Challenge: Determine why the incidence of early-onset cancers in adults is rising globally
Since the mid-20th century the incidence of early-onset cancers, defined as cancers diagnosed in adults under 50 years of age, has been rising globally.
In this demographic, cancers in the bone marrow, breast, colorectum, endometrium, extrahepatic bile duct, gallbladder, head and neck, kidney, liver, oesophagus, pancreas, prostate, stomach, and thyroid have increased globally. Some of this may be attributed to the increased implementation of screening programmes, but this does not explain the full picture.
Changes in the exposome and the environment in recent generations may in part explain this observation, including changes in diet, the microbiome, physical activity, obesity, alcohol consumption, sleep patterns, antibiotics use, stress levels, pollution, or environmental contaminants among others.
Understanding and preventing the increase in the incidence of early-onset cancers is now critical to address this emerging global health problem.
Barriers and opportunities
To address the emerging issue of early-onset cancers, we need to understand the mechanisms linking lifetime exposures in multiple cancer types with cancer initiation and promotion.
Examples of the questions that could be addressed in this challenge include but are not limited to:
Can we elucidate the mechanisms linking exposure types to cancer initiation and promotion, to explain the lack of an obvious mutational burden on many of the patients with early-onset cancer?
Will the use of data and samples from existing prospective cohorts enable us to understand the impact of environmental insults, particularly early in life?
Can we gain a better understanding of early-onset cancers from a genetic, genomic, epigenomic, transcriptomic and immunologic point of view?
To address this challenge, proposals could include pilot interventional studies on how to implement risk stratification and risk reducing interventions in younger populations.
Vision and Impact
The goal of this challenge is to gain a robust understanding of the mechanisms underpinning the biological and environmental causes behind the global phenomenon of early-onset cancers. Addressing this challenge will require an inter-disciplinary team that could include epidemiologists, biologists, environmental scientists, geneticists, and optimally could involve oncologists from high-, middle-, and low-income countries.
If we better understand the mechanisms by which changes in the exposome lead to higher cancer burden at a younger age, translatable interventions that may reduce the associated morbidity and mortality may be designed subsequently. Please note that the development and testing of interventions are not required in proposals.
Plain language summary: Why early-onset cancers?
Since the 1950s, the incidence of some cancer types in adults younger than 50 years old has been rising. This trend cannot be explained by the increase in screening programmes alone. The incidence of these ‘early-onset’ cancers – including a variety of types, such as bone marrow, breast and colon cancer – has increased in multiple countries.
Younger generations, compared with previous generations, may be at greater risk of developing some types of cancer earlier in life, because they are exposed to different levels and types of environmental factors, such as diet, physical activity, obesity, alcohol, sleep patterns, antibiotics, stress levels, pollution and environmental contaminants.
This challenge aims to identify and understand the processes through which different biological and environmental factors cause early-onset cancers. In the future, this knowledge could be used to develop strategies to protect populations at risk.