Next steps in the international arena.
In October 2019, Andrea (Andi) Dwyer at the University of Colorado, Dr. Jose Perea at the Fundación Jiménez Díaz University Hospital in Spain, and Dr. Hisham Hussan from the Ohio State University released this editorial in response to the Fight CRC EAO Working group’s manuscript published in Gastroenterology in August 2019.
Experts meet to discuss colorectal cancer in young adults.
On February 1st, Fight Colorectal Cancer (Fight CRC) convened a working group composed of thought leaders, researchers, oncologists, and patient advocates in Denver, Colorado to examine research initiatives specifically aimed at investigating sporadic early-age onset colorectal cancer.
Since the mid-1990s, the number of new cases of colorectal cancer has been increasing among adults under 55 years old. Of those 20-54-year-old patients, mortality rates initially declined between 1970 and 2004, but took a turn and have been steadily rising every year between 2004-2014.
Early-Age Onset Colorectal Cancer is defined as colon and rectal cancers occurring in individuals under the age of 50.
The biggest issue, according to those in the field, is that no one knows why the number of cases in young adults is on the rise.
“Fight CRC is working to understand the research priorities and will work with funders and policymakers to ensure this research takes place. We want to go to our partners and say, here is the roadmap. This meeting will create that roadmap” says Anjee Davis, Fight CRC president.
What has Fight CRC previously done to address the rise in EAO CRC cases?
In May 2018, a manuscript published in Cancer informed guidelines that screening should begin at 45 years of age for average-risk adults. This publication was the result of the collaborative efforts of Fight CRC, the American Cancer Society (ACS), Memorial Sloan Kettering in the United States, and Erasmus University in the Netherlands.
The ACS’ new recommendations now suggest for those at average risk for colorectal cancer to lower the screening age from 50 to 45.
Lowering the screening age was an exciting step in getting at the cause of EAO CRC. Fight CRC continues to hear from our community of survivors, both the stories and impact that early-age onset colon and rectal cancers have in this population, and saw the need to convene a working group to further understand what is causing this rise in young adults. Fight CRC has a responsibility and commitment to pursue this issue and address the burden for all of those affected by colon and rectal cancers.
According to Andrea (Andi) Dwyer, Fight CRC’s Director of Health Promotion, in a joint appointment with the Colorado School of Public Health, “We created an approach to the meeting to figure out a means to identify and prioritize what is causing this dangerous increase in early-age onset colorectal cancer. Examining data and reducing the screening age for screening guidelines is essential but won’t tell us the reason why. It is our responsibility to explore the “why.”
— Reese FCRC (@ReeseFCRC) February 1, 2019
Next steps and research priorities
The workshop was an initial, fundamental step in continuing to examine early-age onset colorectal cancer.
Over 40 experts from the United States, the Netherlands, the United Kingdom, and Spain attended in person to collaborate and work with peers and patients. Disciplines ranged from epidemiology, biostatistics, and providers with expertise in screening and prevention, treatment, and molecular biology to name a few.
The four objectives of the meeting included:
- Determine the prioritized risk factors to be studied
- Determine the means by which we can study these priorities with existing studies and/or data repositories
- Determine the means by which we can study these priorities with new studies
- Understand the perspectives of policymakers and funders on our conclusions
According to Anil Wali, Program Director in the Integrated Networks Branch of the National Cancer Institute’s Center to Reduce Cancer Health Disparities (CRCHD), “it was a great event to hear the experts of colorectal cancer come together and discuss the state-of-the-science, causal factors, and proposed remedies in addressing early-age onset of malignancy among young adults from diverse racial/ethnic population groups.”
Where do we go from here?
Salient themes that emerged from the workshop included strategies to engage with the National Cancer Institute and the American Cancer Society regarding funding and policy opportunities, continuing to convene and engage working group members, taking a deeper dive into the existing data repositories, working to determine the major research priorities, and reporting out the day’s findings in necessary publications.
At the end of the day, this work and the subsequent research is for those that are facing the unnecessary burden of colorectal cancer. Andrea (Andi) Dwyer noted, ‘Hosting this meeting, critically examining the question of causation with world leaders, I can authentically tell patient and the parents, children, and spouses who have lost loved ones in the prime of their lives, we are doing something about this!”
“It was amazing to watch, listen, and participate in discussions, and to have my voice heard adding the patient perspective. All of the doctors came from different perspectives and areas of expertise in research and came up with many ideas and directions to head and as the day progressed. It was fascinating to see how the group could bring it all together to head in a similar direction.” -Karen Wehling, Stage IV CRC survivor
Alongside our community of fighters, champions, and survivors, Fight Colorectal Cancer will continue to advocate for the best research and funding to understand the rise in EAO CRC.
— Reese FCRC (@ReeseFCRC) February 1, 2019
Fight CRC is actively bringing together experts and funding research to get to the bottom of why we’re seeing a rise in CRC in young adults.
The Early Age Onset #ColorectalCancer Twitter account is LIVE! This account is the collaborative efforts of the #FightCRC EAO #CRC workgroup. Be sure to follow @EarlyOnsetCRC on twitter for the most up to date research in early age onset CRC! #EAOCRC https://t.co/DIKibkCdAK pic.twitter.com/YYcYxFJIcR
— Fight Colorectal Cancer (@FightCRC) May 31, 2019
Be sure to follow the new Early Age Onset CRC twitter account at @EarlyOnsetCRC! As part of the next steps from this meeting, researchers highlighted the need to have a centralized location to communicate the latest research updates in #EAOCRC.
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