Rising Early‑Onset CRC Rates in Asia Underscore Global Trend in Incidence and Need for Coordinated Research Efforts

The growing prevalence of early‑onset colorectal cancer CRC) highlights the need for greater understanding of its epidemiology and biology in diverse populations, particularly across Asia, where data remain limited, and this gap in knowledge prompted an analysis of early-onset CRC within a large, multiracial cohort in Singapore, according to Evelyn Y. Wong, MD.

In an interview with OncLive®, Wong discussed the rationale for evaluating early-onset CRC incidence, molecular characteristics, and survival outcomes in this Asian cohort. Key findings from the analysis presented at the 2025 ESMO Gastrointestinal Cancers Congress showed that a greater minority representation (P < .0001), aggressive histology (P = .0022), and fewer APC mutations (P = .0167) were observed among patients in the early-onset cohort (n = 212) compared with the late-onset cohort (n = 2167).

Wong also highlighted the implications for global research efforts into the rising incidence of early-onset CRC and outlined the importance of multicenter collaborations and prospective data collection to better characterize this growing patient population and inform future clinical trial design.

Wong is a consultant medical oncologist specializing in gastrointestinal cancers at the National Cancer Centre Singapore.

OncLive: What was the rationale for conducting this study on the incidence of early‑onset CRC in 2025 in a multiracial Asian cohort?

Wang: What really made me want to explore more [about] the concept of early‑onset CRC was the patients we were seeing [in] the clinic. A lot of people [with early-onset CRC were] asking the question, ‘Why me? What is it about my disease?’ And there [were] a lot of questions about [whether early-onset CRC] is genetically predisposed, or if there something more [going on] at this point [in] time.

Most of us feel that the evidence is multifactorial. There are a lot of factors that influence [whether] young‑onset CRC [develops in] a patient [and] why he or she could have this disease.

What I wanted to do [was] study [this incidence] in an Asian cohort, especially one that is multiracial, like [we have] in Singapore, to see whether there [are] differences in the molecular characteristics and the survival patterns of our early‑onset population as compared with our late‑onset patients.

How was this study designed, and what methods were used to evaluate molecular characteristics and survival outcomes in this cohort?

We had [2379] patients from a consented cohort within Singapore that we analyzed for both survival data and molecular characteristics. It would be great if we could have more patients, not just within 1 nation, but through multicenter collaborative efforts across academic institutions. More importantly, it would be valuable to have prospective data.

A lot of the current studies in early‑onset CRC are trying to address the question of why [by] looking at the epidemiology, understanding how it may influence molecular features, and exploring whether there are specific trials that could be designed exclusively for patients with early‑onset CRC.

[These data] add to the evolving field of early‑onset CRC, and, more importantly, raise awareness of this disease not just among researchers, but also within pharmaceutical companies and patient advocacy communities. We need these groups to speak up and engage more actively in this disease area.

[From the] clinical perspective, we recognize that patients are often looking for others they can relate to, people of a similar age with similar needs and experiences. Having this paper and presenting it on an international stage is important to communicate that early‑onset CRC is not only a rising epidemiologic trend in the United States, but is also increasingly seen in Asia and in many other countries across Southeast Asia.

What were the key survival outcomes and molecular characteristics observed in your analysis of early‑onset CRC within this multiracial cohort?

The top finding is that there was actually not much difference in the molecular characteristics of early-onset CRC compared with late-onset disease. This has also been reported in multiple published studies by Memorial Sloan Kettering Cancer Center, and many other [institutions in] the United States have published similar studies, showing that there is not much difference in molecular characteristics.

The question then becomes: why are these younger patients developing the disease in the first place? Epidemiological studies are more challenging to conduct, as they require prospective cohorts. One of the aims of my study was to determine whether there were differences in outcomes because there is a general belief that early-onset CRC tends to have a worse prognosis.

However, in this cohort, we found that patients with early-onset CRC actually had better outcomes [median overall survival (OS), 34.6 months] than those with late-onset disease [median OS, 28.8 months]. I suspect this may be due to the fact that younger patients are generally able to tolerate more intensive chemotherapy and treatment options.

Finally, we wanted to assess whether the observed differences in survival outcomes were related to age itself. To address this, we incorporated a cancer-specific survival calculation into the study, and we still found that early-onset patients had better outcomes than patients with late-onset disease.

With these findings in mind, what points should international clinicians be aware of regarding early-onset CRC prevalence and treatment?

One of the things that I feel we could do better, particularly regarding molecular characteristics, is to have multicenter collaborations. The limitation of this current study is that, although we have more than 2000 patients, which is a very large number, it still [used] data from a single institution. It would always be better to have collaborative efforts, not only within Asia, but also internationally.

Another interesting area would be to explore whether we can relate specific molecular characteristics to exposures during early childhood, and [then analyze] how these exposures may influence cancer development or predispose patients to particular tumor molecular profiles. This type of research cannot be done retrospectively; it must be conducted prospectively.

It is encouraging that many academic centers are starting to discuss this topic and that various groups are becoming engaged in this research space. Hopefully, these efforts will lead to collaborations that can strengthen future studies. I am glad to contribute to raising awareness of early-onset CRC and the need for global cooperation in understanding and addressing it.

Reference

Wong EYT, Boon TS, Hui LRC, et al. Survival outcomes and molecular characteristics of early-onset colorectal cancer patients (EOCRC): A multiracial cohort. Presented at: 2025 ESMO Gastrointestinal Cancers Congress; July 2-5, 2025; Barcelona, Spain. Abstract 77P.