How Dana-Farber’s Young-Onset CRC Center addresses the medical, emotional and practical needs of younger patients.
Thejus (TJ) Jayakrishnan, MD, a gastrointestinal oncologist at Dana-Farber Cancer Institute, wasn’t surprised by a recent American Cancer Society study showing that while overall cancer mortality among Americans under 50 has declined, colorectal cancer rates have risen. In fact, colorectal cancer incidence has steadily increased since 2005 and, by 2023, became the leading cause of cancer death among Americans under 50.
“The increase in colorectal cancer among younger adults is something we’ve been noticing over the last several years,” said Dr. Jayakrishnan, who treats patients at Dana-Farber’s Young-Onset Colorectal Cancer (CRC) Center, led by Dr. Kimmie Ng. “The creation of a dedicated center reflects how urgently this trend needs focused clinical care and research.”
The reasons behind the surge in cases are still largely unknown, though researchers have identified several potential contributing factors. One pattern, known as a “birth cohort effect,” suggests that successive generations face higher risks of developing colorectal cancer before age 50. “Because this increase is happening over generations, it’s likely related to environmental exposures – changes in diet and lifestyle,” Dr. Jayakrishnan said. Studies have linked risk to factors such as consumption of sugar-sweetened beverages, ultra-processed foods, obesity, sedentary lifestyles, alcohol use, and smoking.
Yet these known factors don’t tell the whole story. “I see patients who are physically fit and lead active lifestyles, and they still develop young-onset colorectal cancer,” Dr. Jayakrishnan said. Other potential contributors, including exposure to microplastics and pollution, are still under investigation, and the complex ways these environmental factors may interact remain unclear.
Emerging research also points to differences in the gut microbiome between younger and older patients with colorectal cancer, though how these changes affect disease progression and treatment is not fully understood. “We are beginning to see that young-onset colorectal cancer often presents more aggressively and may not respond to treatments as well as cancers diagnosed at the typical age of onset,” Dr. Jayakrishnan said. “We don’t yet know why this is, which makes it a critical area for research.”
For now, the rise of colorectal cancer in younger adults underscores the need for vigilance, awareness and continued investigation. Physicians and researchers hope that by identifying the underlying causes, from lifestyle factors to environmental exposures and microbiome differences, they can develop more effective prevention strategies and treatment options for this vulnerable population.
“Ultimately, we need more research to understand the disease and design better treatments for younger patients,” Dr. Jayakrishnan said. “The goal is to improve outcomes and, hopefully, prevent these cancers from developing in the first place.”
Addressing the full spectrum of young-onset CRC
At the Dana-Farber Young-Onset CRC Center, care goes far beyond treating the disease itself. The center was designed to address the unique challenges faced by patients under 50, a population often confronting not only cancer but complex personal, professional, and psychosocial issues.
“When Dr. Kimmie Ng developed the Young-Onset CRC Center, the team conducted a study to understand patients’ experiences and needs,” said Dr. Jayakrishnan. “Through the study we learned that younger patients face challenges ranging from navigating careers and financial pressures to fertility concerns and long-term treatment toxicity. Therefore, the center was designed with a mission to address all of these factors.”
A hallmark of the center is its multidisciplinary approach. Patients meet with medical oncologists, surgeons and radiation oncologists who specialize in young-onset CRC. Genetic counseling is also a key component, as younger patients are more likely to have inherited cancer syndromes than older individuals. “Even though most patients do not have a genetic predisposition, we make sure those who do – and their families – receive appropriate screening and guidance,” Dr. Jayakrishnan explained.
Fertility preservation is another focus. Patients receive consultations with reproductive health specialists to explore options for having children in the future and provide counseling regarding sexual health. Dedicated social workers help patients manage psychosocial stressors, from mental health concerns to the emotional toll of cancer during a formative stage of life.
Research and clinical trials are integrated into the care model. “Many young patients are motivated to participate in research. We provide access to studies that explore risk factors, biomarkers, and response to treatment, as well as opportunities to enroll in clinical trials,” Dr. Jayakrishnan said.
By addressing the medical, emotional and practical aspects of cancer care, the Dana-Farber Young-Onset CRC Center is setting a new standard for treating younger patients. “Our approach ensures patients aren’t just treated for cancer – they’re supported as individuals navigating a complex and challenging life stage,” Dr. Jayakrishnan said.
Early screening: Promises and barriers for young adults
The U.S. Preventive Services Task Force (USPSTF) made headlines in 2021 when it lowered the recommended age for colorectal cancer screening from 50 to 45. While the move was widely seen as a proactive step, the impact on outcomes is still emerging.
“It may be too early to see a measurable effect,” said Dr. Jayakrishnan. “Adherence to screening is still not 100%, and the benefits of colonoscopy take years to manifest. Research is ongoing to determine whether this change will help reduce rates of advanced colorectal cancer through early detection.”
