Emerging exposure-driven accelerated colorectal carcinogenesis: a model with implications for screening colonoscopy effectiveness.

Exposure-driven processes may cause accelerated colorectal carcinogenesis, accounting for up to 20% of early-onset and post-colonoscopy CRC cases, challenging current prevention models.

• Why it matters: Understanding why some CRCs develop rapidly despite screening is crucial, especially as incidence rises in low- and middle-income countries and early-onset cases increase, indicating gaps in existing models.
• What they did: The authors developed a conceptual model based on environmental and lifestyle exposures promoting mucosal changes, including inflammation and epigenetic remodeling, leading to faster tumor development.
• The result: This model explains why some CRCs evade traditional screening and suggests new avenues for risk assessment, screening strategies, and targeted interventions to improve prevention outcomes.