What was discovered in the survey was patients and gastroenterologists alike are looking for treatments that could have more durability and preserve a patient’s quality of life as well
March 20, 2025
A recent colorectal cancer survey shows a significant spike in the disease among adults under the age of 50, further dismantling the once-held notion that associated the disease with older people.
It also suggests the need for innovative advocacy for early screening and treatment options.
The survey, commissioned by Agenus with participants— patients and medical providers from across the U.S., mirrors similar trends observed globally, including in Africa—where CRC is among the top five leading causes of death in young to middle-aged.
This underscores the urgent need for transformative solutions in colorectal cancer treatment, said medical experts, patients, and cancer advocacy groups alike, including Colorectal Cancer Alliance Chief Executive Officer Michael Sapienza who agreed with the survey findings that effective innovative treatment options that prioritize both survival and quality of life of patients facing colorectal cancer are very much needed now.
“Depending on what stage a patient’s disease is and when they are being treated, whether it is pre-surgery or post-surgery or metastatic disease, the main stage for CRC is chemotherapy or surgery,” Stefanie Perna-Nacar, Agenus’ Chief Communication and Government Relations Officer told Africa Bazaar magazine in a phone interview. “While chemo might have fast responses, it loses durability very quickly. As we know, as chemo targets mutated cells, it also targets good cells, [which] can have long-term hash effects that patients will experience, with the quality of life being affected.”
She also noted there’s a similar adverse effect with surgical removal, stating that many patients who undergo surgery to have their colon removed also end up needing other surgeries as well as having challenges with their gastrointestinal system.
“When you think about more and more younger patients being diagnosed with CRC, patients with a young family in their 40s and 50s, compared to patients in their 60s and 70s, there’s a tremendous impact on the quality of life,” Perna-Nacar said.
Colorectal cancer remains the second leading cause of cancer-related deaths globally and places a significant burden on individuals, their families and loved ones, and the healthcare system alike.
American actor Chadwick Boseman died from the disease at age 43.
Nearly all medical providers surveyed agreed that the current treatment options for CRC are insufficient. Chemotherapy remains the dominant approach, despite its debilitating side effects.
Among many CRC patients, there is an urgent demand for less adverse effects alternatives to chemotherapy, including immunotherapy.
“What was discovered in the survey was patients and gastroenterologists alike are looking for treatments that could have more durability and preserve a patient’s quality of life as well. So when we talk about innovation, some of those could include target therapy and immunotherapy. There are different types of immunotherapies and the ability to have the immune system be able to educate and recognize the cancer cell, which has been very difficult in CRC, and have the immune system fight cancer itself, there’s been a lot of interest,” Perna-Nacar said.
Immunotherapies can also be used in combination with other treatments.
According to the American Cancer Society, immunotherapy has now become a cornerstone of treatment for people with either early or advanced-stage CRC, if the tumor has findings of deficient mismatch repair or MSI-H
The National Institute of Health in a statement on its website states immunotherapy, which leverages a patient’s immune system to fight cancer, is the latest game-changer with data showing its efficacy in treating CRC, especially in CRC patients with Micro Satellite Instability (MSI) or Micro Satellite Instability-H (MSI-H) tumors.
MSI occurs when there are deficiencies in the DNA repair system, leading to errors in DNA reproduction and repair, especially in repetitive DNA sequences called micro-satellites. These errors can create a high mutational burden in the tumor cells, resulting in the overproduction of many new proteins that the immune system recognizes as foreign and can lead to a more immunogenic tumor environment.
MSI tumors are found in 5 percent of CRC patients in the metastatic setting and 15 percent in early-stage disease. The rest are Micro Satellite Stability (MSS).
Immunotherapy currently is approved and has shown data to work in a very small subset of CRC patients that have deficient MSI, or MSI—H, which refers to factors influencing the efficacy of immunotherapy as tumors with MSI-H often showing a high mutational burden and neoantigen expression, making them more susceptible to immune checkpoint inhibitors.
Perna-Nacar believes this later group with MSS can benefit from immunotherapies offerings such as the ones Agenus provides and other novel treatments.
