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Early-onset colorectal cancer is on the rise, but the usual culprits — smoking, alcohol, obesity, and common genetic variants — don't appear to be driving it in younger patients. A new study using data from the All of Us Research Program found that traditional risk factors are largely associated with late-onset disease (diagnosed at 50+), not early-onset. Researchers suspect novel environmental exposures or early-life factors may be to blame.
Colorectal cancer (CRC) is increasingly being diagnosed in people under 50, but a new study published in Diseases of the Colon & Rectum suggests the well-known risk factors aren't the ones fueling this trend. Researchers analyzed data from the All of Us Research Program and found that smoking, alcohol use disorder, BMI, and 283 common genetic variants showed no meaningful age-specific association with early-onset CRC — pointing to an entirely different set of drivers.
The study compared 485 early-onset CRC cases (diagnosed before age 50) with 1,970 late-onset cases, finding that traditional risk factors like heavy smoking and alcohol use disorder were significantly linked to late-onset disease but not early-onset. Family history of CRC was the one factor that cut across both groups equally.
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Why it matters: If traditional risk factors don't explain early-onset CRC, current screening and prevention strategies may be missing the mark for younger patients. Identifying the true drivers — likely novel environmental or early-life exposures — is critical to reversing this troubling trend.
