Digestive Disease Week (DDW) was an exciting time for colorectal cancer (CRC) screening and research. Four days dedicated solely to digestive diseases is something we get super excited about! At this year’s meeting, Fight Colorectal Cancer (Fight CRC) convened with a host of dedicated research and medical experts and contributed to the most prestigious gastroenterology meeting in the world.

Medical Experts and Advisors in Action at DDW!

At the pre-meeting of the World Endoscopy Meeting, Drs. Jen Kolb and Caitlin Murphy showcased their contributions and work of the larger Fight CRC Early-Age Onset (EAO) workgroup. This international network collaborates, explores, and reacts to the trend of increased EAO colorectal cancer, as well as strategies to reverse it.

Dr. Fola May, Fight CRC Board Member and Medical Advisory Board Member, had the opportunity to share her expert perspective on disparities in colorectal cancer screening and research for all populations. Many of the Fight CRC medical advisors and leaders presented oral abstracts and posters during the meeting as well.  

Fight CRC Hosted Experts to Keep Moving the Needle in EAO CRC Research

After DDW, Fight CRC hosted a panel to continue the discussion on early-age onset disease and research and ask the timely question: “If we are going to make progress in early-age onset colorectal research, what must we do differently, and how do we build off of our current efforts?”

To kick off the meeting, Dr. Murphy provided the provocative discussion about early-age onset disease, which included following key points: 

Theme 1: Generally, at this time, it seems that there is no difference in magnitude of risk for early- vs. later-onset colorectal cancer.

Theme 2: There are some differences by tumor site (colon vs. rectum) based on a number of studies:

• Low fiber intake is more strongly associated with rectal cancer vs. colon cancer. 
• Obesity is associated with colon cancer vs. rectal cancer. 
• Metabolic syndrome associated with colon cancer vs. rectal cancer. 
• Antibiotics increased risk of colon cancer but decreased risk of rectal cancer 

Many (if not all) of the well-established risk factors for later-onset CRC are risk factors for EAO CRC. At the same time, these risk factors cannot explain all of the increase in incidence rates for young people, and they never explained much of the variation in older adults. Dr. Murphy suggested that we think outside the box and be creative in our approaches to study early-age onset disease such as considering if environmental chemicals play a role. There are specific generations who are at higher risk. Do we need to consider earlier life exposure to specific chemicals? What about antibiotics, which may persist in the environment?  

The question of clinical care is also very important. Dr. Josh Demb shared work that is being spearheaded with by more than 10 research scientists through Fight CRC EAO CRC actions items, which include exploring global considerations for clinical care, understanding the knowledge gaps in screening and diagnostic workup, strength of association between symptoms, and better understanding of racial/ethnic disparities.

The voices of patients and advocates will be instrumental in the work ahead in explaining the barriers to care. Fight CRC was joined by one special advocate, Mrs. Carol Ahnen, wife of the late Dr. Dennis Ahnen. Carol joined DDW this year in continued support of Dennis’ legacy. 

The EAO CRC Work Must Continue!

Dr. Ahnen and countless others drove exploration with research questions that are helping us make great movement today. But the questions must continue. Questions drive us in our thinking and we need you all to join us in the inquiry.

While we are exploring the possible origin of what is causing EAO CRC, there is potential for us to use the tools we do have. Dr. Heather Hampel, shared data from a very energizing research effort, which Fight CRC was part of. The results note that 12% of early-age onset patients have a mutation in a cancer gene. With the work of Dr. Hampel and colleagues, it is now known that 16.4% of early-age onset colorectal cancer cases are potentially preventable (screening would have started more than five years before diagnosis). The change in United States Preventive Services Task Force screening guidelines to begin screening at 45 could result in earlier diagnosis for 41.3% of early-age onset colorectal cancer cases (those who are 45-49). The bottom line is there is so much already known that we can do to address early-age onset colorectal cancer; we absolutely must ensure we implement proven strategies!

Join us in June for More on EAO CRC

To continue this great work, please join us as we head over the pond (virtually) to meet up with Dr. José Perea and team in Spain on June 23 at 11am EST for the 4th Annual EAO CRC International Symposium.

Join collaborators from all over the world to apply what we learned at DDW and continue working toward a global approach to reduce the incidence of early-age onset colorectal cancer.

Dr. Perea presented data at DDW that 5% of patients with early-age onset colorectal cancer have a first-degree relative younger than age 50 with colorectal cancer or have two or more first-degree relatives with colorectal cancer. This could potentially impact screening guidelines. Since screening guidelines vary widely across countries and continents, we need to face the conversation from a global perspective.

As we continue these collaborations, we will always link back to our Path to a Cure Report and mobilize the discussions into real action.