Surgeons can play a key role in delineating the risk factors for early-onset colorectal cancer (CRC), according to Yin Cao, ScD, MPH, associate professor of surgery and medicine at Washington University in St. Louis and Alvin J. Siteman Cancer Center who is presenting on the topic during Digestive Disease Week® (DDW) 2024.
“The research community needs collaboration from surgeons to understand how risk factors for early-onset CRC impact tumor molecular signatures and to analyze tumor tissues and other biospecimens to infer risk factors,” says Dr. Cao. “Surgeons are often the first physicians that patients see after being diagnosed. They are therefore in a unique position to characterize both the whole patient and their tumor early in the treatment course.”
According to the American Cancer Society, the CRC patient population is rapidly shifting younger — the incidence among those older than 65 years of age is decreasing while it is increasing in younger adults. As a result, the median age of diagnosis for CRC has dropped from 72 years of age in 2001 to 66 in 2015. These changing demographics prompted several organizations to lower the recommended age for screening from 50 years to 45 years.
“We are seeing a rapid change in the landscape of cancer epidemiology. Cancer — especially CRC — used to be a disease of the elderly. We are now faced with the challenge of establishing a pathway of care for early-onset patients from initial symptoms to diagnosis and treatment,” she says. “Hopefully, with dedicated multidisciplinary work, we can begin to personalize treatment and care for these younger patients, addressing their unique challenges and unmet needs to improve their quality of life and survivorship.”
Dr. Cao leads efforts to elucidate risk factors that put younger adults at risk of early-onset CRC. Her group has linked factors such as obesity, metabolic syndrome, prolonged sitting, poor diet, sugar-sweetened beverages and birth via C-section with early-onset CRC. She is co-leading the Cancer Grand Challenges team PROSPECT, a global research initiative to uncover risk factors for early-onset CRC, using a disruptive and accelerated framework that integrates population studies, mechanistic research and interventions.
There is some evidence to suggest that early-onset cancers may have a different histologic and molecular landscape than later-onset cancers, but Dr. Cao stresses that the data are inconclusive and more research is needed.
“We still have a long way to go to fully identify the risk factors driving the increasing burden of early-onset CRC,” she says. “We are bringing this topic to the SSAT community because we are in urgent need of multidisciplinary collaborations that leverage expertise from epidemiologists, surgeons, gastroenterologists, oncologists and primary care providers to tackle this societal challenge together.”
A more rigorous approach is also needed to fully harness the power of multi-institutional collaborations, she says. Most institutions vary in the clinical data collected and have differing protocols on how surgical samples and other biospecimen are collected and analyzed.
“The more we can standardize information-gathering on patients when they first enter care, biospecimen collection, and multi-omic profiling and analyses, the better we can start to understand the full molecular landscape and even causes of early-onset CRC,” she says.
Ultimately, Dr. Cao hopes that additional research could lead to better prevention and more personalized screening strategies for early-onset CRC along with more streamlined care pathways for younger adults, whose concerns may be different than those of older populations.
Dr. Cao’s oral presentation, “Causes of EORC” on Sunday, May 19, at 8:30 a.m. EDT is part of the session “SSAT-ASCRS Joint Symposium: Increasing Incidence of Early Onset Colorectal Cancer: A Different Disease Entity?”
