Global Fight Against Early-Onset Colorectal Cancer: Q&A with Fight CRC Leaders
Written by Melissa Schenkman, MPH, MSJ
Andrea "Andi" Dwyer, MPH, Head Research Advisor and Medical Advisory Board member, and Kiran Ilagan, DrPH, CHES, Director of Research Advocacy at Fight CRC, discuss their groundbreaking Global Think Tank on early-onset colorectal cancer. Read the detailed report from the 2025 meeting in Barcelona, Spain here.
What makes the rising rates of early-onset colorectal cancer so concerning?
Andi: The biggest question right now is causation—what's driving this increase. Even as we've moved screening guidelines from 50 to 45 for average-risk populations, we can't screen away this problem. We're seeing rising cases of early-onset colorectal cancer even as overall CRC rates are declining globally.
Kiran: This isn't just about better detection. We're seeing a real increase in the disease itself across multiple countries, which means something fundamental is changing.
How did the Global Think Tank come about?
Andi: Around 2015-16, I started noticing younger faces at Fight CRC events. The data was showing this wasn't just anecdotal—countries throughout North America, Europe, Australia, and now developing nations were seeing similar trends. I met Jose Perea from Spain at a conference, and we realized we needed global collaboration to understand this phenomenon.
The connection happened somewhat by chance—we were literally passing notes in the back row of a conference, but that led to this amazing partnership that's now involving 25-30 countries.
What made this Global Think Tank unique?
Kiran: This was the first global convening specifically focused on early-onset colorectal cancer. We brought together over 70 researchers, healthcare professionals, survivors, caregivers, and advocates from around the world—true experts in their fields.
Andi: Rather than traditional conference presentations, we designed it as a working meeting with interactive discussions, breakout sessions, and networking. The goal was to create lasting partnerships and a consortium that continues beyond the event.
Why was it crucial to include patient voices in a research-focused meeting?
Kiran: Patient perspectives keep us grounded in why this work matters. We had Mila Ogaia Toledo from Spain share her story—diagnosed at 26 while pursuing an acting career, forced to make immediate decisions about fertility and life plans. Her experience mirrors what we're seeing globally.
Andi: Through surveys and focus groups, we consistently hear from the community that figuring out the "why" behind early-onset CRC is the top priority. Our global survey of over 500 patients from 21 countries showed that nearly 90% had to change their life course or career plans because of their diagnosis.
Andrea “Andi” Dwyer, MPH, spearheaded the creation of the Global Think Tank on Early-Onset Colorectal Cancer. Dwyer is the Director of the Colorado Cancer Screening Program at the University of Colorado Cancer Center and the Colorado School of Public Health and serves as a co-investigator on a number of dissemination and implementation science grants for lung, hereditary, and colorectal cancer screening.
In addition to serving on Fight CRC’s Medical Advisory Board, focusing on research and patient education, she is the Chair of the National Navigation Roundtable, supported by the American Cancer Society.
What were the main research themes that emerged?
Andi: Everyone mentioned obesity and BMI as potential drivers, but we collectively agreed it's not just that. Many young patients are marathon runners and ultra-athletes—very fit individuals. We need to stop studying the same things and open up the box to explore multiple factors working together.
Kiran: We saw common themes across countries: access to care disparities, symptoms being overlooked because patients are "too young," and the need to standardize research tools globally so we can combine data effectively.
Can you explain the working groups that were formed?
Andi: The think tank established five key working groups for two-year commitments:
Etiologic Drivers - Focusing on causation research
Bio-banking - Standardizing tissue and sample collection globally
Epidemiologic Tools - Creating common questionnaires and data collection methods
Risk Stratification and Awareness - Identifying early interventions and high-risk populations
Policy and Funding - Advocating for continued research support globally
Kiran: The epidemiologic tools group is crucial because everyone collects data differently. We're creating standardized methods so we can build a global database and identify bigger patterns.
What immediate research priorities emerged?
Andi: Environmental exposures and how they interact with established factors like nutrition and diet. We need multidisciplinary approaches and to learn from other cancer types. There's also interest in utilizing existing cohorts and platforms like the NCI Prospect study.
Kiran: The alignment between researchers and patients was clear: we need to focus on modifiable risks, understand biology earlier in life, and tackle inequities that delay diagnosis.
What surprised you about the global patient survey?
Andi: Nearly 90% of respondents said their diagnosis disrupted their school, career, or family planning. I knew this happened, but the extent was striking. We're seeing people globally having to make sacrifices they didn't want to make at that stage of life.
Kiran: Mila's story exemplified this—she had to pause her acting career and make immediate fertility decisions she'd never considered. Hearing that 70% of patients worldwide face similar disruptions was really impactful.
Kiran Ilagan, DrPH, CHES, is the Director of Research Advocacy at Fight Colorectal Cancer. She brings nearly 15 years of experience spanning government, academic, and nonprofit sectors, where she has worked on health interventions, prevention initiatives, program evaluation, and policy change.
Ilagan earned her MPH from California State University, San Bernardino, and her Doctor of Public Health (DrPH) in Health Policy and Leadership from Loma Linda University. She has been a Certified Health Education Specialist since 2014.
What are the next steps?
Kiran: The work groups will continue meeting over the next two years to align efforts, share resources, and advance specific projects. We're building toward a unified global strategy to identify causes and save lives under 50.
Andi: This requires significant commitment—I'm up at 5 AM for calls, Kiran at 4 AM, colleagues in Australia at 11 PM. We're already planning meetings in Montreal and presenting findings at national conferences. The goal is creating something that lasts beyond two years.
How can people get involved or stay informed??
Kiran: People can connect through fightcrc.org and subscribe to our new "More Time, More Options" newsletter for updates on clinical trials and research advocacy work. We welcome donations and support to join this fight against colorectal cancer.
Andi: This podcast and similar outreach are part of the plan. People need to know this work is happening and how they can support it. Fight CRC is celebrating 20 years of bringing hope—and hope means seeing the potential every day for breakthrough discoveries that will prevent young people from facing this disease.
Want to learn more about Fight CRC? Check out the YMyHealth podcast on your favorite streaming channels and YouTube!