Lugano (Switzerland), 2 July 2021 – Doctors and patients have been advised to cut back on antibiotic use after new data suggests that these medications may increase the risk for colon cancer in younger people. (1) New concerns have been raised by the ESMO World Congress on Gastrointestinal Cancer (30 juin-3 juillet) despite the fact that there is no direct cause and effect. (2)"This is the first study that links antibiotic use to the rising risk of colon cancer in children and young adults. This disease has increased at an average rate of at least 3 percent per year for the past 20 years. (3) While junk food, sugary drinks and obesity are likely to be a contributing factor in this rise, our data emphasize the importance of avoiding unnecessary anti-biotics, particularly in young people," stated Ms Sarah Perrott from the University of Aberdeen in Aberdeen, UK.The study compared nearly 8000 people with bowel carcinoma (colon or rectum) with those without it using a large Scottish primary-care database. The study found that antibiotic use is associated with a higher risk of colon cancer in all ages. However, the risk was almost half-way increased in the under-50s as compared to the 9% for the over-50s. The risk of colon cancer in the right side (the first part) was higher among the younger group. These right-side cancers were linked to Quinolones, sulfonamides/trimethoprim and other drugs that can be used to treat many infections.Senior author of the study, Dr Leslie Samuel from Aberdeen Royal Infirmary in the UK, explained that the right side of the colon contains more liquid, and that the natural bacteria found there, the microbiome (or natural bacteria), may be different than those further down the colon.We are now trying to determine if there is an association between antibiotic use and changes to the microbiome, which could make the colon more vulnerable to cancer, especially for younger people. This is a complicated situation because we know that even after bowel surgery, the microbiome can quickly return to normal. Samuel said that we don't know yet if antibiotics could have any effects on microbiome which could directly or indirectly contribute towards the development of colon cancer.Professor Alberto Sobrero from Ospedale San Martino in Genoa, Italy commented on the research. He explained that among the 2 million colon cancer cases worldwide, 44,000 people between 20 and 40 have a worse prognosis because they are diagnosed later.Patients with abdominal discomfort due to colon cancer are less likely than those in their 70s to see a physician. Also, younger patients are not eligible for screening for bowel cancer. Their cancer is often diagnosed later in life, which makes it more difficult to treat," he explained.He believes, like Samuel and Perrott, that doctors should consider bowel cancer in patients younger than 50 with symptoms. He also supports increased research into the many possible causes of colon cancer.It is too early to determine if the excessive use of antibiotics may be a cause. We need to learn more about the role of the microbiome and bowel cancer before we can consider the effects of antibiotics on intestinal flora. The new research reminds us that antibiotics should only be administered when they are absolutely necessary. We cannot rule out the possibility that people may be at increased risk for cancer by using antibiotics in excess," Sobrero said.###Notes for EditorsPlease use the official name of this meeting in your reports: ESMO World Congress on Gastrointestinal Cancer 2020Official Congress Hashtag #WorldGI2021DisclaimerThis press release includes information provided by the author for the highlighted abstract. It also reflects the content in the abstract. This press release does not necessarily reflect or represent the views of the ESMO WGI Organisations. They cannot be held responsible if the data is incorrect. The press release requires commentators to adhere to the ESMO Declaration of Interests policy as well as the ESMO Code of conduct.Refer to1 Abstract SO-25 "Global rise in early-onset colorectal carcinoma: An association with antibiotic intake?" Dr Sarah Perrott will present during Session VII: Presentations of Selected Colorectal Cancer Abstracts, Friday, July 2, 08:00-12:00 CEST. Annals of Oncology Volume 32, Supplement 3 July 2021 https:/// /www. worldgicancer. http://www.worldgicancer.com2 Klein EY; Van Boeckel TP; Martinez EM et all Global increase in antibiotic consumption and geographic convergence between 2000-2015, Proc Natl Acad Sci U S A. 2018 Apr 10th;115(15),:E3463-E3470.3.Vuik FE. Nieuwenburg SA. Bardou M et.al. Over the past 25 years, Europe