Limerick-based researchers' leading role in international bowel cancer study

The sharp rise in bowel cancer in those under the age of 50 is one of the most urgent questions in cancer research, said a Professor of Cancer Genomics in University of Limerick (UL).

Researchers at UL and UL Hospital Group will lead Ireland’s contribution to a major international study investigating why bowel cancer is on the rise among young adults.

Latest studies have revealed that those born in recent decades are much more at risk of rectal cancer compared with those born in previous generations with one in 10 cases of bowel cancer now seen in those under 50.

The Early Onset Colorectal Cancer (ECCE) study, coordinated by the World Health Organisation’s International Agency for Research on Cancer (IARC), brings together researchers from 16 countries to uncover what is driving the global increase in early‑onset disease.

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The study aims to determine whether these upward trends are linked to shared global exposures or to local environmental and lifestyle factors.

Ireland's contribution to the international study will be led by Professor Aedín Culhane, Professor of Cancer Genomics in UL's School of Medicine and Director of the Limerick Digital Cancer Research Centre at UL, and Professor Christina Fleming, Adjunct Clinical Associate Professor at UL's School of Medicine and Consultant Colorectal Surgeon in the UL Hospital Group.

Prof Culhane said the sharp rise in bowel cancer in those under the age of 50 is one of the most urgent questions in cancer research.

“UL’s involvement in this global study highlights the university's expanding role in global cancer research. With international partners, UL will study the causes of early‑onset bowel cancer, towards the development of earlier detection, better prevention and improved outcomes for future generations.”

Prof Culhane’s team at UL’s Limerick Digital Cancer Research Centre will analyse tumour and blood samples from patients to identify DNA 'fingerprints' associated with early‑onset cancer.

“By reading these DNA damage 'fingerprints', we hope to unlock and begin to understand what is driving this rise in early onset bowel cancer.”

“These patterns of genetic damage may reveal clues about exposures that have changed in recent decades, including diet, environment and the gut microbiome.

“Understanding why early onset bowel cancer occurs allows us to develop better strategies for early detection which we know saves lives. Research like this could provide the scientific evidence needed to support earlier screening because when caught early, bowel cancer is highly treatable and curable, yet many cases particularly in younger adults are identified at a later stage.”

Prof Fleming, who will co-lead the Irish project with Prof Culhane, said the most common question she is asked by early onset bowel cancer patients is, “why did this happen to me?”

“As bowel cancer surgeons it is very challenging to still be unable to offer an answer to this question as the usual risk factors associated with bowel cancer are often not seen in those with early onset.

“We are thrilled that patients in the Mid-West of Ireland will have the opportunity to participate in this international study. Not only will this study aid our global understanding of why early onset bowel cancer occurs, but it will also allow us to define the DNA ‘fingerprint’ of early onset bowel cancer specifically in the Mid-West of Ireland,” said Professor Fleming.

Professor Paul Brennan, Head of the Genomic Epidemiology Branch at the International Agency for Research on Cancer, will lead the global ECCE study. Speaking at UL, Prof Brennan said Ireland offers a particularly valuable perspective.

“Colorectal cancer is increasing among young adults in Ireland, as it is in other European countries, and understanding the reasons behind this will need international collaboration.

“The rise in early-onset colorectal cancer appears to have happened later in Ireland in comparison to the UK and other European countries, suggesting a possible 'time-lag'. This means Ireland may provide unique insights into when and how risk factors begin to influence cancer development and may help predict what could happen in the years ahead.

“We are delighted that colleagues from UL are joining this large international effort to understand the reasons behind this trend and hopefully allow us to prevent these cancers occurring in the future.”

Patient advocate Brendan Muldoon from Bowel Cancer Ireland was first diagnosed with colon cancer in 2011 at the age of 35. He welcomed UL’s involvement in this global study.

“Rates of colorectal cancer in people under 50 have nearly doubled in 25 years, yet the causes remain unclear. This global research effort will generate the evidence needed to guide prevention and inform policy.”

When caught early, bowel cancer is one of the most treatable cancers. Currently in Ireland, bowel cancer screening is available for those aged 57 to 71. According to the HSE, around 2,500 people are diagnosed with bowel cancer in Ireland every year, making it the second most common of all cancers in men and the third most common of all cancers in women in Ireland.

Prof Culhane said the symptoms of bowel cancer can seem subtle or easy to dismiss, which is why awareness is so important.

“Don’t be afraid to tell your doctor or ask the question, ‘Could this be bowel cancer?’. This research highlights an important message – understanding the causes of cancer is key to stopping it and through international collaboration, we are getting closer to that goal,” concluded Prof Culhane.