Why Colorectal Cancer is suddenly affecting so many young people?

Globally, the incidence of colorectal cancer in young individuals is on the rise at a rapid pace. It is projected that by 2030, this form of cancer will be the primary cause of cancer-related deaths in the age group of 20 to 49 in the United States.

Despite the alarming increase in cases, the root cause of this trend remains uncertain. In a recent publication in Science, experts from the Dana-Farber Cancer Institute shed light on the intricate nature of the disease and the imperative research required to unravel its mysteries.

“The rising incidence of young-onset colorectal cancer is extremely concerning, and it is urgent that the scientific community comes together to better understand the underlying causes and biology,” remarks co-author Kimmie Ng.

According to the authors, young-onset colorectal cancer (CRC), also known as early-onset CRC, differs from later-onset CRC in multiple ways. The disease is often more aggressive, manifests on the left side of the colon, and frequently presents with rectal bleeding and abdominal pain.

At the molecular level, however, research has produced contradictory results that indicate both similarities and dissimilarities in the genetic mutations that drive the disease. The authors attribute this complexity to the intricate nature of the disease and suggest that future research account for this variability.

Furthermore, more research is required to determine if the risk factors for CRC in young people are comparable to those for older adults. While obesity and environmental exposures have been linked to young-onset disease, other factors such as increased antibiotic use or Cesarean section frequency could also play a role in influencing the microbiome. To gain insight into the risk factors, the authors recommend that investigations incorporate a combination of genetics, environmental exposures, diet and lifestyle measures, as well as immune system interactions and microbiome composition.

The fact that young-onset CRC is often found after the illness has progressed is one obvious distinction. This is partly because colorectal cancer screening in the U.S. begins at age 45, which means that the illness often goes unnoticed in younger individuals.

“It’s important not to dismiss the idea that a young person could have colorectal cancer even though the disease is still more common in older adults,” adds co-author Marios Giannakis.

To address the intricacies of early-onset CRC, Ng and Giannakis emphasized the need for a multidisciplinary research approach that simultaneously explores several areas of investigation. For instance, genome-wide association studies, which aim to identify genes that increase the risk of the disease, should also incorporate information about environmental exposures that could augment risk.

By integrating such studies, researchers may discover novel methods to identify young individuals at heightened risk of early-onset CRC and recommend appropriate screening for colorectal cancer.

“Risk stratification is going to be very important as we think about screening for young-onset disease,” adds Giannakis.

Clinical studies should additionally encompass the collection of blood, tissue, and stool samples from patients over time to provide insight into the role of immune cells, environmental exposures, and the microbiome in the onset, progression, and treatment response of the disease. Ng and Giannakis urge global collaborations to facilitate the collection of these specimens, such as the Count Me In Colorectal Cancer Project (https://joincountmein.org/colorectal), which collaborates directly with patients in the United States and Canada, making all data available for research.

Ng and Giannakis further advocate for increased efforts to ensure that diverse populations are included in studies of early-onset CRC. Studies reveal that underrepresented minorities bear a disproportionate burden of early-onset CRC, and non-Hispanic Black patients exhibit higher mortality rates when compared to non-Hispanic whites.

“Although each of these steps require commitment and perseverance,” adds the authors, “it is the growing numbers of young patients bravely battling this disease that will be the compass that keeps us on the path towards better understanding, preventing, and treating young-onset colorectal cancer.”

Source: 10.1126/science.ade7114 

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