Biological Age as a Tool to Predict Early-Onset Colorectal Cancer Risk

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Recent research has established a connection between a person’s “biological age” and their risk of developing colon polyps, which are known to be a risk factor for colorectal cancer. Biological age can be measured through various tests and reflects the impacts of lifestyle choices, genetics and environmental factors on an individual’s body. Unlike chronological age, which simply counts the years a person has lived, biological age is based on physiological markers.

“Biological age is an interesting concept, and it leads to the idea of accelerated aging when your biological age exceeds your chronological age,” said Shria Kumar, M.D., a colorectal cancer researcher at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine.

So, if someone is 50, but their biological age is 55, they have five years of accelerated aging.

“You can imagine how that might reflect their body’s overall functioning,” said Dr. Kumar, an assistant professor in the Miller School’s Digestive Health and Liver Diseases. “It sounds pretty theoretical, but actually accelerated aging has been shown to be predictive of time to death and even of multiple cancers.”

This line of research adds to a growing area of study within epigenetics, which examines the mechanisms behind deteriorating cell functions.

A new study published in Cancer Prevention Research, a journal of the American Association for Cancer Research, links accelerated aging to raised colorectal cancer risk. If a person has accelerated aging, it might make sense to get screened for colorectal cancer early. Early detection can improve a person’s treatment options and outcomes.

Increased Colorectal Cancer Risk in Those Under 50

Rates of colorectal cancer in people under 50, called early-onset colorectal cancer, have been rising. According to the American Cancer Society, since 2011, colorectal cancer rates have been increasing by 2% a year in people younger than age 50.

With this rise, researchers have been asking when the best age is to start screening for colorectal cancer. The U.S. Preventive Services Task Force recently lowered the starting age from 50 to 45. However, this might not fully address the problem, Dr. Kumar said. Half of early-onset colorectal cancers are in people under 45, according to the National Cancer Institute.

The complexity of this question lies in the numerous options available for colorectal cancer screening. The standard procedure, a colonoscopy, is an outpatient test that requires sedation and a physician’s assistance. During the colonoscopy, the doctor can identify and remove polyps, which can then be tested for cancer.

Polyps are soft-tissue growths that can lead to colorectal cancer. They are quite common, affecting about 20% to 30% of adults. Removing them during a colonoscopy can help prevent cancer.

“What’s really, I think, exciting about the opportunity in colorectal cancer is that we have a clear prevention tactic,” Dr. Kumar said. “Colonoscopy is not just early detection. It is actual prevention of cancer.”

To prevent colon cancer, Dr. Kumar said, we need to ensure that individuals at the highest risk of polyps receive early colonoscopies.

Impact of a Person’s Biological Age

Some factors that raise a person’s risk of early-onset colorectal cancer also raise their biological age. These include obesity, drinking alcohol and other lifestyle factors.

“Aging is multifaceted, and we need larger studies to establish whether most people’s biological age is the same as their chronological age,” Dr. Kumar said. “It is pretty striking that multiple studies, ours included, have found that biological age gives distinct health information.”

Researchers investigated whether biological age is a risk factor for colorectal cancer by studying individuals under 50 who were undergoing colonoscopies. Chloe Brown and Maria Yow from Sylvester’s Biospecimen Shared Resource played a crucial role in this research. They were responsible for enrolling participants, shipping samples and collecting data.

The team assessed the patient’s biological age and compared it to their colonoscopy results. They discovered that each year of accelerated aging correlated with a 16% increased risk of developing polyps.

New Colorectal Cancer Risk Factors

Interestingly, the study didn’t link other factors, like body mass index and smoking history, to polyp risk. It did find that male sex was the strongest risk factor for polyps.

“While I think the biological age finding is interesting and maybe exciting, the strongest risk factor for having a pre-cancerous polyp was male sex,” Dr. Kumar said. “While we continue to look at things like biological age and other risk factors, we also need to evaluate why sex is such a big differential risk.”

As the risk factors for colorectal cancer become clearer, they can help improve early detection. Risk-based screening could focus on people with accelerated aging.

“Even people outside of screening guidelines, if we can really home in on their risks, we could put them through colonoscopy and prevent cancer,” Dr. Kumar said. “On the flip side, people who are low risk, who are unlikely to have these polyps, don’t need to undergo any sort of screening until they turn age 50.” Dr. Kumar mentioned that the team will need to repeat this small study with larger sample sizes. Conducting more research on biological age can assist researchers in identifying risk factors for colorectal cancer. Ultimately, this could lead to improved strategies for preventing colorectal cancer and add to the growing research in epigenetics.