Early-onset colorectal cancer album |
Original Lancet
The Lancet Gastroenterology & Hepatology and The Lancet Oncology jointly released an album on early-onset colorectal cancer. A comprehensive overview of the epidemiology, clinical features, biology, and risk factors of early-onset colorectal cancer; disease prevention and early detection; and a discussion of the treatment and management of patients with early-onset colorectal cancer.
Editorial | Respond to the increasing incidence of early-onset colorectal cancer
The Lancet Gastroenterology & Hepatology published the first article on the album. As stated in a previous editorial [see related reading], the epidemiology of colorectal cancer has changed in recent decades: although the incidence of colorectal cancer in the elderly population has remained stable or declining, the number of new colorectal cancer patients in the population under 50 years of age worldwide, that is, early-onset colorectal cancer, is gradually increasing.
In the first article on the album, Swati Patel and colleagues conducted an extensive review of the epidemiology, clinical features, biological features, risk factors, and early detection of early-onset colorectal cancer. The reasons for the increase in incidence have not been fully elucidated. The available data show a cohort effect, with an increased risk of early-onset colorectal cancer in people born after the 1960s compared with previous generations. This finding suggests that a common risk factor for a generation may be responsible for an increased risk of disease. Trends such as obesity, sedentary lifestyles, Westernization of diets, and increased antibiotic use in early childhood and antibiotic use in the food chain may be major causes of increased risk. However, we need more in-depth research to fully identify and understand the complex interrelationship between exposure to risk factors and an increased risk of colorectal cancer so that we can come up with targeted prevention recommendations rather than just promoting the benefits of maintaining a healthy lifestyle. Compared with late-onset colorectal cancer, patients with early-onset colorectal cancer are often diagnosed with a progressionary phase. Part of the reason may be related to the time interval between the onset of symptoms and a definitive diagnosis, and the time interval between the onset of symptoms and a definitive diagnosis is generally longer in patients with late-onset colorectal cancer than in patients with late-onset colorectal cancer. One possible cause is that patients ignore the symptoms and do not see a doctor in time, or delay in assessing symptoms at community health care visits; Inadequate knowledge of hereditary cancer syndromes, inadequate documentation, awareness and communication of the family history of colorectal cancer, and our limited understanding of specific risk factors make risk-based screening for early-onset colorectal cancer not yet feasible. One option is to lower the recommended age at which the average risk population began screening, and the United States is at the forefront of this. In 2018, the American Cancer Society made a reasonable recommendation to lower the age at which screening should begin from 50 to 45; other relevant colorectal cancer screening guidelines in the United States have correspondingly lowered the recommended age. Opportunistic screening or population-based colorectal cancer screening is currently recommended in other countries, and the vast majority of countries recommend starting screening at age 50 years or older, which needs to be adjusted accordingly to local epidemiological conditions.
The second article on the album, written by Cathy Eng and colleagues, elaborates on the management of patients with early-onset colorectal cancer. In general, treatment and palliative care are the same for patients with early- and late-onset colorectal cancer, and the key to decision-making lies in potential side effects and long-term complications. We must recognize the impact of a diagnosis of early-onset colorectal cancer on a patient's life, and how early-onset patients differ from the concerns of older patients – for example, an unexpected cancer diagnosis can affect a person's academic or professional ambitions. Supportive measures should take into account not only the patient's physical health and symptoms, but also their mental and emotional health. Given the age of the patient, it is particularly important to have a compassionate discussion about fertility and reproductive health. Eng and colleagues also discussed one factor that is often overlooked in cancer care — its impact on patients' financial well-being. Young patients may have insufficient savings and assets, lack job security, or lack the family support that older patients have; we should also consider giving patients financial guidance and work assistance. Researchers are conducting studies to fully elucidate the causes and risk factors of early-onset colorectal cancer. The album proposes several currently available methods to address the increased incidence of early-onset colorectal cancer more quickly. Educating clinicians and the public about early-onset colorectal cancer is critical to ensuring timely diagnosis and initiation of treatment. We should re-evaluate and adjust existing screening guidelines based on additional evidence. Perhaps most importantly, a coordinated approach to comprehensive supportive care for patients with early-onset colorectal cancer focuses on the unique challenges they face. END