Colorectal Cancer in Persons Under Age 50: Seeking Causes and Solutions

Area of Science:

• Oncology
• Gastroenterology
• Public Health

Background:

• Colorectal cancer (CRC) incidence and mortality are decreasing in individuals aged 50 and older.
• Conversely, early onset colorectal cancer (EOCRC), defined as CRC in individuals under 50, is increasingly prevalent.
• EOCRC often presents in the distal colon and rectum and may possess distinct pathological and genetic characteristics.

Purpose of the Study:

• To highlight the rising incidence and mortality of EOCRC.
• To discuss the unique features and potential distinct pathogenesis of EOCRC.
• To explore the implications and challenges of earlier CRC screening for EOCRC detection.

Main Methods:

• Review of current epidemiological trends in CRC incidence and mortality.
• Analysis of pathological and genetic features distinguishing EOCRC from later-onset CRC.
• Discussion of the potential impact of revised screening guidelines on healthcare burden.

Main Results:

• EOCRC incidence and mortality are increasing, contrasting with declining trends in older populations.
• EOCRC tumors frequently occur in the distal colon and rectum.
• Germline mutations are less commonly associated with EOCRC, suggesting a potentially different disease origin.

Conclusions:

• EOCRC represents a growing concern with unique epidemiological and clinical characteristics.
• Optimal management strategies and understanding of EOCRC pathogenesis remain critical unmet needs.
• Implementing earlier CRC screening (40-45 years) could increase early-stage detection but poses significant healthcare system challenges.