Biological Age Algorithm Identifies Early-Onset Colorectal Cancer Risk in Young Adults
Accelerated biological aging measured through routine blood tests 93% higher risk of early-onset colorectal adenocarcinoma in adults under 50, according to a large prospective cohort study published in Clinical Gastroenterology and Hepatology. Researchers analyzed health screening data from 198,491 Korean adults younger than 50 and found that individuals exhibiting advanced biological markers faced a 93% higher incidence of the disease compared to their peers with normal or decelerated aging profiles. Chronological age alone frequently fails to flag early risks, as more than half of early-onset colorectal cancer cases are diagnosed before the current 45-year recommended screening threshold.
Phenotypic Age Calculation Using Routine Clinical Biomarkers
Led by Yoosoo Chang, MD, PhD, of the Sungkyunkwan University School of Medicine in Seoul, Republic of Korea, the research team evaluated participants who were free of colorectal cancer at baseline between 2011 and 2021. The study followed participants for a median duration of 7.7 years. To calculate biological age, researchers utilized the phenotypic age algorithm—a mathematical model that integrates chronological age alongside nine standard blood parameters: white blood cell count, red cell distribution width, lymphocyte percentage, mean cell volume, alkaline phosphatase, albumin, creatinine, glucose, and C-reactive protein.
Participants were categorized into three groups based on how their biological age compared to the cohort average for their chronological age:
- Decelerated aging: More than 2 years younger than the average.
- Reference group: Within 2 years of the average.
- Accelerated aging: At least 2 years older than the average.
Colon Adenocarcinoma Risks Outpace Rectal Findings
During the follow-up period, 127 participants developed early-onset colorectal adenocarcinoma. Individuals in the accelerated biological aging group demonstrated a 93% higher risk for early-onset colorectal adenocarcinoma, yielding a hazard ratio of 1.93. Every single 1-unit increase in biological age acceleration corresponded to a 7% higher risk.
The statistical association varied significantly by tumor location and type. Colon adenocarcinoma showed a stronger link to accelerated aging, with a hazard ratio of 2.32, whereas rectal adenocarcinoma showed no statistically significant association. Early-onset colorectal neuroendocrine tumors displayed no consistent relationship with biological age acceleration, indicating that the marker is specific to adenocarcinoma.
Limitations of the Study's Findings
While the authors noted that biological aging measures derived from routine clinical biomarkers could help identify younger adults at elevated risk beyond chronological age alone, the study carries notable limitations. Because the cohort consisted primarily of East Asian participants, the findings might not directly translate to other populations. Researchers reported that a low number of early-onset colorectal adenocarcinoma cases in specific subgroups and anatomical sites limited the statistical power to detect smaller differences.
Lifestyle habits were only partially captured, lacking detailed metrics on diet and smoking. Consequently, the investigators could not rule out the possibility that unmeasured daily habits partly explained the observed associations. Financial support for the research was supplied by the Southampton National Institute for Health and Care Research Biomedical Research Centre, the Institute for Information & Communications Technology Planning & Evaluation, and the National Research Foundation of Korea, with one author additionally disclosing research grant support from Echosens.