International data provide some optimism. Countries such as Austria and Italy which have implemented early-onset colorectal cancer screening programs, have reported improvements in early detection and a decline in incidence of young-onset CRC. In the U.S., similar population-level effects are still being studied.
For younger adults, however, barriers to screening remain significant. “Younger adults are often at a stage of life where they’re establishing careers, raising families, or may lack insurance coverage,” Dr. Jayakrishnan explained. “Colonoscopy requires time off work, and many people in this age group haven’t had major hospitalizations, so awareness of personal risk can be limited.”
The consequences of these barriers can be severe. Dr. Jayakrishnan has seen patients diagnosed at stage four – sometimes with minimal symptoms – during their first screening. “Early screening can make a difference, but awareness and access are critical. Overcoming logistical, financial, and educational barriers is key to ensuring more young adults get screened in time,” he said.
As the medical community continues to study the effects of earlier screening, experts emphasize that education and access may be just as important as lowering the screening age itself. Awareness campaigns and patient outreach could help ensure that the promise of early detection translates into tangible outcomes for younger adults at risk.
Technology, innovation, and awareness
As colorectal cancer continues to rise among adults under 50, researchers and clinicians are exploring how technology and innovation can change the trajectory of the disease. For Dr. Jayakrishnan, the next five to ten years hold both promise and challenges.
“One area that’s generating a lot of discussion is whether the screening age should be lowered even further,” Dr. Jayakrishnan said. “On an individual level, expanding screening may seem intuitive, as it would allow more people to be tested. However, there are important considerations regarding cost-effectiveness at the population level, and this remains an active area of evaluation within health policy.”
To address these concerns, Dana-Farber and other institutions are engaged in research that may inform risk-stratified screening, which uses machine learning and artificial intelligence (AI) to identify individuals at higher risk. By analyzing environmental exposures, diet, lifestyle factors, microbiome characteristics, and genetic markers, these tools aim to pinpoint who may benefit from earlier screening, rather than screening everyone in a broad age group.
“AI is also helping us study biomarkers and molecular characteristics more efficiently,” Dr. Jayakrishnan explained. “For example, we’re analyzing the microbiome of patients with young-onset colorectal cancer, intending to identify molecules produced by microorganisms that may drive cancer development. The goal is to develop interventions that can block these mechanisms and potentially prevent disease.”
Advances in targeted therapies are also encouraging. Recent clinical studies presented at gastrointestinal oncology conferences have demonstrated new treatments that attack specific molecular targets in colorectal tumors. These approaches may reduce side effects compared with traditional chemotherapy while providing more effective disease control. “These innovations are promising for all patients with colorectal cancer, including younger adults,” Dr. Jayakrishnan said.
Despite the promise of technology, Dr. Jayakrishnan emphasizes that awareness and timely evaluation remain critical. Many young-onset colorectal cancers are detected only after symptoms appear, such as blood in the stool, persistent abdominal pain, or changes in bowel habits. “Patients and primary care physicians need to take these symptoms seriously,” he said. “Early evaluation can make a major difference in outcomes.”
The Dana-Farber Young-Onset CRC Center cares for patients who have already been diagnosed with colorectal cancer and provides education about risk assessment and prevention for family members. Patients and their relatives are advised to discuss appropriate screening options with their primary care providers, including alternative screening technologies, such as stool-based tests like Cologuard, which detect tumor-related DNA, and emerging blood-based multi-cancer detection tests that can trigger colonoscopy when abnormalities are found. These tools expand options for early detection and may play an increasing role in identifying cancers before they progress.
The Dana-Farber Young-Onset CRC Center offers comprehensive, multidisciplinary care to individuals diagnosed with this type of cancer. Patients can access specialists in medical oncology, surgery, radiation, reproductive health, and psychosocial support. Fertility preservation consultations, genetic counseling, and guidance on long-term treatment effects are integrated into patient care. Clinical trials across medical, surgical and radiation oncology are also available, allowing patients to explore innovative treatments.
“The Young-Onset Center is one of the first of its kind in the world and remains one of the few dedicated to this population,” Dr. Jayakrishnan said. “Even patients receiving treatment elsewhere can benefit from second opinions, and consultations, and have access to opportunities for enrollment in clinical trials. Addressing the unique challenges of younger patients — medical, emotional, and practical – is at the heart of our approach.”
As research advances and new tools become available, Dr. Jayakrishnan remains cautiously optimistic. “We’re making progress in detection, treatment, and understanding the biology of young-onset colorectal cancer. But awareness, timely screening, and multidisciplinary care are just as important as technology. For anyone under 50 experiencing persistent symptoms, seeking evaluation promptly can save lives.”