has seen an increase in colorectal cancer incidence among young adults. Gut 2019, Oct.68(10):1820-1826.4. IARC/WHO. Globocan 2020. Colorectal Cancer. https:/// / gco. Indicator. fr/ today/ data/ factsheets/ Cancers/ 10_8_9 Colorectum-factsheet. pdfAbout the European Society for Medical Oncology.ESMO is the most prominent professional organization for medical oncology. ESMO has more than 25,000 members who represent oncology professionals in over 160 countries. It is the leading society for oncology information and education. ESMO was founded by a common determination to ensure the best possible outcome for patients. It is dedicated to supporting those who care for cancer by addressing the many needs of #ONEoncologycommunity and offering #educationforLIFE. Visit http://www. Visit http://www. orgInformation about the ESMO World Congress on Gastrointestinal CancerThe ESMO World Congress on Gastrointestinal Cancer is the premier international gathering of oncology professionals. It discusses the most recent research and data in this rapidly evolving scientific field.SO-25 - A global rise in colorectal cancer early-onset: An association with antibioticsS. Perrott1, R. McDowell2, P. Murchie1, C. Cardwell2, L. Samuel31School of Medicine and Medical Sciences, University of Aberdeen. Aberdeen, United Kingdom. 2Centre for Public Health. School of Medicine, Dentistry & Biomedical Science. Queen's University. Belfast, Belfast. United Kingdom. 3Department of Medical Oncology. Aberdeen Royal Infirmary. NHS Grampian. Aberdeen, United Kingdom.Background: Global antibiotic consumption has risen dramatically since the 1980s. Colorectal cancer (CRC), among those less than 50, has also increased. Because the microbiome is a key component of many human processes, altering the microbiome structure or diversity with antibiotic therapy can have a significant impact on CRC genesis in older people. No study has ever examined antibiotic use in the early-onset of CRC (EOCRC). This study will examine the relationship between antibiotic exposure and EOCRC risk and compare it to older CRC patients.Methods: An nested case-control study using data from Scottish primary care was performed. CRC cases were diagnosed between 1999 and 2011. They were identified using GP records. The results were matched up to five controls. EOCRC cases were diagnosed between 1999 and 2011, with later-onset cases being diagnosed at 50 years. The total duration of antibiotic exposure for each set was determined and prescriptions for oral antibiotics were taken. The total exposure time was divided into three categories: 0-1-15, 16-60, or >60 days. Conditional logistic regression was used to calculate the odds ratios (OR), 95% confidence intervals (9CI), and each exposure with CRC (by location), after adjusting for comorbidities. To evaluate any relationship between exposure and response, the Test for Trend was used.Results: We identified 7,903 CRC (5.281 colon, 2.622 rectal) cases as well as 30,418 controls. 445 of the cases were under 50 years old. 45% of the cases were given antibiotics during the exposure. There was an increased risk of colon cancer among both the under-50s and over 50s (ORadj (95%CI 1.07, 2.07); p=0.018). p=0.029 for those aged >50. ORadj (95%CI 1.09 (1.01, 1.18); p=0.029 for those older than 50. The risk of proximal cancer was significantly higher among those under 50 (ORadj (95%CI).3.78 (1.60), 8.92), and not among those over 50 (ORadj (95%CI).1.09 (1.01, 1.18), p=0.029). This difference was statistically significant (p=0.001). This difference was statistically significant (p=0.001). However, quinolones, sulfonamides/trimethoprim, and quinolones were not associated with pCC in EOCRC cohort (quinolones ORadj (95%CI), 7.47 (1.40), 39.94),019; sulfonamides/trimethoprim Oadj (95%CI), 4.66 (1.66), 13.09), p=0.003). Rectal cancer was not linked to antibiotic use in either strata (ORadj (95%CI), 1.70 (1.06–2.74), p=0.029). The evidence for a positive relationship between antibiotic usage and CRC risk was not strong, except in the case of pCC in younger cohorts (p-trend 0.04).Conclusion: We found that antibiotics could play a role in the formation of colon tumours in all age groups, especially those under 50. The possibility exists that antibiotics may have contributed to the increase in EOCRC in the proximal and middle colons. Our study, if confirmed, will give further reasons for reducing unnecessary and frequent antibiotic prescribing.This Study is being done by the Legal Entity: The Authors.Funding: This project was funded by Cancer Research UK (reference A25535/C37316).Disclosure: All authors declare no conflicts of interests.
