Hépato-Gastro & Oncologie DigestiveMENU
Early onset colorectal cancer: how to fight the epidemic? Volume 30, issue 2, February 2023
- Key words: age of onset, colorectal neoplasia, screening, prevention, epidemiology, risk factors, genetics, therapy
- DOI : 10.1684/hpg.2023.2529
- Page(s) : 180-94
- Published in: 2023
The incidence of colorectal cancer in people under the age of 50 (CRC<50) is increasing in the United States to the point where they will account for 12% of CRCs in 2020. A smaller increase is observed in most countries with high incomes and westernised lifestyles. In France, this phenomenon remains marginal: they represented less than 6% of CRCs in 2018. However, there is no doubt that this phenomenon will increase if it is true that the causes are essentially environmental: junk food, sedentary lifestyle, overweight and obesity being the main ones. CRC<50 have some specificities: late diagnosis, rectal and distal colonic location in 75% of cases, hereditary predisposition syndrome and/or family history of CRC present in one third of cases (Lynch syndrome in 8%). Their treatment is not specific and follows the usual recommendations. Particular attention must be paid to the consequences of the disease on fertility, sexuality and the quality of life of the survivors. Their prevention is based on the usual hygienic and dietary advice: Mediterranean diet, physical activity, fight against overweight and obesity, limiting alcohol consumption and stopping smoking. For a minority of individuals at high or very high risk, screening by colonoscopy is recommended: mainly hereditary predisposition syndromes, certain first-degree family histories of CRC and colonic localisations of inflammatory bowel diseases. For the majority of the population, there is currently no satisfactory screening strategy. Pending the advent of new biomarkers (genetic, microbial, volatile organic compounds, etc.), they should be subject to targeted, not codified screening, ideally by quantitative faecal immunochemical test, or by recto-sigmoidoscopy or colonoscopy. General practitioners and gastroenterologists should be aware and not overlook recent persistent symptoms in people under 50.