Treatment of gastrointestinal (GI) cancers is catching up with other areas of oncology and offering patients better prospects for survival and quality of life, but a significant uptick in early-onset cases is raising new questions about effective prevention, diagnosis and treatment. This was the subject of much discussion at the press conference - moderated by Angela Lamarca, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain, ESMO Press Officer - of the ESMO Gastrointestinal Cancers Congress 2024 taking place in Munich, Germany, 26-29 June.
Early-onset GI cancers: A growing concern
Gastrointestinal malignancies account for one in four cancer cases and for one in three cancer-related deaths globally, with colorectal cancer being among the three most common tumor types and causing over 900,000 fatalities each year. Although the overall incidence of colorectal cancer has been stable or declining in high-income countries annual new cases of early-onset disease, i.e., in individuals below the age of 50, have risen by 51 percent in these regions since the 1990s. If this trend continues, seemingly associated with a worse prognosis compared to late-onset disease, colorectal cancer could become the deadliest cancer in the 20-49 demographic by 2030.
Research being presented in Munich tends to confirm that young GI cancer patients are more likely to be diagnosed at an advanced stage, a possible explanation for the poorer outcomes seen in this age group. Similarly, one study found that pancreatic cancer displays more aggressive behavior resulting in worse outcomes among younger individuals. In the area of biliary tract cancers, by contrast, young metastatic patients appeared to have a better prognosis than their older counterparts by virtue of being more likely to have actionable genetic alterations in their tumors making them eligible for personalised therapies.
With almost 455,000 new cases of colorectal cancer diagnosed in Europe in 2022, including 20,000 patients aged between 18 and 49 years, ESMO President Andrés Cervantes highlighted the importance of better understanding the characteristics of this young patient demographic as well as the risk factors they are exposed to in order to help design effective strategies for prevention and early detection. Hereditary cancer risks such as Lynch syndrome make early-onset disease more likely, but these only account for a minority of the cases diagnosed. As the age shift is observed for different gastrointestinal cancers and across high-income countries globally, there is good reason to suspect lifestyle-related factors such as the Western diet, low physical activity or use of antibiotics are playing a role, though these hypotheses still need to be scientifically confirmed.
From prevention to early diagnosis: Extending the reach of GI cancer screening
As a diverse group of diseases, gastrointestinal cancers remain overall an area with high unmet need and in which late diagnosis remains a common issue leading to poor outcomes. "We have a problem with prevention and screening in the GI field, where compliance with invitations to undergo stool testing or colonoscopies is lower than 30% across Europe, compared to adherence to breast cancer screening which is two to three times higher," Cervantes emphasized, calling for educational efforts and collaboration with primary care physicians to improve awareness and acceptance.
Another pressing issue, according to Florian Lordick, University of Leipzig, Germany, Editor-in-Chief of the journal "ESMO Gastrointestinal Oncology", is that screening programs currently focus on older populations: "We are seeing a lot of young patients with advanced colorectal, pancreatic cancers in our clinics, and it will be important to have an intensive exchange about what to do about this in terms of screening," he said. In particular, Lordick underlined the importance of raising awareness about family histories of cancer and their implications among general practitioners and citizens themselves, to ensure high-risk individuals are identified and monitored in time.
Opening up new perspectives in this area are technologies to screen for cancers that are not yet clinically detectable. "Multi-cancer early detection tests, mainly in the form of blood tests, are drawing a lot of interest to allow diagnosis of cancer patients at an earlier stage and increase their chances of being cured," said Benedikt Westphalen, Comprehensive Cancer Centre Munich, Germany, Chair of the ESMO Translational Research and Precision Medicine Working Group, who saw potential for these non-invasive methods to increase participation in GI cancer screening, particularly in younger age groups.
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