Although colorectal cancer (CRC) rates in the U.S. have slowly declined over the last decade, the incidence is alarmingly growing in people under the age of 50. While we don’t fully understand the reason for this, the The Colorectal Cancer Center at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Richard J. Solove Research Institute (the OSUCCC – James Colorectal Cancer Center) has established specialized programs to identify these patients, decrease the risk of CRC formation and provide needed services.
About one-third of early onset (less than 50 years of age) CRC arises within some inherited genetic predisposition. Identifying these cases and causes is crucial to patient care and maximizing outcomes.
In 2023, Matthew Kalady, MD, director of the Department of Surgery's Division of Colon and Rectal Surgery, led the effort to make genetic testing universally available to all patients with CRC at Ohio State. Mutations or variations in specific genes that can be detected in a blood or saliva sample define particular risks. This program, one of only a few dedicated programs in the country, allows identification of those patients with a CRC hereditary condition, and encourages testing of other family members who are at risk.
For people at risk, screening starts earlier and more often to try to prevent CRC and other cancers.
“There are several different hereditary colorectal cancer syndromes, each with a defined genetic cause,” Dr. Kalady says. “These patients are at a much higher risk to develop CRC – sometimes 100% – and early and often screening is critical. In addition to CRC, these patients and their families are prone to developing other cancers. Realizing what different screenings need to be done can save a life.”
Importantly, it’s not always easy to predict which patients have one of these inherited syndromes, so offering testing to all patients can identify those that might otherwise be missed, Dr. Kalady says. “Once diagnosed with a particular syndrome, we then manage these patients and families for life.
“We see about 700 patients with a hereditary CRC syndrome in our clinic each year, with most coming in for yearly surveillances,” he says. “We can really impact their overall health, and often end up caring for entire families and developing long-term relationships.”
For those people under 50 who don’t have a defined hereditary syndrome, Ohio State offers the Early Onset CRC Program, which provides additional services such as fertility preservation and financial counseling.
Beyond the clinics, the team’s expertise and research efforts have led to the identification and development of biomarkers associated with CRC detection and prognostic biomarkers related to treatment response and overall survival.
“Because of the high numbers of patients we see, we have the ability to gather data, which speeds up our learning about these relatively rare diseases and can change the way they are managed,” Dr. Kalady says.
“We want to give patients the ability to get ahead of this condition,” Dr. Kalady says. “We now know enough of the hereditary nature of CRC that we can do this, but we need to make sure the community is aware of this huge and growing problem and how we can help. With all of us on board with this focus, we hope to make a meaningful impact on early detection in central Ohio and beyond.”