Early-Onset Gastrointestinal Cancers Surge Globally, Rising Faster Than Any Other Cancer Type in Young Adults

Early-onset gastrointestinal cancers are rising at alarming rates worldwide and, in the United States, are increasing faster than any other type of early-onset cancer, including breast cancer, according to two comprehensive literature reviews from Dana-Farber Cancer Institute published in JAMA and the British Journal of Surgery.

The surge extends beyond colorectal cancer to include gastric, esophageal, and pancreatic cancers among other less common GI malignancies. Early-onset GI cancer is typically defined as cancer diagnosed in adults younger than 50 years.

Dramatic Increase Across Multiple Cancer Types

Between 2010 and 2019, newly diagnosed cases of early-onset GI cancers rose by 14.8%, with the steepest increases observed in the youngest age groups. While cancer cases are highest among those aged 40 to 49, the rate of increase is progressively steeper in younger populations.

"Colorectal cancer is the most common early-onset GI cancer worldwide, accounting for more than half of the cases, but it is not the only GI cancer that is rising in younger adults," said Dr. Kimmie Ng, senior author of both reviews and director of the Young-Onset Colorectal Cancer Center at Dana-Farber. "Unfortunately, pancreatic, gastric, and esophageal cancers are also increasing in young people."

The data reveals striking generational differences in cancer risk. People born in 1990 are twice as likely to develop colon cancer and four times as likely to develop rectal cancer compared to those born in 1950. Recent Centers for Disease Control and Prevention data shows an even more dramatic trend, with colorectal cancer incidence more than tripling among 15- to 19-year-olds and nearly doubling among 20- to 24-year-olds.

Gender and Racial Disparities Emerge

The JAMA study documented significant increases in several early-onset GI cancers between 2018 and 2022, with particularly pronounced rises among women. Colon cancers increased 5% annually for women compared to 3.5% for men, while esophageal cancers surged nearly 6% yearly for women versus 1% for men. Stomach cancers rose approximately 4% annually for women and under 3% for men.

The British Journal of Surgery review highlighted that the rise in early-onset cases disproportionately affects Black, Hispanic, Indigenous populations, and women, underscoring significant health disparities in cancer incidence.

Critical Screening Gaps Despite Guidelines

Despite recommendations to begin colorectal cancer screening at age 45 for average-risk individuals, fewer than 1 in 5 (19.7%) U.S. adults aged 45 to 49 were screened in 2021, indicating a significant gap in early detection efforts.

"Screening adherence is absolutely critical," said co-author Dr. Thejus Jayakrishnan, also of Dana-Farber. "We have strong evidence that colorectal cancer screening saves lives by reducing both the number of people who develop colorectal cancer and the number of people who die from it. Each missed screening is a lost opportunity to detect cancer early when it is more treatable, or to prevent cancer altogether by identifying and removing precancerous polyps."

Risk Factors and Genetic Predisposition

The reviews identified several common risk factors associated with early-onset GI cancers. Modifiable lifestyle factors include obesity, poor diet, sedentary lifestyle, smoking, and alcohol consumption. Non-modifiable factors encompass family history and hereditary syndromes like Lynch syndrome.

Notably, the JAMA review found that 15% to 30% of these cancers have pathogenic germline variants, indicating a hereditary predisposition to developing cancer. Both reviews emphasize the importance of genetic testing for all patients with early-onset GI cancers to assess familial cancer risk and guide treatment decisions.

Treatment Challenges and Outcomes

Treatment approaches for early-onset GI cancers mirror those for later-onset cases, potentially involving chemotherapy, surgery, and radiation depending on cancer stage. However, patients with early-onset cancers often receive more aggressive treatment but may have similar or shorter survival rates compared to older patients.

The authors advocate for establishing specialized centers with multidisciplinary teams to support patients with early-onset GI cancers, addressing unique challenges such as fertility preservation, parenting concerns, and psychosocial distress.

Call for Enhanced Research and Prevention

"Taken together, these two reviews are a call to action for further research on why rates of GI cancers are increasing in younger adults," said Dr. Ng. "There is currently limited data available, especially in pancreatic, gastric, and esophageal cancers. This comprehensive look at what data exist can help raise education and awareness which is important because as a collective group, digestive system cancers account for a significant proportion of cancer-related deaths in younger adults in the U.S. and around the world."

The rising incidence of early-onset GI cancers underscores the urgent need for enhanced prevention strategies, improved early detection methods, and increased awareness among healthcare providers and the public about this alarming trend affecting younger populations globally.