Increasing Incidence of Early-Onset Colorectal Cancer

At the 2023 World Congress on Gastrointestinal Cancers in Barcelona, Spain, Irit Ben-Aharon, MD, PhD, discussed various explanations for the increase in early-onset colorectal cancer as well as important consideration for this patient populations.

Transcript:

Hello, my name is Professor Irit Ben-Aharon. I'm the head of the Fishman Oncology Center at the Rambam Healthcare Campus in Haifa, Israel. I'm also from the Faculty of Medicine in the Technion. I serve as the chair of the Early-Onset Cancer Task Force in the GI group of the EORTC.

I'm going to talk today at the 2023 World Congress on GI Cancers on the evolving incidence of early-onset colorectal cancer. This is a very important topic since in the last 2 decades, we have been witnessing a steady increase in the incidence of early-onset colorectal cancer in specific areas in the world. We can say it is a trend that we can see worldwide, but in specific areas such as in the USA, Western Europe, Australia, and South America, yhe incidents have drastically increased in the past decade. Most of those cases are sporadic cases. The percentage of hereditary cases is only up to 25% upon most of the studies indicating the role of environmental factors within this pathogenesis. 

When we talk about environmental factors first, it's very hard to study those factors since most of them would occur long before cancer is diagnosed. But we do see some critical environmental factors that had been correlated with the increasing incidence of early-onset colorectal cancer, the first of which is obesity. We have several studies indicated that high BMI, which is a BMI of more than 30, has been correlated with increased risk of early onset colorectal cancer. The second one is antibiotics. Though there is conflicting evidence regarding the effect of antibiotics under microbiome or other perspectives and the correlation to early onset colorectal cancer. We have some lifestyle factors such as sugared foods and sedentary TV-viewing that had been correlated with increased risk of early-onset colorectal cancers. Some studies indicated that maybe the microbiome has an effect, though again, the data is conflicting.

When we talk about early-onset colorectal cancer, we also have some unique implications that are relevant to this unique population and different from other age groups that we usually treat. And we are talking about reproductive outcomes, future cardiovascular morbidity, cognitive function, sexual function. With that, we do see that there is lack of evidence regarding this unique population of GI cancer, specifically young patients with colorectal cancer. Most of the evidence relies, for example, on reproductive outcomes on what we have, the recommendations for breast cancer and hematological malignancies. We don't really have concrete evidence regarding counseling patients with GI cancer. And this is something that we should further explore in the future. When we talk about cardiovascular morbidity, we do have some evidence indicating that protocols may be cardiotoxic or vascular toxic in the older population, but we do not have any data regarding the younger population. Also, regarding financial toxicity and psychosocial issues that are relevant, we don't have enough evidence. 

All of these indicate that we should emphasize in the future and in the present on studying these future effects long-term toxicities of anti-cancer treatments in the population of younger patients with GI cancer, to elucidate the short-term and long-term adverse events that may have a tremendous effect in their future life. Thank you all for watching.

Source:

Ben-Aharon I. Early-Onset Colorectal Cancer. Presented at the 2023 World Congress on Gastrointestinal Cancers; June 28-July 1, 2023; Barcelona, Spain.