Peer-Reviewed Publication
Nat Rev Cancer2026August 26, 2026Journal Article
Shaping the future of early-onset colorectal cancer prevention.
Ruiyi Tian1,2,3, Sina Azadnajafabad1,2, Erika A Waters1,2, Emily P Balskus4,5, Yasmine Belkaid6, Jordana T Bell7, Sarah E Berry8, Jason D Buenrostro9,10, Curtis Huttenhower11,12, Anisha Patel13,14, Gary J Patti2,15,16,17,18, Nicola Segata7,19,20, Bhawna Sirohi21, Tim D Spector7,22, Ömer H Yilmaz12,23,24, Andrew T Chan12,25,26,27,28, Yin Cao29,30,31,32
1Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
2Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis and Barnes-Jewish Hospital, St. Louis, MO, USA.
3Division of Biology and Biomedical Science, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
4Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA, USA.
5Howard Hughes Medical Institute, Harvard University, Cambridge, MA, USA.
6Metaorganism Unit, Department of Immunology, Institut Pasteur, Paris, France.
7Department of Twin Research, Ageing and Genomic Epidemiology, King's College London, London, UK.
8Department of Nutritional Sciences, King's College London, London, UK.
9Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA.
10Biology of Adversity Project, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
11Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
12Broad Institute of MIT and Harvard, Cambridge, MA, USA.
13NHS General Practitioner, London, UK.
14Patient Ambassador, Bowel Cancer UK, London, UK.
15Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
16Department of Chemistry, Washington University in St. Louis, St. Louis, MO, USA.
17Center for Mass Spectrometry and Metabolic Tracing, Washington University in St. Louis, St. Louis, MO, USA.
18Department of Genetics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
19Department of Cellular, Computational and Integrative Biology, University of Trento, Trento, Italy.
20IEO, Istituto Europeo di Oncologia IRCSS, Milan, Italy.
21Vedanta Medical Research Foundation (BALCO Medical Centre), Raipur, India.
22ZOE Ltd, London, UK.
23Department of Biology, The David H. Koch Institute for Integrative Cancer Research at Massachusetts Institute of Technology, Cambridge, MA, USA.
24Department of Pathology, Beth Israel Deaconess Medical Center, Massachusetts General Hospital, Boston, MA, USA.
25Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
26Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
27Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
28Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
29Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. yin.cao@wustl.edu.
30Alvin J. Siteman Cancer Center, Washington University School of Medicine in St. Louis and Barnes-Jewish Hospital, St. Louis, MO, USA. yin.cao@wustl.edu.
31Division of Gastroenterology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. yin.cao@wustl.edu.
32Center for Translational Bioinformatics, Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. yin.cao@wustl.edu.
Abstract
Early-onset colorectal cancer (EOCRC) among individuals under age 50 is increasing globally. Lifestyle factors such as obesity, metabolic comorbid conditions, poor diet and sedentary behaviours are linked to EOCRC, but critical gaps remain in identifying additional risk factors, with growing evidence for early-life and gut microbial-related exposures. In addition, how or when the risk factors act,…
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