Fight Colorectal Cancer (Fight CRC) is excited to award this year’s research grant to Dr. Christine Molmenti from the Feinstein Institute for Medical Research at Northwell Health and Heather Hampel from The Ohio State University. Their research, titled “A feasibility study to determine history of advanced adenoma(s) among first-degree relatives of early onset colorectal cancer patients participating in the Ohio Colorectal Cancer Prevention Initiative” ultimately aims to determine the prevalence of advanced adenomas among first degree relatives of Early Age Onset (EAO) colorectal cancer (CRC) patients. To better understand this landscape, investigators will initially study how easy it is to recruit 50 EAO patients, contact their first-degree relatives, collect medical data, and determine the accuracy of self-report colonoscopy results from first-degree relatives. This will serve as a jumping off point to inform a larger study in the future which will estimate the prevalence of advanced adenoma among first-degree relatives (FDR) in a larger early-age onset CRC cohort.
According to Dr. Dennis Ahnen from the University of Colorado Cancer Center and a steering committee member for the National Colorectal Cancer Roundtable (NCCRT), “this project arose out of discussions among members of the Family History and Early Onset CRC Task Group of the NCCRT and is a good example of the importance of collaborative efforts between organizations like the NCCRT, Fight CRC and researchers

Anjee Davis, Fight CRC president and Andrea (Andi) Dwyer, Fight CRC Director of Health Promotion are also on the NCCRT Steering Committee and work alongside experts at the table to bring research like this to life!

Why Study EAO?

Colorectal cancer has been declining in those over the age of 50 for the past three decades. Recently however, the incidence rates in those under the age of 50 have been rising--so much so that predictions expect colon cancer cases to increase by 90% and rectal cancer cases to increase by 124% in young adults by 2030.

What We Know About EAO CRC Development

Although we don’t know why there is an increase in the number of EAO CRC cases, there are a few things we do understand that may help us better understand the disease, and how to best approach prevention and treatment. It’s been established that the majority of EAO CRC cases arise from polyps, which are non-cancerous small clumps of cells that grow in the lining of the bowel. Polyps can also be classified as adenomas, also known as adenomatous polyps. This type of polyp can have varying growth patterns, some more indicative of cancer than others. An adenoma becomes classified as advanced when the polyp is larger than one centimeter, has a certain growth pattern, and has characteristics of high-grade dysplasia (looks like cancer).

It’s highly recommended that advanced adenomas be removed due to their ability to develop into cancer. This can be done during a colonoscopy. If adenomas are detected during a CT colonography screening, a follow up colonoscopy should be performed to fully remove the polyp.

This study will serve as a starting point to begin understanding the prevalence of advanced adenomas in the early-age onset CRC population.

First-Degree Relatives

First-degree relatives (FDRs), defined as a biological parent, sibling, or child of individuals diagnosed with advanced adenomas are at a higher risk for developing colorectal cancer compared to those that do not have a first-degree relative, irregardless of the age at diagnosis. This risk increases with the number of family members diagnosed with advanced adenomas. According to Hampel and Molmenti, “the prevalence of advanced adenoma among FDRs of EAO CRC patients is currently unknown, yet we suspect family history of advanced adenoma plays an important role in the development of early age onset CRC”. The researchers state that understanding the familial link between advanced adenomas in EAO CRC cases is necessary to lowering the incidence and mortality.

Conducting the Research

Over the course of 12 months, researchers will contact and enroll 50 EAO CRC probands through the Ohio Colorectal Cancer Prevention Initiative (OCCPI).

A proband is the person who serves as the starting point in a genetic study.

They will then obtain contact information for the FDRs related to the initial person, enroll the FDRs in the study, and collect and verify colonoscopy results for those family members who had received a colonoscopy before the proband’s diagnosis. The purpose of these efforts is to understand how feasible it is not only to obtain information from the primary patient (proband), but also their first-degree relatives ultimately equipping researchers with the necessary knowledge to be able to design a large-scale study.

Clinical Implications

This type of research is extremely important for colorectal cancer survivors, caregivers, and those at an increased risk of developing the disease.
Dr. Ahnen states, “if they [Hampel and Molmenti] are able to determine what percent of this group has a first degree relative with advanced precancerous polyps, it will help define the magnitude of the contribution of familial and hereditary syndromes to early onset CRC and highlight the importance of earlier screening in these groups.”
Investigators believe that this research will raise awareness among gastroenterologists (GI) and primary care physicians (PCP) to improve polyp finding communications to patients and family members- ultimately encouraging proper screening guidelines adherence and follow up.
According to Hampel, “Research on early-onset colorectal cancer is critically important so that we can identify the risk factors and work toward prevention. In this case, we would like to identify what proportion of EAO CRC is potentially preventable. We know what proportion of EAO CRC patients has a hereditary cancer syndrome and or a family history of colorectal in a first-degree relative. Now, we would like to know what proportion of EAO CRC patients has a first-degree relative with an advanced adenoma. These cancers are potentially preventable if the familial risk factor is identified and earlier cancer surveillance is initiated.”
Seeing the need to advance our understanding of early-age onset CRC, Fight CRC is convening a workgroup with global experts to prioritize next steps in research. Be sure to follow @FightCRC on Twitter and Fight Colorectal Cancer on Facebook to receive the latest updates on EAO research! Fight with us and donate today to keep these vital efforts going!

Nov. Webinar – Research Update: advanced adenomas among first degree relatives of Early Age onset CRC patients

Fight CRC has funded Dr. Christine Molmenti from Northwell Health and Dr. Heather Hampel from The Ohio State University Comprehensive Cancer Center to research the feasibility of determining advanced adenoma(s) history among first degree relatives of early onset colorectal cancer patients. In this month’s webinar, Dr. Molmenti and Andrea (Andi) Dwyer from Fight CRC and University of Colorado, will explain why the research is important, how Fight CRC is involved, and how the results could have clinical implications. [button] Register Now! [/button]