Early-Onset Colorectal Cancer: Rising Incidence Demands New Screening and Biomarker Strategies
The incidence of colorectal cancer in individuals under 50 is increasing globally, driven by environmental exposures that cause genetic, epigenetic, and microbiome alterations. Early-onset CRC has distinct molecular features compared with later-onset disease, suggesting the need for age-specific biomarker panels and screening strategies. For diagnostic laboratories, this trend creates urgency for validated molecular markers to enable earlier detection, including ctDNA-based liquid biopsy approaches and microbiome-based risk stratification tools.
The original study
Rising incidence of early-onset colorectal cancer - a call to action.
- Authors
- Akimoto N, Ugai T, Zhong R, Hamada T, Fujiyoshi K, Giannakis M, et al.
- Journal
- Nature reviews. Clinical oncology
- Type
- Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Review
- PMID
- 33219329
Original abstract
The incidence of early-onset colorectal cancer (CRC), which occurs in individuals <50 years of age, has been increasing worldwide and particularly in high-income countries. The reasons for this increase remain unknown but plausible hypotheses include greater exposure to potential risk factors, such as a Western-style diet, obesity, physical inactivity and antibiotic use, especially during the early prenatal to adolescent periods of life. These exposures can not only cause genetic and epigenetic alterations in colorectal epithelial cells but also affect the gut microbiota and host immunity. Early-onset CRCs have differential clinical, pathological and molecular features compared with later-onset CRCs. Certain existing resources can be utilized to elucidate the aetiology of early-onset CRC and inform the development of effective prevention, early detection and therapeutic strategies; however, additional life-course cohort studies spanning childhood and young adulthood, integrated with prospective biospecimen collections, omics biomarker analyses and a molecular pathological epidemiology approach, are needed to better understand and manage this disease entity. In this Perspective, we summarize our current understanding of early-onset CRC and discuss how we should strategize future research to improve its prevention and clinical management.