Individual Abstract within a Delegate Designed Symposium 2025 Joint Meeting of the COSA ASM and IPOS Congress

Call for specific young-onset colorectal cancer guidelines, data and care pathways (126381)

Sophie Boffa 1 , Makala Ffrench-Castelli 2 3 , Prasad Cooray 4 5 , Walter Cosolo 6 , Vicki Carson 7 , Mary-Ann Davey 8 , Rebecca J Bergin 9 10 11
  1. National Consumer Committee, ECORRA program, Deakin University, Melbourne, VIC, Australia
  2. Oncana, Brisbane, Qld, Australia
  3. PC4 Consumer Advisory Group, Primary Care Collaborative Cancer Clinical Trials Group, Melbourne, VIC, Australia
  4. Epworth Healthcare, Melbourne, VIC, Australia
  5. Department of Surgery, Austin Health, University of Melbourne, Melbourne, VIC, Australia
  6. John Fawkner Oncology, Melbourne, VIC, Australia
  7. Royal Women's Hospital, Melbourne, VIC, Australia
  8. Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, Australia
  9. Centre for Quality and Patient Safety Research, Institute of Health Transformation, Deakin University, Geelong, Vic, Australia
  10. Department of General Practice and Primary Care, University of Melbourne, Melbourne, Vic, Australia
  11. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia

Young-onset colorectal cancer (y-CRC), diagnosis under the age of 50 years, has seen a concerning rise in incidence over the past two decades. Australia has the highest incidence of
y-CRC globally with it being the deadliest cancer for those aged 25-44 years. Despite the severe mortality and morbidity of y-CRC, there are no specific diagnostic and treatment guidelines that adequately address risk thresholds and the unique biological, psychosocial, and clinical characteristics of younger patients.  Y-CRC patients are often diagnosed at advanced stages, necessitating y-CRC-specific diagnostic strategies and an innovative approach to the management of stage IV disease. Additionally, younger patients face complex life challenges, including fertility preservation, and require a nuanced and personalised model of care. 

A particularly under-addressed subgroup within y-CRC is pregnancy-associated colorectal cancer (p-CRC), diagnosis during pregnancy or within 12-months of delivery, which poses significant diagnostic and therapeutic challenges. Overlapping symptoms between pregnancy and colorectal cancer, such as anaemia, abdominal discomfort, or altered bowel habits often lead to delayed/misdiagnosis. Balancing maternal treatment with fetal safety complicates clinical decision-making, and there is limited guidance on optimal investigation and intervention modalities. The absence of basic incidence data for cancer in pregnancy and standardised protocols for managing p-CRC underscores the urgent need for evidence-based, multidisciplinary guidelines that incorporate obstetric, oncologic, and ethical considerations.

Developing targeted diagnostic and treatment guidelines for y-CRC (including p-CRC) is essential to improve timeliness of diagnosis and improve patient outcomes. Incorporating specific y-CRC risk stratification tools, biomarker testing, and survivorship planning into routine practice could enhance care delivery. Dedicated research, registry data, and clinical trials focusing on this cohort are critical to shaping the necessary guidelines, care pathways and associated supports that this patient group, and their treating teams, so desperately require.