Why ZOE is focusing on early-onset colon cancer

ZOE has partnered with hundreds of incredible scientists, including researchers at King’s College London (KCL) to investigate colon cancer.

Specifically, they will focus on early-onset colon cancer, which occurs in people aged under 50.

In this article, we’ll explain why this research is urgently needed and how the teams at ZOE and around the world will help shed light on the topic.

Early-onset colon cancer on the rise

Overall, the incidence of colon cancer has been steadily falling over recent decades. This is thanks to screening programs and improved treatments. 

However, a more alarming trend has also become apparent: The number of cases in people under 50 is growing.

Scientists have now identified similar patterns in the United States, Europe, Latin America, and Asia. 

The birth cohort effect implies that early life exposures may increase your chance of developing early-onset colon cancer. We urgently need to understand what these exposures are and how to tackle them. 

So, ZOE scientists aim to identify the key risk factors that underpin early-onset colon cancer and, importantly, how to minimize or reverse these risks. 

The project is called Pathways, Risk Factors, and Molecules to Prevent Early-Onset Colorectal Tumors (PROSPECT). 

What will PROSPECT do?

Team PROSPECT will analyze samples from diverse populations around the world to explore risk factors that contribute to early-onset colon cancer. They’ll examine known risk factors, such as obesity and poor diet, and new risk factors, including environmental and social factors. 

In the laboratory, scientists will also investigate how these factors lead to cell changes linked to the disease. 

The researchers will combine data from a range of sources, including TwinsUK and ZOE’s datasets, to determine what causes early-onset colon cancer and understand how diet can help reduce and possibly reverse the risk.

“The large-scale community experiment component of this research will explore the real-life application of dietary advice to reduce colorectal cancer risk in a way that hasn’t been done before.”

As we mentioned, the birth cohort effect hints that early exposure to risk factors may be important. But up until now, few studies have collected information on risk factors throughout the life course and across multiple generations. 

The PROSPECT network has three main objectives:

1. What: Identify the underlying risk factors for early-onset colon cancer using huge datasets and new animal models.

2. How: Unpick the precise mechanisms that link these risk factors to the disease.

3. Prevention: Explore ways to limit these factors and reduce colon cancer risk.

Possible risk factors for early-onset colon cancer 

The team isn't starting from scratch; scientists — some of whom are involved in PROSPECT — have already identified risk factors that are likely to be involved. 

The most well-established risk factors for colon cancer are family history, obesity, diet, and alcohol intake. The PROSPECT team will further investigate how these factors interact across the lifespan — from the womb to mid-life.

They will also explore less established risk factors and how they relate to each other. 

For instance, using street-level data, the scientists will study the role of food deserts and swamps:

• Food deserts: Areas with limited access to healthy foods.

• Food swamps: Areas with high access to unhealthy foods, like fast food.

The role of diet and the microbiome

Research suggests that certain dietary factors might increase the risk of colon cancer. Some of the best evidence so far supports a link between colon cancer and soda intake.

Also, research suggests that higher intakes of processed meats and following a Western diet is also involved.

The scientists will revisit these relationships and investigate other dietary compounds that might play a role, like sucrose (table sugar) and palmitic acid. This fatty acid is a component of many oils but is particularly high in palm oil, which is mostly found in packaged industrial foods. 

Over the last 10 years, scientists — including Nicola Segata, one of ZOE’s scientific collaborators and member of the PROSPECT team — have described the links between the gut microbiome and colon cancer.

However, there are still unanswered questions; for instance:

• How do gut microbiome changes relate to early-onset colon cancer, specifically?

• Do changes in the gut microbiome cause colon cancer, or do they occur because of colon cancer?

• We know that people who live together share gut microbes, so could this mean that colon cancer risk can be transmitted between people? 

• Can lifestyle factors, like diet, alter the gut microbiome in a way that reduces colon cancer risk?

ZOE’s extensive database of gut microbiome and dietary information from our amazing members will help the team dig into these questions.

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The future and beyond

PROSPECT is a long-term project that promises to shine a light on the worrying rise of early-onset colon cancer. Using rich datasets and some of the top scientists in the field, we will: 

• Identify new risk factors and understand how they increase risk.

• Explore how risk factors interact with each other.

• Learn how to identify individuals with an increased risk.

• Find ways to intervene to reduce that risk.

At ZOE, we’re incredibly excited to be part of such important work. We'll keep you informed as the project progresses and we start to develop fresh insights. Thanks to our members for making this vital research possible.

*PROSPECT is funded by Cancer Research UK, the National Cancer Institute, the Bowelbabe Fund for Cancer Research UK, and Institut National Du Cancer through Cancer Grand Challenges.