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Determine why the incidence of early-onset cancers in adults is rising globally

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Dr Yin Cao

Dr Yin Cao, Co-team Lead

Associate Professor of Surgery & Medicine

Washington University in St. Louis

Dr Andrew Chan

Professor Andrew Chan, Co-team Lead

Daniel K. Podolsky Professor of Medicine

Massachusetts General Hospital




France, India, Italy, UK, US


Cancer Research UK, National Cancer Institute, the Bowelbabe Fund for Cancer Research UK, Institut National Du Cancer (INCa)


biochemistry, cancer biology, clinical and global oncology, computational biology, epidemiology, epigenomics, gastroenterology, immunology, microbiome, nutrition, pathology

Pathways, risk factors and molecules to prevent early-onset colorectal tumours

Funded by:

PROSPECT funders

Team PROSPECT will employ a disruptive, transdisciplinary approach spanning cells, individuals and populations to uncover the mechanisms linking lifetime exposures to early-onset colorectal cancer, and test new strategies to combat this cancer type. 

Although recent decades have seen a decrease in the overall incidence of colorectal cancer, there has been an alarming rise in the number of cases diagnosed in people under 50 years of age (early-onset colorectal cancer [EOCRC]) in multiple countries across the world. Research suggests that this risk is increasing with each new generation and is likely linked to exposures in early life and throughout an individual’s lifetime that are specific to their birth cohort. 

Although progress has been made in understanding some of the factors associated with increased risk of EOCRC, such as obesity, sedentary behaviours and poor diet, many unanswered questions remain about the mechanisms responsible for the rise in cases.  

Team PROSPECT aims to address the global rise in the incidence of EOCRC by understanding the pathways, risk factors and molecules involved in its development. The team’s collective vision is to understand and ultimately reverse the network of causal factors throughout the life course that disrupts biological homeostasis to promote EOCRC. 

Tackling the Early-onset cancers challenge

The team has three overarching objectives for tackling this challenge: 

  1. Identify the risk factors associated with EOCRC

To identify the risk factors that contribute to the rising incidence of EOCRC, the team will leverage prospective data from more than 15 diverse human cohorts from across the UK, US, multiple countries in Europe, and Mexico, encompassing over 2,700 EOCRC cases.  
The team will look at exposure to known risk factors (such as obesity and poor diet) and novel risk factors (including environmental and social factors), as well as features of the microbiome that could contribute to EOCRC. These exposures are collectively known as the exposome.   

  1. Characterise the underlying mechanisms of causal risk factors

The population data the team collects will feed into research to understand how the identified risk factors cause biological changes that increase susceptibility to, or drive the progression of, EOCRC. Insights and hypotheses from human data will be tested in innovative animal models and in vitro organoid models. 

Integrating population-based and experimental studies, the team hopes to identify at which life stage the risk factors begin to play a role in the development of EOCRC. 

  1. Develop precision prevention strategies

PROSPECT’s ultimate goal is to identify ways to prevent the development of EOCRC. The team will set up two types of trials: precision prevention trials (in the US and UK) to explore if treating young adults with an increased risk of EOCRC with anti-obesity drugs or dietary interventions can interfere with the molecular pathways linked with increased risk; and community risk assessment trials (in the UK and India) to determine whether knowing EOCRC risk influences people’s motivation to adapt their lifestyles or undergo screening to reduce or prevent this risk. 

From identifying the causes and mechanisms of EOCRC to developing clinical trials and interventions to reduce the burden of this cancer type, PROSPECT’s goal is to shape a hopeful and healthier future for younger generations. The team’s patient advocates will ensure that its studies are inclusive and address the needs of diverse communities. 

Dr Andrew Chan

Professor Andrew Chan, Co-team Lead

Daniel K. Podolsky Professor of Medicine

The alarming rise of colorectal cancer in young people around the world demands immediate action. Only by pushing the boundaries of our individual fields can we move quickly to identify opportunities for preventive interventions that can benefit younger generations.

Plain language summary

More and more people under 50 years of age are being diagnosed with bowel (or colorectal) cancer in at least 18 countries around the world. These cases are called early-onset colorectal cancer (EOCRC), and each new generation faces higher risks of developing this cancer type. 

Research has uncovered a few drivers of this alarming trend, including obesity and poor diet. However, prior studies usually assessed the impact of these factors at a single time point in adulthood. There remains a pressing need to further the understanding of existing risk factors throughout an individual’s lifetime, as well as to identify new risk factors. 

Team PROSPECT will study factors contributing to EOCRC by analysing samples from diverse populations worldwide. They will look at known risk factors (such as obesity and poor diet) and new risk factors (including environmental and social factors). In laboratory experiments, they’ll investigate how these factors lead to cell changes linked to EOCRC.  

By understanding the complex network of risk factors that lead to EOCRC, PROSPECT aims to develop new methods to assess risk and prevent colorectal cancer in individuals under 50 years of age. The team will test these methods in trials in the clinic and in communities. 

Dr Yin Cao
Dr Andrew Chan
Dr Emily Balskus
Yasmine Belkaid
Dr Jason Buenrostro
Dr Curtis Huttenhower
Dr Gary Patti
Dr Nicola Segata
Dr Bhawna Sirohi
Dr Tim Spector
Dr Ömer Yilmaz
Dr Anisha Patel