Announcing The Lancet Regional Health—Europe series on the alarming surge of early-onset colorectal cancer: a multidisciplinary call to action

Abstract

The rising incidence of early-onset colorectal cancer (EOCRC), defined as a diagnosis in adults younger than 50 years, has emerged as a critical global public health challenge. 1 While colorectal cancer (CRC) rates in older populations have stabilized or declined due to successful screening programs, the incidence among younger adults is surging at an unprecedented rate. 2 Projections suggest that by 2030, one-third of all colo-rectal cancers will be diagnosed in individuals under the age of 50. 3 This “unprecedented tumor epidemic” might be driven by a significant birth cohort effect, suggesting that generational shifts in environmental exposures, lifestyle factors, such as obesity, westernized diets, antibiotic usage, and potentially associated alterations in the microbiome are reshaping the epidemiological landscape of CRC. 4 The rising incidence of EOCRC has prompted increasing scientific attention, though substantial knowledge gaps still remain. No specific etiologic factors have been clearly identified, limiting our understanding of disease biology and hindering the development of effective prevention tools and tailored management strategies. Although EOCRC shows distinct clinical and pathological features, clear associations with specific molecular alterations have not yet been demonstrated. As a result, no obvious molecular targets have emerged so far to support the development of dedicated targeted therapies. Moreover, EOCRC affects individuals during the most productive years of life, adding complexity to their clinical management. Patients face a broad range of unmet needs including fertility, relationships, career, and long-term survivorship, which are often insufficiently addressed within current care models. The higher prevalence of hereditary cancer