Andrew T. Chan, MD, MPH, director of Epidemiology at Mass General Cancer Center, chair of the Clinical and Translational Epidemiology Unit and Stuart and Suzanne Steele MGH Research Scholar 2017-2022, is a gastroenterologist focused on cancer prevention. Dr. Chan was recently selected to co-lead the global team known as PROSPECT who is working to determine why the incidence of early-onset colorectal cancers (EOCRC) in younger adults is rising globally.
Team PROSPECT received a grant of up to $25 million over five years to study early-onset colorectal cancer from Cancer Grand Challenges — a partnership between the National Cancer Institute and Cancer Research UK that aims to provide multiple rounds of funding for interdisciplinary research teams whose novel ideas offer the greatest potential to advance bold cancer research and improve outcomes for people affected by cancer.
PROSPECT aims to identify the risk factors associated with early-onset colorectal cancer, characterize the underlying mechanisms of risk factors and develop precision prevention strategies. We sat down with Dr. Chan to talk about his team, their work and their goals.
What do you want folks to know about the rise in cases of EOCRC, and how they can best care for themselves?
The rise in early-onset colorectal cancer has been an issue in the United States since the late 1990s, but now we are seeing it spread across the globe, across cultures and diverse populations — really emphasizing to us the extent of this problem.
A cancer diagnosis is devastating at any age, but for young people in particular who are often at the height of their careers and responsible for the care of children and older adults, an unexpected diagnosis can have massive impacts on not just the individual, but their whole community. In addition, because these early-onset diagnoses are often made in the absence of screening, they are often caught at a later stage, and the treatments used can be very aggressive with intense, adverse side effects.
We know that things like inactivity, obesity and consumption of large amounts of sugar and red meat are risk factors for colorectal cancer, but we are also seeing health-conscious young people who are being diagnosed, even folks who run marathons and are extremely active. So, there are clearly other factors at play when it comes to this increase in diagnoses, and those are the things we are working to identify.
We want folks to know that colorectal cancer is no longer a disease of just older people. We want young people to be aware that they are potentially at risk for cancer so they can make positive lifestyle changes where they are able, and to take potential symptoms (like gastric distress, changes in bowel habits and blood in stool) seriously and seek medical attention — not to assume that those symptoms can be ignored.
“I have spent much of my career working to understand not only the real-world impact of screening on cancer rates, but other novel ways we can prevent cancer from ever occurring. If we can detect the cancer early, we are more likely to be able to treat and cure it.”
How are you uniquely qualified to co-lead the PROSPECT team?
As a gastroenterologist, I’ve focused my career on the prevention of gastro and digestive system cancers. In the clinic, we focus a lot on screening — things like colonoscopies and stool testing — but also recognize that screening is very resource intensive, and not everyone has the ability to access it. So, we are working to develop improved prevention strategies.
Over the last few years, we’ve seen a dramatic increase in the number of people who are developing colorectal cancer at a young age — years before they would have qualified for traditional screening. It became clear that these cases of colorectal cancer would not have been prevented by screening alone.
I have spent much of my career working to understand not only the real-world impact of screening on cancer rates, but other novel ways we can prevent cancer from ever occurring. If we can detect the cancer early, we are more likely to be able to treat and cure it. Co-leading Team PROSPECT provides me the opportunity to apply all the work I’ve done in cancer prevention to a younger population, where it could potentially have an even greater impact.
I was also fortunate to be funded as an MGH Research Scholar. The funding provided me with the resources to conduct some of the studies that have laid the groundwork for the research we’re currently doing. It allowed us to compete for funding to create Team PROSPECT. The generosity of donors and their faith have been critical in enabling us to marshal the resources we need to pull together this team — philanthropic funding is so vital to this work.
What are some aspects of the research Team PROSPECT is conducting that you’re most excited about?
We created Team PROSPECT to conduct more in-depth research on the rise in EOCRC, and to approach it from a multidisciplinary and international perspective. This issue has been so intractable, and we have found so few clues as to why this is happening, that we felt like we needed to think outside the box. We have brought experts onto the team, who don’t typically work in this area, to really be disruptive in our approach to this research.
It was important to us to include the patient perspective in the work that we’re doing. We have a team of EOCRC patients and caregivers from around the world collaborating with us, sharing their experiences and questions with us in order to guide our thinking in designing studies identifying risk factors.
What does the future of this research look like?
The goals of this study are very ambitious, novel and disruptive in this field. It’s high-risk, high-reward. The grant Team PROSPECT won from Cancer Grand Challenges provides the scaffolding for this research as we uncover potential risk factors and preventative strategies, but we will need passionate donors to continue to support this work in all the new research areas this current project leads us.
One research area we want to pursue is the connection between gut microbiome health and cancer risk. In the future, it may be possible to use gut microbiome health as a biomarker for those at risk for EOCRC, and even therapeutically target the gut microbiome to reduce cancer risk.
Many people struggle with gastrointestinal symptoms, and the work Team PROSPECT is doing will hopefully provide concrete solutions not only for early-onset colorectal cancer, but for all patients struggling with their gut health.
I would really encourage folks to focus on maintaining good nutrition and a healthy diet. Eating the right things can mitigate risk of cancer and help you stay healthier overall. This is an area that is very understudied with few funding opportunities, so we hope that more people will become interested in supporting this work.
To learn more about how you can support colorectal cancer research at Mass General, contact us.
