Rise in early-onset gastrointestinal cancers drives need for better prevention and diagnosis

Although the treatment of gastrointestinal cancers is catching up with other branches of oncology and patients' prospects for survival and quality of life are improving, a significant increase in early-onset cases is raising new questions about effective prevention, diagnosis and treatment. This was the subject of much discussion at a press conference during the ESMO Gastrointestinal Cancer Congress 2024, taking place in Munich, Germany, from 26-29 June, moderated by ESMO Press Officer Ángela Lamarca of the Jiménez Díaz University Hospital in Madrid, Spain.

Early-onset gastrointestinal cancer: a growing concern

Gastrointestinal malignancies account for one-quarter of cancer cases and one-third of cancer-related deaths worldwide, with colorectal cancer being among the three most common tumors, causing more than 900,000 deaths annually. While the overall incidence of colorectal cancer has stabilized or decreased in high-income countries, these regions have seen a 51 percent increase in early-onset, i.e., annual new cases in individuals under the age of 50, since the 1990s. If this trend continues, which is likely to result in a poorer prognosis compared to later-onset disease, colorectal cancer could become the most deadly cancer in the 20-49 year old population by 2030.

The studies presented in Munich tend to confirm that younger patients with gastrointestinal cancers are more likely to be diagnosed at an advanced stage, which may be one of the reasons for the poor prognosis seen in this age group. Similarly, a study found that pancreatic cancer shows a more aggressive behavior, which results in a worse prognosis in younger individuals. In contrast, in the field of biliary tract cancer, young metastatic patients seem to have a better prognosis than older patients, since their tumors are more likely to have actionable genetic mutations, making them more suitable targets for personalized treatment.

With nearly 455,000 new cases of colorectal cancer to be diagnosed in Europe in 2022 (including 20,000 patients aged 18-49 years), ESMO President Andrés Cervantes highlighted the importance of a better understanding of the characteristics of this younger patient population and the risk factors to which they are exposed in order to develop effective strategies for prevention and early detection. Although inherited cancer risks such as Lynch syndrome increase the likelihood of early onset, these only account for a minority of diagnosed cases. Given the age shift observed in various gastrointestinal cancers and in high-income countries around the world, there is good reason to suspect that lifestyle-related factors such as a Western diet, reduced physical activity and antibiotic use may play a role, but these hypotheses still need to be scientifically confirmed.

From prevention to early diagnosis: Expanding the scope of gastrointestinal cancer screening

Gastrointestinal cancers, as a diverse group of diseases, are an area of ​​high unmet need overall, with delayed diagnosis remaining a common problem and leading to poor prognosis. “Gastrointestinal prevention and screening are problematic, with adherence to stool testing and colonoscopy recommendations across Europe ranging from 10% to 20%. Breast Cancer Screening “The rate is two to three times higher,” Cervantes stressed, calling for educational activities and collaboration with primary care physicians to increase awareness and acceptance.

Another pressing issue, according to Florian Roedick, editor-in-chief of the journal at the University of Leipzig in Germany, isThe biggest problem for ESMO Gastrointestinal Oncology is that screening programmes are currently focused on the older population. “In our clinic, we see a lot of younger patients with advanced colorectal and pancreatic cancer. It's important to have an intensive dialogue about what to do about this in terms of screening.” In particular, Mr. Rodick stressed the importance of raising awareness about family history of cancer and its impact among general practitioners and the public themselves, to ensure that high-risk individuals are identified and monitored in a timely manner.

What opens up new horizons in this field are technologies that can screen for cancers that are not yet clinically detectable.”Multi-cancer early detection tests, mainly in the form of blood tests, are attracting great interest as they enable earlier diagnosis of cancer patients, thus increasing the chances of cure.” Benedikt Westfalen, Chair of the ESMO Translational Research and Precision Medicine Working Group, from the Munich Comprehensive Cancer Center in Germany, said he sees potential for these non-invasive methods to increase uptake in gastrointestinal cancer screening, especially among younger populations.