It’s imperative that everyone understands the importance of screening and makes it a priority, so more lives can be saved
“In CRC, some immunotherapies currently are approved or have shown data to work in a small subset of CRC patients, which is those that have deficient in MSI-H in later stages of CRC patients, which is only 5% of patients particularly. The rest of the patients are Micro Satellite Stability disease that immunotherapy and other novel treatments have not been able to previously show activities, so we’re hoping there’s going to be some potential treatments to help broader patients,” Perna-Nacar said.
Helping more patients, health experts say should also include a holistic approach to CRC diagnosis and treatments with an emphasis on early screening and education. The current recommended age for CRC screening in the U.S. is 45, compared to 50 before. In other countries, screening starts at 55 or 60 years old.
Despite the access to early CRC screening in the U.S., too many Americans delay or avoid screening because of fear, misinformation, or competing priorities,
Americans understand that CRC colonoscopies can detect cancer, however, most are unaware that these screenings can prevent colorectal cancer by removing precancerous polyps, according to a recent survey commissioned by the Colorectal Cancer Alliance which found that more than half of American adults (51%) would rather prioritize household chores, such as laundry and childcare, over life-saving colorectal cancer screenings. Another 69 percent say they would rather file their taxes than get a colonoscopy.
Ninety-eight percent of those surveyed said they would be more likely to undergo the screening if they know precancerous polyps, can be removed during colonoscopy.
People are encouraged to pay close attention to CRC symptoms, which include a change in bowel movement, and a sudden loss in weight.
With colorectal cancer cases rising in more younger adults, health experts say these startling statistics underscore the urgent need for increased awareness and education surrounding prevention and the importance of timely screening.
Christopher Lieu, M.D., medical oncologist and advisor to the Colorectal Cancer Alliance said these results reveal a life-threatening gap in public awareness of colorectal cancer.
“Colorectal cancer is the second deadliest cancer among men and women, and incidence is rising in younger people. It’s imperative that everyone understands the importance of screening and makes it a priority, so more lives can be saved,” Lieu said.
Aside from intentional avoidance and procrastination, another major reason for the lackadaisical attitude toward early CRC screening is the hidden symptoms of the disease.
“One thing with CRC is the symptoms are not so overt, so the patient might experience or interpret them as standard, [which is why] it’s important that any type of symptoms that perpetuate or extended for a period of time, the patient should advocate for themselves, go see their doctor and push their doctor for testing,” said Perna-Nacar.
March is National Colorectal Cancer Awareness Month.
Other than raising awareness, researchers suggest another way to boost early CRC screening is to improve access and empower patients by offering different screening methods that cater to individual preferences and needs such as providing self-stool sample testing kits (FIT/gFOBT), adding a deadline to CRC screening invitation, and colonoscopies to increase screening completion rates.
Aside from the U.S., a study by NIH revealed CRC is also becoming a growing concern in Africa, with the latest data showing over 70,000 cases in 2022. CRC mortality is the highest in Sub-Saharan Africa, with an estimated 49,000 people succumbing to the disease in 2019, and the forecast indicates a significant rise in both incidence and mortality by 2050, particularly among young people if urgent action is not taken.
Among the factors linked to the increase in CRC in Africa include a rise in urban populations, along with adoptions of Western lifestyle habits, including increased meat consumption, sugars, and alcohol.
Unlike in the Western world—where there is access to early CRC screening, lack of screening guidelines, diagnostic services shortages, and limited high-quality cancer reporting systems or non-existing national cancer registries are some of the barriers contributing to the rise in CRC mortality in Africa, experts say.
Another contributing factor across the African continent is the prioritization of other cancer screenings such as breast, cervical, and prostate cancers, which get more attention than CRC. There is also the issue of stigma associated with the disease.
Runcie C.W. Chidebe, a Nigerian cancer advocate and executive director of Project PINK BLUE is trying to change that with his new documentary, “Blood in my Stool” produced in collaboration with the Global Colorectal Cancer Association to bring awareness to the public about the disease.
