Bowel cancer in young people is on the rise globally, and researchers from King's College London are calling on the UK public to help them discover why.
The trial features on a BBC Panorama episode airing today which investigates the sharp rise in bowel cancer in the under 50s.
The major PROSPECT-UK community study, led by researchers at King's College London and ZOE, is urgently looking to tackle the crisis by recruiting 250,000 participants across the UK. PROSPECT-UK will contribute to the work of the global interdisciplinary team PROSPECT, funded through Cancer Grand Challenges to build a clearer picture of what may be driving the rise across different countries and populations.
The trial will follow thousands of adults over time to understand how diet, lifestyle, daily habits, gut health, and environmental exposures influence risk.
The study is calling for anyone over 18 and living in the UK to take part in the study to help the research team find answers. Participants will contribute valuable information about their diet and lifestyle which will help the researchers identify patterns and trends.
Over just a few generations our lifestyles, diets and environments have changed dramatically. But we don't know which of these changes are increasing people's risk of bowel cancer or which ones could help reduce it. We urgently need large-scale, long-term data to uncover the true causes of early-onset bowel cancer."
Professor Sarah Berry, Professor of Nutritional Sciences at King's College London and PROSPECT-UK Chief Investigator
Bowel cancer has long been considered a disease of older adults, but since 1990 the amount of people under 50 diagnosed has doubled. The UK now has one of the fastest‑rising rates among countries seeing this trend, with projections suggesting that by 2030 cases could be double in comparison to 2010.
Although early‑onset bowel cancer, also known as early-onset colorectal cancer, still only represents around 10% of all bowel cancer cases, its occurrence is increasing by 1-2% every year in adults under 50.
The researchers are keen to highlight that there are some easy lifestyle changes that people can adopt to help reduce their risk of cancer more generally. This includes increasing fibre intake, consuming a diet high in fruits, vegetables and whole foods, and keeping active.
Although rates of early-onset bowel cancer are rising, it remains relatively uncommon, which means we need large groups of people to take part in research to help us understand why we are seeing this worrying trend. At the same time, our food environment has become increasingly complex, and this means we need to look at diet in much greater detail."
Dr Rosiered-Brownson Smith, PROSPECT-UK research associate at King's College London
"In the UK, around 60% of our calorie intake comes from highly processed foods, but these foods are not all the same. They can differ substantially in their ingredients, processing methods and nutritional composition - even within the same food category. PROSPECT-UK is innovative because, for the first time, we are collecting detailed, brand-level information about the foods people actually eat. This will allow us to better understand which foods and dietary patterns may be linked to the development of early-onset bowel cancer.
"Combining detailed dietary information with long-term health data, we hope PROSPECT-UK will help us better understand the complex relationship between what we eat and our risk of disease."
Participants in the study will complete short online questionnaires on their diet, lifestyle, environment, health and other factors, and asked for consent to link their electronic health records. A small subgroup will be invited to complete more detailed diet diaries and provide blood and stool samples.
Dr Rosiered-Brownson Smith added: "Unfortunately, many younger adults are diagnosed too late - partly because routine screening begins later in life and symptoms are often overlooked. Symptoms to watch include blood in stool, persistent abdominal pain, changes in bowel habits, and unexplained weight loss. Anyone experiencing these symptoms should seek medical advice."
The PROSPECT-UK study is part of Team PROSPECT, a global effort to understand why rates of early-onset bowel cancer are increasing around the world. The team is funded by Cancer Research UK, the National Cancer Institute in the US, The Bowelbabe Fund for Cancer Research UK and The French National Cancer Institute (INCa), through Cancer Grand Challenges.
Cancer Grand Challenges is a global initiative that identifies the toughest challenges in cancer research and empowers teams of scientists from around the world to take them on. Cancer Research UK's funding supports the academic research team; it does not fund ZOE.
To take part in the trial, go to https://healthspanconnect.kcl.ac.uk/take-part/
Dr Anisha Patel is an NHS GP, author, broadcaster and Lead Patient Advocate for Team PROSPECT, part of Cancer Grand Challenges. In September 2018, she was diagnosed with stage IIIB rectal cancer at the age of 39. Her children were still young, and the diagnosis turned family life upside down.
Her symptoms had developed gradually and intermittently: constipation, urgency, a feeling that her bowel had not emptied properly, and a little blood on the paper when she went to the toilet. She initially thought they could be explained by IBS or piles. There was a painful irony in the diagnosis: Anisha was a GP, and her husband was a consultant bowel cancer specialist.
Anisha had no known family history of bowel cancer and no obvious traditional risk factors. She had grown up eating a largely vegetarian diet, did not smoke and exercised regularly. Yet she needed 2 major surgeries, a temporary stoma and chemotherapy. The effects did not end when treatment finished. She continues to live with bowel dysfunction, premature menopause, infertility, peripheral neuropathy, and the psychological impact of cancer.
Her experience has shaped her work since her diagnosis and has blogged her way through as @doctorsgetcancertoo. She is an Ambassador for Bowel Cancer UK and also sits on their clinical advisory board. Raising awareness of early onset bowel cancer and has seen her take this matter to print press and media outlets as well as no.10 Downing Street.
Subsequently she was asked to lead the patient advocate team with PROSPECT, which is investigating why colorectal cancer is rising in younger adults. As Lead Patient Advocate, Anisha helps bring the realities of diagnosis, treatment and life after cancer into the research. She is particularly committed to ensuring that studies include people from different ethnicities, communities and backgrounds, so that the questions researchers ask and the answers they find are relevant to everyone.
Dr Anisha Patel said: "When I was diagnosed at 39, I had two young children and a life I thought I understood. I was a GP, I was active, and I had no family history of bowel cancer. I had even been running races and climbing a mountain shortly before my surgery. Cancer was the last thing I expected.
"For younger people, a bowel cancer diagnosis can arrive in the middle of raising children, building a career and making plans for the future. Treatment can save your life, but it can also leave lasting changes. I've had to learn to live with bowel dysfunction, early menopause, infertility and nerve damage, as well as the emotional impact of everything that happened. I've also lost friends diagnosed young, leaving families and children behind. Those realities must remain visible when we talk about early onset cancer.
"We still do not know exactly why more younger adults are developing bowel cancer. My experience makes me want to understand what risks we may be missing, whether exposures at different stages of life matter, and how we might identify people at risk sooner. That is why being part of Team PROSPECT means so much to me. I want patients to help shape the research from the outset, and I want that research to reflect the full diversity of the people affected. Finding answers feels like a race against time."
