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The conundrum of colorectal cancer: it increases alarmingly in the young and decreases in the elderly

2023-03-16T19:25:44.415Z


Incidence soars 3% per year in people under 50 in some wealthy countries, with unknown causes Experts from half the planet are warning of a disturbing phenomenon. Colorectal cancer cases are declining in older people, but skyrocketing globally in those under 50. The incidence has increased at an "alarming" rate of around 3% each year in many countries, with even faster increases in those under 30, according to two of the world's leading specialists, Kimmie Ng and Marios Giannakis of the Da


Experts from half the planet are warning of a disturbing phenomenon.

Colorectal cancer cases are declining in older people, but skyrocketing globally in those under 50.

The incidence has increased at an "alarming" rate of around 3% each year in many countries, with even faster increases in those under 30, according to two of the world's leading specialists, Kimmie Ng and Marios Giannakis of the Dana-Farber Cancer Institute, in Boston (United States).

The causes of this enigmatic process are intuited, but are unknown.

Oncologist Kimmie Ng says she sees it every day at her hospital.

“We have spent many years seeing more and more patients, very young, who are admitted with already metastatic colorectal cancer, many of them without genetic predisposition or obvious risk factors,” she points out.

They are women and men in their twenties, thirties or forties who have had non-specific symptoms —such as constipation or diarrhea— for months, without anyone suspecting cancer at their age.

The doctor considers the situation "extremely worrying" and urges the scientific community to unite to understand what is happening.

Her call to action is published Thursday in the journal

Science

.

Colorectal cancer, responsible for the death of almost a million people each year, is the second most lethal in the world, behind lung tumors.

The team led by Rebecca Siegel, chief scientist of the American Cancer Society, already warned in 2019 that this cancer was increasing in those under 50 years of age in at least 19 countries.

In a dozen of them, these tumors decreased in people over 50 years of age, but increased rapidly in younger adults, as occurs in New Zealand (4% per year), the United Kingdom (3.3%), Canada (2.8%), Australia (2.8%), United States (2.2%), Sweden (1.6%) and Germany (1.3%).

We have been seeing more and more very young patients for many years

Kimmie Ng, oncologist

The two researchers from the Dana-Farber Cancer Institute acknowledge that the exact reasons for this phenomenon "are unknown", but they list the main hypotheses.

“We suspect that environmental factors, such as diet and lifestyle, contribute,” explains Kimmie Ng.

“We have identified obesity, a sedentary lifestyle, increased consumption of sugary drinks, and vitamin D deficiency as risk factors,” she points out.

In Spain there is no national cancer database, because no government has dedicated resources to it, but there are a couple of dozen local registries, covering 27% of the country's population.

The president of this Spanish Network of Cancer Registries, the epidemiologist Jaume Galceran, points out that none of the three large European countries of the western Mediterranean —Spain, Italy and France— has detected an increase in incidence rates, at least of moment.

Galceran details that the figures for colorectal cancer remain "stable" in Spain, with one annual case for every 15,000 people under 50 years of age, according to their data, from the period 2002-2016.

However, as the epidemiologist acknowledges, there are hardly any local records in the center and south of the country, where some of the regions with the greatest problems of childhood and youth obesity are concentrated.

Galceran, responsible for the Tarragona Cancer Registry, urges the Spanish authorities to bet on a single national registry.

"It's a matter of will and resources," he says.

The epidemiologist does not rule out that this rebound in cases of colorectal cancer among young adults ends up reaching Spain, a country where obesity and a sedentary lifestyle are growing, as happened decades ago in the United Kingdom and the United States.

Oncologist Ana Fernández Montes, from the Ourense University Hospital Complex, believes that it is already happening.

“In Spain we do not have a national registry that tells us that the incidence is increasing, but we do have the perception that it is happening.

We have more and more young people.

I have a 36-year-old boy right now, ”she explains.

The same thing will happen here, due to the lifestyle habits we lead

Ana Fernández Montes, oncologist

Fernández Montes, a member of the board of directors of the Spanish Society of Medical Oncology, fears the rate of growth observed in countries like the United States.

"It's a barbarity.

And the same thing will happen here, because of the lifestyle habits we lead.

We are already seeing an alarming increase in young people”, he affirms.

The oncologist herself recalls a recent US study that suggested that drinking two or more sugary drinks a day doubles the risk of suffering from colorectal cancer before the age of 50.

"The message is that you have to have healthy lifestyle habits: exercise, not drink sugary drinks, avoid ultra-processed products," proclaims the doctor.

The biotechnologist Cayetano Pleguezuelos mentions other protagonists: the bacteria of the digestive system.

"From my perspective, the most suspicious factor are changes in the intestinal microbiota," says this Spanish researcher at the Hubrecht Institute in the Netherlands.

His team was the first to demonstrate a direct connection between these bacteria and the DNA damage in human cells that causes cancer.

Pleguezuelos explains that junk food itself changes the composition of the bacterial communities in the intestine, but acknowledges that science in this field is in its infancy.

“We still don't know exactly what factors contribute to these changes in the microbiota or what bacteria [are linked to cancer],” he admits.

The biotechnologist collaborates with Kimmie Ng herself in an international consortium, called Optimisticc, to investigate the impact of gut microbes on colorectal cancer.

In October, a group from Yale University pointed to the bacterium

Morganella morganii

, common in the human intestine, as the suspected cause of these tumors.

Oncologists Kimmie Ng and Marios Giannakis predict that by 2030 early-onset colorectal cancer will become the leading cause of cancer death in people aged 20 to 50.

The authors suggest reinforcing early detection programs in young adults, as has already been done in the United States, where tests for hidden blood in feces are recommended starting at age 45.

In Spain, these tests are done from the age of 50.

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Source: elparis

All news articles on 2023-03-16

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