We are reporting on the rising rates of early-onset colorectal cancer. Looking for perspectives from oncologists, gastroenterologists, and researchers on risk factors, biology, and clinical management. 1. What differences are you seeing in tumor biology or clinical presentation in early-onset colorectal cancer compared to average-age cases? 2. How do you interpret the growing evidence around early-life exposures, such as antibiotics or environmental factors, in relation to rising CRC incidence? 3. What gaps remain in risk stratification for younger patients, and how should clinicians approach screening and early detection? 4. Are there modifiable factors after diagnosis, such as vitamin D or lifestyle changes, that you actively address in younger CRC patients?

As CEO of Lifebit, our federated AI platform integrates global oncology genomic and multi-omic data, revealing tumor biology patterns in early-onset CRC like distinct mutational profiles from diverse real-world datasets. Early-life exposures link to rising incidence through genomic evidence of altered pathways, as seen in our analyses of scattered EHRs and pathology data showing environmental influences on non-European ancestries underrepresented in over 80% of studies. Risk stratification gaps stem from data silos limiting federated analysis of younger cohorts; clinicians should prioritize genomic profiling in TREs for early detection, harmonizing phenotypic and imaging data pre-diagnosis. Post-diagnosis, we address modifiable factors via AI-driven RWD insights, recommending vitamin D optimization and lifestyle integration into personalized plans, drawing from our oncology workflows predicting outcomes.