Early-onset CRC: A patient perspective from digestive cancers Europe

Ms Zorana Maravic, CEO of Digestive Cancers Europe (DiCE), presented a patient-centered perspective on early-onset colorectal cancer (EOCRC) at the 2025 ESMO-GI Congress in Barcelona. DiCE, based in Brussels, serves as a pan-European umbrella organisation representing the digestive cancer community, advocating for patients and caregivers and promoting improvements in care across Europe. The organisation also hosted its 10th annual Masterclass during the congress, welcoming over 60 delegates from across Europe to engage with the latest scientific advances and share lived experiences.

Ms Maravic’s presentation focused on the increasing incidence of colorectal cancer in individuals under the age of 50—a population traditionally considered at low risk. Over the past three decades, the incidence of EOCRC has risen sharply. Projections indicate that by 2030, colon cancer cases in individuals aged 20 to 34 could increase by 90%, while rectal cancer may rise by as much as 124% in this age group. These are individuals at the beginning of their adult lives, often launching careers or starting families, and they do not typically consider cancer as a potential diagnosis.

Many EOCRC patients report presenting to general practitioners with nonspecific symptoms such as fatigue, anaemia, or rectal bleeding. Due to their age and the rarity of cancer in this group, they are frequently misdiagnosed or experience significant diagnostic delays. DiCE conducted a qualitative study through focus groups in seven European countries, engaging nearly 50 individuals to explore common barriers in the patient journey. Findings consistently showed that patients often consult multiple healthcare providers before receiving a correct diagnosis, which can take several months. As a result, many are diagnosed at an advanced stage and require more aggressive treatment. The consequences of such treatment are particularly profound for younger patients. Many pursue intensive therapy in the hope of a cure but must then confront side effects that include infertility, early menopause, and long-term physical and psychological impacts. Female patients with rectal cancer, for instance, may experience premature menopause, leading to emotional distress as they reconcile cancer survivorship with the loss of future parenthood.

Another major challenge identified is the lack of age-appropriate support. Young adults are typically treated alongside older patients, whose needs and concerns differ significantly. Many patients report feeling isolated due to the absence of peers and limited access to psychological support services. While psychosocial care is essential, it remains inconsistently available across Europe. In some cases, access is complicated by administrative barriers, such as requiring a referral from a general practitioner to begin psychotherapy.

Ms Maravic emphasized that the growing EOCRC burden demands urgent attention—not only to raise awareness but to advocate for systemic changes. These include earlier recognition of symptoms, improved diagnostic pathways, and tailored support services for younger patients and their caregivers. DiCE remains committed to ensuring that these voices are heard and that healthcare systems evolve to meet the complex needs of this emerging patient population.