearbook. Clinicians say they are watching it arrive in younger and younger people, similar to patterns the rest of the world is experiencing. A study led by the American Cancer Society found that early-onset colorectal cancers are rising in 27 countries around the world, led by Australia, Puerto Rico, New Zealand, the United States and South Korea. Some hypotheses point to shared factors, such as obesity, Western diets, sedentary lifestyles and high alcohol consumption, as possible links. 

Armenia was not included in that analysis, but cases here have risen from around 700 new annual diagnoses in recent years to nearly 1,000 in 2024. In his 2020 study on colorectal cancers in Armenia, Samvel Bardakhchyan, an oncologist at the Yeolyan Hematology and Oncology Center, found late diagnosis was common—38% of cases were caught at stage three and about 18% at stage four. “We should do something to at least find these patients earlier, in the first or second stage, when we can do curative treatment,” he says. 

International guidelines have mostly shifted the screening age for colorectal cancers from over 50 down to 45, though Armenia’s screening initiatives are still focused on an older age group. But Bardakhchyan also noted that for a 25 or 30-year-old arriving at the hospital with abdominal discomfort, a colon cancer diagnosis isn’t what anyone is expecting. “Nobody is thinking that the first symptom of abdominal discomfort is going to turn out to be colon cancer,” he said. Unwillingness to undergo a colonoscopy is also a persistent issue in all age groups. 

Sargysan described seeing patients in their twenties and thirties presenting with advanced disease. She says younger-onset colorectal cancers seem to be more aggressive, but that young people also easily dismiss their symptoms. Those who had symptoms for several months tended to attribute them to stress, and symptoms such as constipation were often ignored, she says. The same is true of gastric cancer. “A lot of people think they have gas,” says Sargsyan, or other symptoms that can be easily overlooked. But the issue is, the disease has usually already progressed when it begins to show symptoms such as these, she says. 

On the day we spoke, she had just started treating a 26-year-old athlete with gastric cancer, the same as Nune’s daughter, Satenik. The patient didn’t have any family history of the disease and no obvious risk factors. He’d had back pain that sent him to have a scan. “It used to be a disease of the elderly,” Sargsyan says, but she now counts 18 and 19-year olds among her patients.                             

She describes the challenge of treating these younger patients who are in the middle of building their lives. Plans for their lives are derailed by needing constant care and receiving treatments that leave them fatigued and unable to spend time with their peers. Instead, they become emotionally, physically and financially dependent on their parents and caregivers, she says. “This is a concern, because these are young people who have to work for your country,” she says. “This is the driving force of the country, and you are seeing more and more people not working, but rather depending on others.”                       

The government covers basic chemotherapy, and has recently boosted support for cancer treatments through a fledgling insurance scheme, but the drugs that have transformed outcomes for certain cancers in wealthier countries are still out of reach. Immunotherapy, which are targeted therapies that work on specific molecular subtypes of cancer, are expensive and often difficult to procure. A course of Pembrolizumab, a targeted treatment for certain colorectal cancers, costs about 2,500 euros per infusion, says Sargsyan. A patient with advanced disease might need the drug every three weeks for several years. Other immunotherapies can cost much more.

In her 2023 study of gastric cancer patients, only few were tested for biomarkers that could determine a patient’s eligibility for immunotherapy. And even those who were found eligible often didn’t complete their courses because of cost and access barriers. Similarly, few colorectal cancer patients are assessed for whether their specific cancer type would respond to these modern targeted treatments, according to data from the 2020 study. And the decision on whether to give these treatments alongside chemotherapy is largely financially driven.

Bardakhchyan’s own data shows the median survival for stage four colorectal cancer is around 20 months, compared to 30 or more in higher income countries. The five-year overall survival rate across all stages was approximately 52%, below the 65% in the United States. “The main reason,” he says, “is the low availability of new drugs.”

But statistics say nothing about what it means to watch a loved one exhaust every option and still not survive. After 37 years as a schoolteacher in Artsakh and then Yerevan, Satenik Safaryan’s mother now works in administration at the same cancer ward where her daughter was first a doctor, and then a patient. She brings scarves printed with her daughter’s photography and sells them to raise money for the palliative care unit. The photos are mostly from Cologne where, after a surgery that cut large swathes of cancerous tissue from her body, Satenik had still insisted on seeing the sights with her mother. After her death, Nune donated the unused funds raised for Satenik’s surgery in Germany to furnish a children’s room in the same building. 

Her daughter told her not to waste time crying, and that whatever she does, to do it beautifully. Nune still tries to follow these instructions. “I’m obligated to do what she said,” Nune says. “I can’t do even 10% of what she did, at this age I can’t become a doctor, but deep down I feel good that I can somehow continue the work.” 

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