Table 4.
Roadmap of strategies to reduce the public health burden of early-onset CRC.
| Theme | Strategy | Note |
|---|---|---|
| 1: Education | 1.1: Educate physicians, other healthcare workers, and general individuals to raise awareness of early-onset CRC. | This can be implemented. |
| 2: Screening | 2.1: Expand genetic testing for individuals with family history of CRC. 2.2: Conduct research to create and refine prediction models for early-onset CRC. 2.3: Evaluate available evidence and screening guidelines for early-onset CRC. 2.4: Develop personalized screening strategies. |
Further research, including comparative effectiveness research, is needed. |
| 3: Etiological research | 3.1: Utilize existing resources to study etiologies. 3.2: Design additional studies, including life-course cohort studies, combined with biospecimen collections and omics analyses. 3.3: Study genetic and epidemiologic risk factors, including early-life exposures, (and GxE interactions) for early-onset CRC. 3.4: Study etiological mechanisms using experimental model systems. |
Determination of risk factors and their effect sizes can help us improve primary, secondary, and tertiary prevention strategies. |
| 4: Clinical care and research | 4.1: Set up specialized centers, units, and/or clinics focused on early-onset CRC, to deliver improved care. 4.2: Conduct clinical trials to determine personalized treatment strategies. 4.3: Communicate with early-onset CRC patients regarding treatment options and considerations as well as implications for potential familial risks. |
Randomized clinical trials integrated with assessments of tumor characteristics (including tissue microbiota and immunity) are needed. Genetic, fertility, and social counseling may be indicated for patients. |
Abbreviation: CRC, colorectal cancer; GxE, gene-by-environment.