Early-Onset GI Cancers Rising Globally, With Urgent Need for Early Detection and Risk Stratification
A global review has confirmed that early-onset gastrointestinal (GI) cancers—defined as GI cancers diagnosed before age 50—are rapidly increasing in incidence and now represent the most rapidly rising group of early-onset cancers in the United States.
Among all early-onset GI cancers worldwide in 2022, colorectal cancer (CRC) accounted for the largest proportion (54.3%; 184,709 cases), followed by gastric (23.8%), esophageal (13.2%), and pancreatic cancers (8.6%). In the U.S. alone, 20,805 individuals were diagnosed with early-onset CRC, with smaller but significant numbers for gastric (2,689), pancreatic (2,657), and esophageal (875) cancers.
“Early-onset GI cancers, typically defined as cancer diagnosed in individuals younger than 50 years, are among the largest subset of early-onset cancers globally,” the authors reported.
Multiple modifiable risk factors were identified, including obesity, poor-quality diet, sedentary lifestyle, smoking, and alcohol use. Nonmodifiable risks include family history, hereditary syndromes such as Lynch syndrome, and inflammatory bowel disease in early-onset CRC. Genetic testing plays a central role in the evaluation of these patients: 15% to 30% of early-onset GI cancers harbor pathogenic germline variants, such as in BRCA1/2 or mismatch repair genes.
“All patients with early-onset GI cancers should undergo germline and somatic genetic testing to guide treatment, screen for other cancers, and assess familial risk,” the authors advised.
Treatments are similar to later-onset disease and may involve surgery, chemotherapy, radiation, and targeted therapies. However, younger patients tend to receive more intensive treatments and often face additional challenges, including fertility concerns, psychosocial distress, and financial strain. Despite aggressive management, survival is similar or shorter compared with later-onset GI cancers.
These findings highlight a growing clinical need to improve prevention strategies and establish earlier detection methods for high-risk individuals.
Reference
Jayakrishnan T, Ng K. Early-onset gastrointestinal cancers: a review. JAMA. Published online July 17, 2025. doi:10.1001/jama.2025.10218
