If you have been diagnosed with early-onset bowel cancer, you are managed according to clinical practice guidelines that are not age specific.

Until now.

A multidisciplinary international group (DIRECt), composed of a panel of 69 experts, was convened to develop the first evidence-based consensus recommendations for early-onset bowel cancer.

The DIRECt group produced 31 statements across various topics, including: risk factors; symptoms, endoscopic detection, diagnosis, and treatment; genetics; pathology; surgery; oncological treatment; fertility; supportive care; and surveillance.

Each statement underwent three rounds of voting and reached a consensus level of agreement of ≥80%.

The main recommendations were as follows:

  • If you are younger than 50, you should undergo risk stratification (based on family history) and prompt symptom assessment for bowel cancer.
  • If you have been newly diagnosed with early-onset bowel cancer, you should receive germline genetic testing (multigene panel), ideally before treatment.
  • If you have been diagnosed with early-onset bowel cancer, you should be referred to a reproductive medicine or fertility specialist to discuss:
    • Potential impact on your reproductive function and any risk of infertility
    • Fertility preservation options, if needed
    • Potential issues with pregnancy or menopause.
  • Endoscopic, surgical, and oncologic treatment of early-onset bowel cancer should not differ from later-onset bowel cancer, except if you have a genetic variant of concern.

There is currently insufficient evidence to recommend changes to established chemotherapy treatment protocols.

The DIRECt group highlighted areas to prioritise in future research, including screening start age for the general population, use of faecal immunochemical tests, chemotherapy, endoscopic therapy, and post-treatment surveillance for early-onset bowel cancer.

As part of our #N2Y Advocacy Agenda, we have summarised the first consensus recommendations for early-onset bowel cancer, helping empower you to be an advocate for your own health.

You are #Never2Young for bowel cancer.

Early-onset bowel cancer