Paulus on Factors Contributing to Earlier Onset of CRC in Younger Patients

"This is important for all patients diagnosed with CRC, but because we are seeing this real difference and gap for the early-onset patients, it warrants special attention."

Jessica Paulus, ScD, the senior director of Observational Research at Ontada, discussed factors that have contributed to an earlier onset of colorectal cancer (CRC), particularly in patients younger than 50 years of age.

Results from a real-world, retrospective analysis of such factors were presented at the 2025 ASCO Annual Meeting. Three major findings emerged from the analysis. First, racial and ethnic minority groups, including Black, Asian, American Indian, and Alaskan Native populations, showed higher incidences of early-onset CRC compared with those in the same populations diagnosed at the average onset age, Paulus reported. This disparity underscores the need to further examine the role of social determinants of health and genetic predisposition in disease presentation among younger individuals, she explained.

Second, investigators identified a higher prevalence of obesity at diagnosis among early-onset CRC cases compared with average-onset patients, Paulus detailed. Obesity is a well-established risk factor for CRC, and its increasing prevalence among younger patients may contribute to the shifting epidemiology of the disease, she said.

Third, and perhaps most clinically significant, early-onset CRC was associated with a 10% higher likelihood of being diagnosed at an advanced stage—specifically stage III or IV—compared with patients diagnosed after age 50, Paulus stated. This stage shift has direct implications for patient outcomes, as later-stage disease is strongly correlated with poorer overall survival, she noted. Paulus added that stage at diagnosis, particularly stage IV, emerged as the most significant predictor of survival across all age groups in this analysis.

The findings highlight an urgent need for improved strategies to promote earlier detection and diagnosis of CRC in younger populations, Paulus emphasized. Although delayed diagnosis is a concern across all age groups, the observed disparities and unfavorable stage distribution in early-onset CRC warrant focused efforts to address these gaps, she reiterated. Discussions following the presentation emphasized the importance of tailored screening approaches, increased awareness of CRC symptoms in younger individuals, and interventions aimed at mitigating modifiable risk factors such as obesity, she concluded