Researchers chart a course for understanding, preventing, and treating young-onset colorectal cancer

Date:
March 16, 2023
Source:
Dana-Farber Cancer Institute
Summary:
Researchers outline the complexities of young-onset colorectal
cancer and the research needed to map out a path toward
understanding it.


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FULL STORY ========================================================================== Colorectal cancer among young people is increasing globally and rapidly.

Experts expect it to become the leading cause of cancer death in
individuals aged 20-49 in the U.S. by the year 2030.


==========================================================================
Yet no one is certain why this disease is suddenly affecting so many
young people. In a new paper published in Science, Dana-Farber Cancer
Institute researchers outline the complexities of the disease and the
research needed to map out a path toward understanding it.

"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,"
said co-author Kimmie Ng, MD, MPH, associate chief of gastrointestinal
oncology and director of the Young- Onset Colorectal Cancer Center at Dana-Farber. The Center provides expert care for patients and conducts
the multidisciplinary research required to understand colorectal cancer
in young adults and develop new ways to prevent, detect and treat it.

Young-onset Colorectal Cancer: a unique challenge Young-onset colorectal
cancer (CRC), also called early-onset CRC, differs from later-onset CRC
in several ways, according to the authors. Young-onset disease is often
more aggressive, presents on the left side of the colon rather than the
right, and often presents with rectal bleeding and abdominal pain.

At a molecular level, however, studies have shown conflicting results
that suggest both similarities and differences in the genetic mutations
that drive the diseases. This is likely due to the complexity of the
disease, according to the authors, and future research should account
for this variability.

More study is also needed to determine if CRC risk factors for young
people are similar to those for older adults. Obesity and environmental exposures, for instance, have been associated with young-onset disease,
but other factors could also play a role, such as increased antibiotic
use or the frequency of Cesarean sections, both of which could influence
the microbiome. To begin to understand the risk factors, the authors
suggest that investigations should include a combination of genetics, environmental exposures, diet and lifestyle measures, as well as immune
system interactions and the microbiome composition.

One clear difference is that young-onset CRC is typically discovered
after the disease has advanced. This is due in part to the fact that
screening for colorectal cancer starts at age 45 in the U.S., so the
disease often goes undetected in younger people.

"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," said co-author Marios Giannakis, MD, PhD, a gastrointestinal oncologist at Dana-Farber.

Responding with multidisciplinary research involving diverse populations
To account for the complexity of young-onset CRC, Ng and Giannakis said
that research should be multidisciplinary and include many areas of investigation simultaneously. For instance, genome-wide association
studies, which aim to find risk genes for the disease, should also
include data about environmental exposures that could also increase risk.

These types of studies could point to new ways to identify young people
who are at high risk of young-onset disease and should be screened for
CRC. "Risk stratification is going to be very important as we think
about screening for young-onset disease," said Giannakis.

Clinical studies should also include the collection of blood, tissue,
and stool samples from patients over time to shed light on the role of
immune cells, environmental exposures and the microbiome in disease onset, progression, and treatment response. Ng and Giannakis encourage global collaborations aimed at facilitating the collection of these specimens,
such as the Count Me In Colorectal Cancer Project, which directly partners
with patients in the U.S.

and Canada and makes all data available for research.

Ng and Giannakis also call for more effort in ensuring diverse
populations are included in studies of young-onset CRC. Studies show underrepresented minorities are disproportionally burdened by young-onset
CRC and non-Hispanic Black patients have a higher mortality rate when
compared to non-Hispanic whites.

"Although each of these steps require commitment and perseverance,"
said 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."
* RELATED_TOPICS
o Health_&_Medicine
# Colon_Cancer # Diseases_and_Conditions # Breast_Cancer
# Cancer # Lymphoma # Chronic_Illness # Prostate_Cancer
# Lung_Cancer
* RELATED_TERMS
o Colorectal_cancer o Stem_cell_treatments o
Positron_emission_tomography o Cervical_cancer o Breast_cancer
o Prostate_cancer o Ovarian_cancer o Adult_stem_cell

========================================================================== Story Source: Materials provided by Dana-Farber_Cancer_Institute. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Marios Giannakis, Kimmie Ng. A common cancer at an uncommon
age. Science,
2023; 379 (6637): 1088 DOI: 10.1126/science.ade7114 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2023/03/230316140939.htm

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