Over the past several decades, the incidence of early-onset colorectal cancer
(EOCRC; in patients <50 years old) has increased at an alarming rate. Although robust and
scientifically rigorous epidemiological studies have sifted out environmental elements linked
to EOCRC, our knowledge of the causes and mechanisms of this disease is far from complete.
Here, we highlight potential risk factors and putative mechanisms that drive EOCRC and
suggest likely areas for fruitful research. In addition, we identify inconsistencies in the evidence
implicating a strong effect of increased adiposity and suggest that certain behaviours (such as
diet and stress) might place nonobese and otherwise healthy people at risk of this disease.
Key risk factors are reviewed, including the global westernization of diets (usually involving
a high intake of red and processed meats, high-fructose corn syrup and unhealthy cooking
methods), stress, antibiotics, synthetic food dyes, monosodium glutamate, titanium dioxide,
and physical inactivity and/or sedentary behaviour. The gut microbiota is probably at the
crossroads of these risk factors and EOCRC. The time course of the disease and the fact that
relevant exposures probably occur in childhood raise important methodological issues that are
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