Strategies to Curb the Increasing Burden of Early Onset Colorectal Cancer

The incidence of early onset colorectal cancer (EoCRC), defined as colorectal cancer (CRC) in patients under age 50, has been increasing in the United States. This is due to a birth cohort effect in which the younger generation has experienced an accelerating rise in EoCRC for reasons currently unknown, although epidemiologic research points to several traditional and emerging generation-specific risk factors. There are several racial/ethnic and geographic differences in the presentation of EoCRC with disparate outcomes. A subset of EoCRC patients have a familial or hereditary cause of EoCRC, although the etiology for most EoCRC remains to be discovered. Our current approach to prevention and early detection includes early screening for familial CRC, germline genetic testing for all cases of EoCRC, triage of alarm symptoms with prompt evaluation of red flag signs and symptoms (such as hematochezia, iron deficiency anemia, and unexplained weight loss), offering a menu of average-risk screening options to those age 45 and older, and performing outreach/navigation to improve opportunistic screening uptake. Unfortunately, full actualization of these approaches remains suboptimal, and the increasing burden of EoCRC demands immediate action. Opportunities to improve prevention and early detection of EoCRC include initiating organized screening approaches through leveraging the electronic health record, centralization of care in medical homes, outreach using blockchain or social media technology, and biotechnological innovations in diagnosis and risk stratification.