Early Onset Colorectal Cancer Screening: What’s New, What Should We Do?

In either men or women in the United States, colorectal cancer (also known as CRC) is the third largest cause of death from cancer-related causes. Screening programs that start at age 50 and have an average risk have been shown to lower the incidence and death of colorectal cancer in people older than 50 years of age. On the other hand, the incidence of colorectal cancer in people younger than 50 years of age (early onset colorectal cancer, or eoCRC) has recently and substantially increased.
Epidemiologic studies of eoCRC suggest that the cancer is most prevalent in the distal colon and rectum, and that it is associated with a number of risk factors that can be modified, such as diabetes, obesity, diet, sedentary time, alcohol intake, and smoking. The data covering the potential risk factors of prior antibiotic exposure and alterations to the microbiome or direct carcinogen exposure are still in the process of being gathered. It's possible that a delay in diagnosis or more aggressive tumor biology led to the aggressive clinicopathologic characteristics of eoCRC that were observed at presentation. When matched for stage, the outcomes of patients with EoCRC are comparable to those of patients with loCRC; nevertheless, the overall mortality rate is higher due to a higher frequency of advanced illness at a younger presentation, which results in more life-years lost.