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Discovery could lead to new screenings and treatments for people under 50
New Cleveland Clinic research has mapped changes in tumor-related bacteria to uncover potential new strategies to combat the rise of young-onset colorectal cancer (CRC) in people under the age of 50.
The research reveals differences in tumor-related bacteria associated with young-onset colorectal cancer. Published in eBioMedicine (part of Lancet Discovery Science), the findings could lead to new screenings or treatments for this population.
According to the American Cancer Society, the incidence and mortality of young-onset colorectal cancer have increased by 1.5% and 1.2% per year, respectively. If this trend continues, a Journal of the National Cancer Institute report estimates the incidence of colon cancer would double and rectal cancer would quadruple in this age group by 2030.
“The unexplained rise of young-onset colorectal cancer is of great concern,” said Alok Khorana, M.D., Cleveland Clinic oncologist and primary investigator of the study. “Our team discovered that bacteria were more abundant and compositionally distinct in tumors from young-onset patients. These insights help us to better understand the disease causes and inform new prevention approaches, diagnostic markers, and therapeutic targets.”
This retrospective study, funded by the Sondra and Stephen Hardis Family, used gene sequencing technology to compare tissue samples from 136 young-onset colorectal cancer patients with 140 average-age patients with the disease. They identified unique tumor-related bacteria in the younger cohort and found that they were more likely to have left-sided, rectal and advanced stage tumors. Key microbes associated with young-onset cancers included Akkermansia and Bacteroides.
First authors of the paper were Shimoli Barot, M.D., of Cleveland Clinic Cancer Institute, and Naseer Sangwan, Ph.D., of Cleveland Clinic Lerner Research Institute. Dr. Khorana also holds the Sondra and Stephen Hardis Chair for Oncology Research.
“By detailing this microbial signature of young-onset disease, we can look toward new screening biomarkers and drugs targeting related bacteria,” said Dr. Barot.
Dr. Sangwan added that “further research is needed into how lifestyle factors such as diet, medications and obesity may impact gut bacteria and contribute to young-onset colon cancers.”
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation, Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. Cleveland Clinic is consistently recognized in the U.S. and throughout the world for its expertise and care. Among Cleveland Clinic’s 83,000 employees worldwide are more than 6,600 salaried physicians and researchers, and 21,900 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,725-bed health system that includes a 173-acre main campus near downtown Cleveland, 23 hospitals, 300 outpatient facilities, including locations in northeast Ohio; Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2025, there were 15.9 million outpatient encounters, 343,000 hospital admissions and observations, and 336,000 surgeries and procedures throughout Cleveland Clinic’s health system. Visit us at clevelandclinic.org. Follow us at x.com/CleClinicNews. News and resources are available at newsroom.clevelandclinic.org.
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