Colorectal cancer has always been a significant concern for older adults, but alarming trends show that younger adults are increasingly being diagnosed with this disease. Particularly in India, colorectal cancer (CRC) makes up about 3% of all new cancer cases. Unlike the global trend of reducing CRC rates, India faces a steep increase in such cases. What’s even more concerning is that a considerable number of these cases are among the younger population, often diagnosed at more advanced stages.
Globally, the early-onset CRC, which affects individuals under 40, has seen a rise from 3.05 per 100,000 people in 1990 to 3.85 per 100,000 by 2019. Countries with better socioeconomic standards like Vietnam and Saudi Arabia have observed notable increases. In the United States, data from the SEER database between 2010 and 2015 indicated that young-onset CRC accounted for thousands of cases, often showing aggressive disease traits.
Research suggests that by 2030, CRC could become a leading cause of cancer-related death among those aged 20 to 49 in the U.S. However, the incidence rates in India have stayed consistent over the years. Young-onset CRC in India mainly tends to be left-sided and more aggressive, leading to a higher likelihood of recurrence and mortality compared to older adults. While the underlying reasons for these aggressive patterns remain unclear, differences in tumor biology between younger and older patients are evident.
Several studies indicate the importance of understanding genetic factors, as up to 5% of CRC cases may arise due to identifiable inherited syndromes, while another third may result from familial risk. Lynch syndrome and familial adenomatous polyposis are two genetic conditions that increase CRC risk. Pathogenic genetic variants are particularly common, with approximately 20% of young-onset CRC cases displaying these.
Apart from genetic predilections, other factors such as lifestyle choices and environmental exposures also play crucial roles. Obesity, sedentary lifestyle, and poor dietary habits (such as low vegetable intake and high consumption of processed meats) have been identified as contributors. Correlations between early diabetes diagnoses and young-onset CRC have been supported by studies, emphasizing that younger individuals with diabetes have up to a 3.5 times greater risk.
Microbiome changes due to factors like antibiotic usage also potentially impact CRC risk, affecting gut bacteria essential for maintaining colon health. The significance of Fusobacterium nucleatum, Bacteroides fragilis, and Escherichia coli bacteria in the gut hints at their role in promoting aggressive CRC forms. Consequently, understanding one’s diet and lifestyle could significantly contribute to implementing foods to prevent cancer growth and optimizing overall health.
The transition from research to treatment is crucial, as the treatment burden is often heavier for young-onset CRC individuals. The aftermath of CRC surgeries often includes long-term bowel dysfunction, urinary issues, and sometimes more profound sexual and psychological effects. Notably, these issues can lead to considerable anxiety, body image concerns, and embarrassment, impacting the patient’s quality of life long after the treatment concludes.
Financial toxicity further complicates the challenge of CRC among younger individuals. Young patients often grapple with significant financial strain due to medical expenses, potentially leading to skipped treatments and compromised health outcomes. Their financial and professional aspirations may suffer immensely, disrupting personal and professional growth trajectories.
With international guidelines emphasizing the equivalent treatment across age groups, it’s imperative to customize approaches for young-onset CRC to address both medical and psychosocial needs effectively. Treatment should also incorporate potential for fertility preservation and exploration of less invasive treatment methods.
As we progress, the future of CRC management could benefit from deep learning algorithms and innovative biomarkers for tailored therapies. One accessible screening method is the fecal immunochemical test, known for high sensitivity and specificity, reinforcing the potential benefits of implementing broad screening initiatives, especially among high-risk populations.
In navigating the challenges of CRC, a comprehensive strategy incorporating genetic screenings, pragmatic lifestyle adjustments, and nuanced treatments is vital. Proactive steps today can lay the groundwork for more effective management and a potential decline in young-onset CRC’s incidence in the years to come.
South Asian Journal of Cancer
10.1055/s-0044-1791225
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